Definition:—This condition, incorrectly termed phosphatic diabetes, when much of the watery portion of the urine is passed, depends upon the persistent presence of an excess of the phosphates in the urine.
Etiology:—In an observation of twenty-five years I have looked for this condition when there was persistent nervous strain which tended to produce nervous prostration, either local or general. I have observed it in those conditions of neurotic type where there was constant nervous irritation and an undue degree of nervous excitability or irritability. It is also present where with insufficient nerve force there must be persistent physical exercise or an overwrought muscular system from constant, unremitting toil. It is present also in certain faults of the digestion, in acute atrophy of the liver, and in the presence of anemia, tuberculosis, cancer, or any severe wasting disease of a chronic character.
Estimating the total quantity of phosphates passed in twenty-four hours with some cases suffering from polyuria or from diabetes mellitus, it will be found that they are passing an inordinate quantity of these salts. It is this form of the disease that is termed phosphatic diabetes, and occasionally it will be found that glycosuria follows this condition.
The condition also follows those conditions which induce alkalinity of the urine, as is found present in chronic cystitis, where there are vesical calculi of the triple phosphates; where the urine has been retained and decomposed in the bladder, and in some cases of paralysis.
Symptomatology:—There are no symptoms of disease referable directly to this condition. The symptoms are those of the constitutional or local conditions which give rise to this.
Diagnosis:—The diagnosis depends upon the presence of the phosphates in the urine; these will occasionally precipitate in crystals almost perceptible to the naked eye, when they cause a great deal of backache and much urinary irritation.
There may be also at the same time small renal or vesical calculi, composed of the phosphates, which in their turn may produce sufficient irritation to cause cystic inflammation, and sometimes pyuria. Under these circumstances the urine is alkaline. When the urine is strongly acid, the phosphates remain in solution, unless they be present in excessive quantity. When in solution the urine is usually clear, of normal amber color, and with varying specific gravity. Upon boiling a specimen of this urine, the phosphates readily precipitate, even when the acid reaction is quite pronounced. To obtain a total precipitation, however, it is necessary to add some alkaline reagent, as ammonium, potassium, or calcium hydrate. Under a low-power microscope, the crystals will be readily distinguished with their characteristic peculiarities.
Treatment:—These patients must have rest, either physical or mental, or both. This is one of the first essentials. The condition of the stomach and appropriative organs must be made as nearly perfect as possible, in order that the patient may become nourished and physically restored. Nerve tonics should be then given which will restore the nervous system and will supply the draught of phosphates which has been made upon it. I have had excellent results from the administration of free phosphorus and the compound syrup of the phosphates. The gycerophosphates have also served an excellent purpose in some cases. When anemia is present, iron should be given in some easily assimilable form. Treatment calculated to prevent the phosphates from being excreted by the kidneys is based on an erroneous theory. The phosphates must be supplied to the system until the nervous tone is sufficient to control or inhibit the excessive output. I have controlled the backache with acetate of potassium, cimicifuga and gelsemium, as named, in lithemia. Benzoic acid, lithium or ammonium benzoate are efficient remedies, given in from five to fifteen grain doses four times daily. Where there is a tendency to extreme alkalinity of the urine, this must be corrected by benzoic acid and sodium borate, and occasionally irrigation of the bladder will be demanded. Five drops of dilute nitric acid four times daily will also increase the acidity of the urine and thus facilitate the retaining of the phosphates in solution until they are passed, which is greatly to be desired.