Ketonæmia and Ketonuria in Childhood.

The formation of ketone bodies and their excretion in the urine in albnormall amounts have for many years been problems of much interest to both physiologist and clinician. Much of our present knowledge of the subject has been gained from the study of carbohydrate metabolism in diabetes, where ketonuria in its classical formi is frequently observed. From this it has been established that an excess of ketone bodies occurs in the blood when the fats are incompletely ' combusted ' as a result of abnormal carbohydrate metabolism, and ample justification has been provided for the well-known sta.tement myiade by Rosenfeld(l) in 1895 ' that fat burns only in the fire of carbohydrate.' A good review of our present knowledge of ketone production and its prevention is to be found in Shaffer's recent lecture entitled ' Antiketogenesis, its Mechanism and Signifiecance. '(2) A fu-ll discussion of the stubject in all its aspects is not within the scope of the present communication, but we may quote Shaffer's statement that ' there is to-day no question that ketosis is due to carbohydrate starvation,' and make special reference also to his remninder that the inhibitory effect of carbohydrate on ketone formation depends, not on the mnere existence of sufficient glucose, as glucose, in the blood (cf. diabetes), but on the presence of a siufficient armount of an oxidation product of glucose which reacts with one of the acetone bodies or its precursors. That ketosis has long been known to occur duiring fasting supports the view that it is due to the faulty cornbustion of fats in the absence of carbohydrate; for the first of the body reserves available is fat, which is then burned in the absence of sufficient glucose for its complete oxidation.