Uremia intoxication is the result of the failure of the kidneys to perform their normal function of eliminating some one or all of the poisonous elements of the urine.
The toxemia may develop suddenly, by a convulsive seizure followed by coma, or come on gradually. Usually the attack is preceded by a decrease in the urinary secretion; although in rare instances, the normal urinary flow has been largely exceeded.
The onset appears usually with headache, dimness of vision, dilated, sluggish pupils, drowsiness, vertigo, deafness, dusky countenance, nausea, vomiting; the mind is dull, deepening into stupor, to be followed by coma, or convulsions precede the coma, which terminates in death, unless the poison causing the attack is rapidly eliminated.
Treatment. The treatment of this dangei7ous manifestation of renal disease is often vain though wonderful recoveries have occurred under judicious management. Whether the symptoms of the disease show themselves gradually or suddenly the first endeavor is to rid the system of the poison that is threatening life, and aid in its elimination through the bowels, skin and kidneys; second, the vital organs must be supported until elimination has been in part at least accomplished; third, any convulsive seizures must be warded off or arrested.
Elimination of the poison may be internal or external; externally, the hot pack being resorted to increase the activity of the skin; internally, the induction of watery purging at once aids elimination through the bowel and relieves dropsy if present. Elaterin 1/16th gr. may be given, dissolved in a few drops of alcohol or whiskey.
In every case of uremia the blood pressure should be taken and an estimate made of the strength of the heart. If the blood pressure is much above normal, say 150 or 160 millimeters of mercury, stimulants are not needed, as a rule, but nitroglycerine ;v gr. or sodium nitrite 1 to 2 gr. may be given. Aromatic spirits of ammonia and Hoffman's Anodyne are valuable if the heart is weak, and are to be followed by strychnin and digitalis if necessary.
For the support of the heart and respiratory function, strychnin 316 gr. may be given, followed by digitalis, 30 minims.
Convulsions, if present or threatened, are to be combated by the use, after the bowels have been washed out, of an enema of 20 gr. of chloral and 60 gr. of bromide of sodium in 3 ounces of starch water, and the hot pack will also be of value, not only to produce sweating, but for its sedative influence on the nervous system. Should the convulsive tendencies be marked, amyl nitrite inhalations may be employed until the chloral and bromide can be absorbed.
An attack of acute uremia is always a very grave condition. The prognosis depends upon the amount of retained poison, the length of time it has been retained, and the conditions of the organs of elimination.
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