In 1907, a patient on whom I had operated for acute appendicitis with abscess, eighteen hours after operation developed great restlessness, vomiting, convulsions and coma. She was treated by injection of normal salt solution by rectum and intravenously, hot packs and stimulation; and fortunately she recovered. Although not recognized at the time, the condition was later thought to be due to acid intoxication, but no examination of the urine for acetone or diacetic acid was made. About a year later two other cases of this kind occurred among Dr. F. F. Simpson's patients, and in these acetone was present after operation. Both of these patients recovered under similar treatment except that sodium bicarbonate was given by bowel. Ether was the anesthetic used in all three cases.
These cases led Dr. Simpson to have the urine examined for acetone and diacetic acid both before and after operation. Since this routine examination
CHALFANT SA. ACETONURIA: ITS RELATION TO POSTOPERATIVE VOMITING IN SEVEN HUNDRED CASES OF ETHER ANESTHESIA. JAMA. 1912;LIX(11):852–854. doi:10.1001/jama.1912.04270090096008
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