Despite the frequency and clinical importance of nondiabetic ketosis in childhood, there have been relatively few investigations concerning its mechanism. Recently, the knowledge of ketosis has been considerably extended, due largely to investigations on normal and diabetic subjects. That the interrelationship between the metabolism of fat and carbohydrate plays the major rôle in the mechanism of ketosis has long been known, but the subject has been considerably clarified by the more recent work of Woodyatt, Shaffer, Ladd and Palmer and others.
It now seems reasonably well established that diet operates in proportion to the quantities of fatty acids and glucose made available to the metabolic mixture, and that excess of a definite fatty acid to glucose ratio tends to result in ketosis. Although subject to some variation, it seems probable that in adults the threshold of ketosis is represented by an approximate ratio of fatty acid 1.5 to glucose 1,