UREMIA, a toxic condition caused by the presence in the blood of urinary constituents which normally should be secreted by the kid neys. The nervous system is especially affected by the poisonous blood, as shown by mental disturbances, convulsions, headache, nausea, dyspncea, disordered vision and coma. What the toxic material really is has not been deter mined. It has been proved not to be urea alone, as was formerly believed. Some contend that the poison is a mixed product of uneliminated nitrogenous excrementitious substances; others, that it is a newly formed albuminous substance not related to ordinary waste material, or is due to a disturbance of an internal venal secretion brought about by changed metabolic processes. Uraemia is usually associated with acute or chronic nephritis, or may result from suppres sion or deficient secretion of urine from any cause.
The symptoms of uremia depend upon whether the condition is acute or chronic. Acute uraemia may begin with a violent headache or persistent vomiting, with dyspncea, convulsions, mania or coma. There may be only one of these symptoms present, or two or more may appear. The headache is usually occipital, and may be associated with deafness. The vomiting may be accompanied by diarrhoea, both being efforts to excrete the toxic material. The dyspncea is frequently continuous and severe; the patient cannot lie down or sleep in any position with comfort; there is much restlessness and tossing about; the legs, if resting on the floor, readily swell from edema. There is always a proba bility of pulmonary edema and cyanosis of the face and extremities. Whenever sudden un controllable vomiting occurs without a known cause, or a severe and more or less continuous headache appears, uremia should be suspected and the urine examined. The temperature in acute uremia be but little increased, or may rise 5° to F. just a paroxysm. The pulse varies, depending upon the condition of the heart and arteries; it may be full and throb bing, or small and hard and not especially rapid. The convulsions resemble those of epilepsy, but are not attended by a cry. They may come without warning or be preceded for a few days by twitching of the muscles of the face and hands; and may occur frequently and persist ently until coma ensues. Amaurosis may follow these convulsions for a few days, or hemiplegia or monoplegia may follow or precede them. The delirium of acute uremia may be mild, muttering, or it may be maniacal. Coma is commonly present when there are gen eral convulsions, and may appear without them, sometimes preceded by headache and dullness.
The breathing is stertorous and the breath foul. The patient may recover from the stupor or may remain in it for weeks.
In chronic uremia the patient complains of severe occipital or frontal headache, more or less continuous. There is dyspncea not depend ent on exertion. There may be nausea, vomit ing, diarrhea and stomatitis. The breath is foul, the tongue coated with a brown offensive fur. The urine is usually increased in amount, is clear, acid, has a specific gravity of 1006 to 1010, contains albumen at variable periods, also a few hyaline or granular casts, and sometimes red blood-corpuscles and leucocytes. The urea is often diminished.
The symptoms of chronic uremia may last for months, but acute exacerbations with con vulsions and coma may appear at any time, and such cases are susceptible to inflammation of the pericardium, pleura, meninges and endo cardium. Melancholia and delusional insanity may occur. The skin frequently becomes dry and itches, and muscular cramps are common.
Uremia must be distinguished from typhoid fever, alcoholism with coma, and from some forms of diabetei and meningitis. The prog nosis of uremia is not good, especially in albu minuria patients, and those having advanced heart disease or arteriosclerosis; but patients may recover when apparently hopelessly sick.
Keep the patient in bed and between blankets, especially in acute attacks; prevent him at all times from being chilled; induce free action of the skin by the hot pack, the hot air or steam bath, or the hot tub bath; and keep the bowels free by saline purges. Diuretics, such as water (considered by many as the best diuretic), lemonade with cream of tartar, the liquor ammonia acetatis, and the citrate of potassium, cannot be dispensed with. Cupping and poulticing of the loins (if the urine is scanty), venesection and hot saline injections are advocated. Sometimes heart stimulants, such as camphor, strychnine, digitalis and stro phanthus are necessary. During convalescence tonics may be given and careful outdoor exer cise resorted to, the patient being comfortably clad. In most cases the use of alcohol and tobacco should be interdicted. The diet is of prime importance. In acute urarnia it should be solely of milk, with seltzer, vichy or kumiss. In the chronic form this should be the chief mode of administering food. As improvement sets in the patient may have meat broths, gruels, , egg-albumen, custards, toast, baked potatoes, cereals, soft-boiled eggs, fresh fish, etc. Most authorities believe that red meats should not be given until the amount of urea found in the urine is about normal.