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Portal depletion is of great advantage, especially if the amount of liquid ingested is kept as low as possible, so that the blood vessels may become thirsty and thus tend to absorb an exudate wherever they find it. Much harm has been done, however, and death has been caused by saline purgatives in endeavoring to relieve edemas from a failing heart or to prevent a uremia from kidney inflammation.
For instance, nearly two-thirds of our diphtheria cases, which are properly examined, will show albumin in the urine, showing that the kidney-cells have been attacked and poisoned by the toxin. This may go on to a fatal attack of uremia; but fortunately, not commonly, far less so than in scarlet fever. The kidneys usually recover completely, but this may take weeks and months.
By the tenth year half the remainder will have died, leaving one fourth both of the men and the women who have lived beyond ten years." The causes of death he would place in the following order: gradual cardiac failure; uremia; apoplexy; some complicating acute infection; angina pectoris; accidental causes; acute edema of the lungs and cachexia.
While angina pectoris and edema of the lungs were not infrequent causes of death in men, it was a rare cause of death in women. Dyspnea is a frequent symptom, and one for which many patients seek medical advice. A constant systolic blood pressure of over 200 shows a probability that the patient will ultimately die either of uremia or of apoplexy.
Kraepelin mentions the epileptiform convulsions of uremia as well as delirious and comatose conditions, especially those in advanced pregnancy. These uremic conditions may be both acute and chronic. But Kraepelin has not been able to convince himself of the existence of a clearly defined uremic insanity unless the delirious condition just mentioned may be regarded as such
Prentiss also reported the following case a as adding another to the evidence that jaborandi will produce the effect mentioned under favorable circumstances: Mrs. Her hair and eyebrows had been snow-white for twenty years. She suffered greatly from itching of the skin, due to the uremia of the kidney-disease; the skin was harsh and dry.
Nunneley showed the kidneys of a woman who did not secrete any urine for a period of twelve days, and during this time she had not exhibited any of the usual symptoms of uremia. Peebles mentions a case of suspension of the functions of the kidneys more than once for five weeks, the patient exhibiting neither coma, stupor, nor vomiting.
Sooner or later these irritants cause kidney irritation, and chronic interstitial nephritis may develop. just which process becomes the farthest advanced and finally kills the patient is an individual proposition and cannot be foretold. The finale may be cirrhosis of the liver, uremia, arteriosclerosis, apoplexy or myocarditis with dilatation or coronary disease.
He finds that patients with uremia ordinarily should not be subjected to the Karell cure, such patients needing more fluid. As long as the patient remains in bed, and as long as his ability to exercise is at a minimum, gentle massage is advisable. In these cases of cardiac weakness, with or without dropsy, unless the diastolic pressure is very high, digitalis is valuable.
If the urine is known to be free from albumin and casts, and there are no signs of impending eclampsia, the slow pulse is indicative of no serious trouble; but the urine should be carefully examined and a possible uremia or other cause of eclampsia carefully considered.
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