It is a matter of common knowledge that ketosis is of frequent occurrence in children, and that it accompanies a variety of clinical conditions, including some of minor nature. It has been especially noted that certain infections of the respiratory tract lead to ketonuria. Frew,1 using the delicate nitroprussid reaction on the urines of a large number of unselected hospital patients, found the reaction positive in a considerable proportion. He considered the ketosis due to metabolic factors which were independent of any particular disease per se. Roberts 2 noted a high incidence of ketosis in children suffering from respiratory infections, although he also found ketosis to be present in a wide variety of conditions. The nitroprussid reaction on the urine is so extremely delicate that a positive test does not necessarily indicate ketosis of a significant degree. The ferricchlorid test is less delicate, and when positive is of greater significance (Bigwood and Ladd3).The present study deals with a group of children suffering from acute infections associated with a ketosis sufficiently marked to give a positive ferricchlorid reaction in the urine.
CAUSEThe ketosis accompanying infections may conceivably be due to one or more of the following factors : ' 1. Insufficient food intake, as a result of anorexia or vomiting.2. An increased metabolism associated with fever, which may result in depletion of the carbohydrate reserves of the body.3. A disturbance of the intermediary metabolism of carbohydrate due to the effects of the infection itself.In order to gain some idea as to which of these factors were opera¬ tive, a study of the blood sugar curve following the ingestion of carbo¬ hydrate was made. If the ketosis were due to a low food intake, or to an increased rate of metabolism associated with fever, one would expect a normal sugar curve, as storage should occur with the ordinary rapidity.
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