Acidosis, or acid intoxication, is a clinical condition occasionally met with in children. The condition is one to which increasing attention is now being paid. It is a toxaemia which is recognised by the peculiar smell of acetone in the breath, the presence of acetone in the urine and vomit, and in some cases diacetic acid in the urine - conditions similar to those met with in diabetes.

The symptoms may be very slight or very serious. In the slighter cases the symptoms are those of minor gastrointestinal trouble; the child is off his food, the bowels are deranged, the tongue is furred, and the child is generally off colour. The breath has the distinctive odour of acetone. In the very severe cases, sudden, uncontrollable vomiting is the most prominent symptom, accompanied by constant nausea, retching, and great prostration. These latter cases may be rapidly fatal.

The cause of the condition is unknown. It is believed to be closely dependent on dietetic conditions, but there is great diversity of opinion as to the defects in the diet which may be responsible. It has been variously ascribed to excess of protein, excess of carbohydrates, and excess of fats, this excess being not necessarily absolute, but only relative to the digestive power of the individual. In the writer's view the carbohydrates are chiefly at fault, and the digestive disturbance is mainly the result of deranged pancreatic activity.

Dietetic Treatment Of The Slighter Degrees

A close examination of some cases of acute gastric irritation, chronic indigestion, intestinal indigestion, and food fever will show that these are associated with acetone in the breath, due to acid intoxication. We may therefore conclude that there is a very close relationship between these different conditions. This close relationship is further reflected in the treatment. If the diet in use be carefully studied, it will be found that it is unsuited to the age of the child. It will either have been excessive in amount, or there may have been a special excess of farinaceous foods and sweets. Correction has to be made accordingly.

The diet must be a simple one, made up largely of protein foods, carbohydrates and fats being restricted. Breakfast should comprise skimmed milk, fish, ham, or tongue, and stale bread or toast, with a little butter. Dinner, - A bowl of clear soup, fish, or chicken, or meat, green vegetables (no potatoes), with toast or rusk; no puddings. A cup of warm diluted milk, with half a slice of toast, may be given for tea; and the Evening meal should consist of a cup of beef-tea, thickened with Plasmon, and a rusk.

The addition of Extract of malt to the diet is often useful, and the administration of large doses of alkali, e.g. bicarbonate of soda (20 to 30 grains), is a valuable remedial measure.

Dietetic Treatment Of Severe Cases

In bad cases the vomiting may be so severe as to preclude the oral administration of food. Nutrient enemata may be necessary, and should consist of peptonised milk, glucose, white of egg, and brandy. Thirst is troublesome, and may be relieved by sips of hot or cold water, or barley-water. When the symptoms mitigate, food of the most easily digested kind is administered. Skimmed milk, peptonised, and perhaps fortified by the addition of Plasmon, white of egg, or Allenbury food, should first be tried. Weak beef-tea, chicken jelly, veal, mutton, and chicken soup may also be utilised. Crisp toast should be the first bread food allowed. A striking feature in these cases is the remarkably sudden recovery often shown. The vomiting and other symptoms may suddenly disappear after a good night's rest, and the patient experiences a sensation of hunger. It is a curious fact that the recovery of the digestive powers appears to take place coincidently, as after the sudden recovery of appetite the patient can digest almost everything. It is, however, advisable to keep the patient on a light diet for at least a week, and for a long time subsequently to pay special attention to the amount and nature of the farinaceous foods and sweets. Extract of malt is of great value as a digestive tonic in these cases.