Definition.—Total Suppression of Urine.
Etiology.—Some cases of intense congestion in acute nephritis are attended, for a time, by complete suppression of the urine, though generally there is only partial arrest of the secretion.
Blocking of the ureters by renal calculi may also give rise to suppression.
Shock following major surgical operations and sometimes the catheterization of a patient may give rise to this condition. During the collapsed stage of cholera and yellow fever, no urine is secreted. Hysteria may be an exciting cause, Charcot reporting a ease where no urine was secreted for eleven days, and Bailey cites a case of a girl who passed no water from December 12th to March 1st, or during a period of fifty days. In the latter case, the physician was undoubtedly deceived.
Symptoms.—These depend largely upon the cause of the suppression and the length of time involved. If due to mechanical obstructions, there may be but little systemic disturbance or discomfort for some time. At other times, there is evidence of uremic poisoning very early, the first symptom being that of irritability, to be soon followed by twitching of the muscles, nausea, vomiting, convulsions, and a profound coma.
Diagnosis.—Is made by the use of the catheter, no urine being present in the bladder. The skin is cool and the temperature often subnormal.
Prognosis.—This will depend upon the cause giving rise to it.
Treatment.—Where the suppression is due to mechanical obstruction, surgical measures will be the only method of relief. To establish the secretion, give the patient a spirit vapor-bath, and after profuse perspiration and complete relaxation, place the patient in bed, with hot applications to loins and feet, and administer gelsemium in five-drop doses in hot water. In extreme cases, wet cups to the back will bring relief. If gelsemium does not establish secretion, give an infusion of marshmallows, haircap moss, or triticum repens. The old compound tincture of Virginia snakeroot, given in hot water, is a very good agent.
Pilocarpin.—Where the skin is dry and the pulse full and bounding, one-eighth or even one-fourth grain of pilocarpin, used subcutaneously, will prove the quickest and most efficient remedy. Pilocarpin causes the system to relax quicker than almost any other agent, and as an eliminator of morbid material has few equals.
Strophanthus.—This is an excellent remedy where the suppression is due to cardiac lesions. One or two drams to four ounces of water, of which a teaspoonful should be given every hour.
Hydragogue cathartics may be given- freely, and their full effects afford relief to the congested kidney.