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In the study of ketosis in diabetic patients, certain problems have gone largely unanswered due to the lack of sufficiently accurate methods for blood ketone determinations. With the development of blood ketone methods accurate at low as well as high blood concentrations, it has been possible to study the problems of (1) the renal threshold for the ketone bodies, and (2) the quantitative relationship between the urinary ketone excretion and the blood ketone level. The studies to be presented summarize the results obtained on (1) 13 diabetic patients in mild ketosis, produced by withdrawing insulin for 12 to 24 hours, a ketogenic diet for 12 to 24 hours, or a combination of a ketogenic diet and insulin withdrawal; and (2) 7 patients entering the Los Angeles County Hospital in moderate to severe ketosis (several in diabetic "coma"). In both types of patients, after initial levels of blood and urine ketone bodies were obtained, insulin and fluids were given as required by .the individual case, and blood and urine ketone levels were. followed until ketosis, as indicated by the qualitative urinary acetone test (modified Lange test), disappeared. The blood ketones 1 were determined by the Barnes-Wick (1) method, and the urine ketones by the Van Slyke (2) gravimetric method in most instances. Table I summarizes the results obtained in the diabetic patients in mild ketosis, and Table II the results in patients -in moderate to severe ketosis. Figures 1 and 2 give the clinical course, during therapy, of two of the most completely studied cases, one in mild ketosis, the other in severe ketosis. These are patients "Ha" and "Wi," from Tables I and II, respectively. The figures illustrate how the data listed in the tables were obtained.

QUANTITATIVE RELATIONSHIPS BETWEEN BLOOD AND URINE KETONE LEVELS IN DIABETIC KETOSIS