PHOSPHATURIA.
This term should be reserved for those serious cases sometimes called Phosphatic Diabetes, where the daily elimination of phosphate is much in excess of the normal (2o to So grs.), and where the calcium greatly exceeds the potassium and sodium phosphates. The mere presence of insoluble earthy or other phosphates in the urine does not constitute true phos phaturia; these may exist when the total output of phosphates is reduced below the normal, as when the urine is markedly alkaline.
The urine in the ureters may he quite normal in every respect, but upon entering the bladder it may be submitted to fermentative changes which render it highly alkaline with the deposition of triple phosphates. The obvious treatment in such cases is the remedying of the vesical conditions by catheterisation, irrigation of the organ, combined with the internal administration of such antiseptic drugs as Urotropine, Boric Acid, Creosote, Salol„ &c., and such surgical measures as will rectify the obstruction to the urinary outflow.
Whilst it is easy to induce a high and constant degree of alkalinity of the urine by the administration of alkalies, it is often impossible to increase its acidity by the administration of acids. Acid Phosphate of Sodium is the only reliable drug, and it may be given in its pure state dissolved in water; as much as r oz. in 5o oz. water may he given in 24 hours to keep the urine acid and to dissolve phosphatic deposits and even small calculi of calcium oxalate.
The treatment of the mild cases, where phosphates continually appear in the urine in nervous, dyspeptic subjects, consists in such alteration of the diet as will correct the disturbed digestive process, together with attention to health laws winch provide for a sufficient amount of open-air exercise and mental rest. The total intake of food must be regulated to
normal requirements, vegetables Being especially curtailed, whilst animal food and liquids may he freely permitted. Insomnia must he relieved by any of the simple hypnotics, and overwork of the brain and worry avoided when possible.
The best routine drug treatment consists in full doses of the Dilute Nitro-Hydrochloric Acid with small doses of Strychnine and Glycerin of Pepsin administered immediately after or along with the food.
The treatment of the true type of phosphaturia is unsatisfactory, and sometimes the condition ends fatally. The cases in which it is associated with saccharine diabetes are especially rebellious to treatment. The diet is to be planned on the recognised lines and excess of food cut off; should sugar be also present with the phosphates, a diabetic diet will be clearly indicated. The measures suitable for the treatment of the milder forms of the disease are indicated, as mental rest, outdoor life, hypnotics, &c., and when the total amount of urine voided is greatly increased, Codeine or Morphia in small amount should be administered as in diabetes, and tonics like Acid. Nit.-Hyd. Dil. with Strychnine should be given. Hagge recommends Urotropine.