Definition.—The presence of sugar, glucose, in the urine.
Etiology.—There are quite a number of causes that give rise to glycosuria. The first, and by far the most serious, is diabetes mellitus, and when due to this cause it is generally permanent. Intermittent and paroxysmal glycosuria may arise from gout, the eruptive fevers, cholera, malaria, hepatic cirrhosis, and organic diseases of the nervous system, especially diseases of the medulla.
Great mental emotion or shock may also be followed by glycosuria, as also may injuries of the brain. Pregnancy may be a cause. Gibier, of New York, has demonstrated on dogs, and proven that certain toxic drugs give rise to this condition; Morphia, atropia, chloral, hydrocyanic acid, and alcohol being a few of the many that produce such a result.
Diseases of the pancreas may also give rise to it. Obesity may be responsible for temporary glycosuria, while the ingestion of large quantities of food rich in saccharine or starchy substances, and beer, give rise to what is known as dietetic glycosuria.
Diagnosis.—The urine is increased to fifty or sixty ounces per day, is clear, of a pale yellow color, and of high specific gravity, 1,025 or more. It has a ripe-fruit odor, and an acid reaction. The finding of sugar or glucose by one of the following tests, makes the diagnosis positive:
1. Fehling's Test.—This test is made by using Fehling's solution which consists of two parts,—a copper solution, and a soda solution. Since a solution made according to the original formula soon decomposes on standing, and since the solution is too concentrated to obtain a delicate reaction, I give the following modification of Fehling's solution, taken from Ogden's work on clinical examination of the urine. This is not only a permanent solution, but at the same time furnishes a rapid and yet delicate reaction.
The solution is divided into two parts; viz., copper solution (A), and alkaline tartrate solution (B).
(A) Cupric, sulphate, 34,639 grams; distilled water, ad-1,000 c. c.
(B) Sodio-potassium tartrate (Rochelle salt), 173 grams; sodio-hydrate (specific gravity 1,120), 500 c. c.; distilled water, ad—1,000 c. c.
These solutions, A and B, are to be kept in separate bottles and in a dark place. Equal parts of the two solutions produce diluted Fehling's solution.
Process.—"Place equal parts of the two solutions, A and B—about one finger breadth of each—in a test-tube, and boil. If the Fehling's solution remains clear on boiling, then add twenty to thirty drops of the suspected urine which is free from albumin.
Do not boil after the addition of the urine.—If much sugar be present, a yellow or red precipitate of suboxid of copper readily appears. In case the quantity of the sugar in the urine is less than one per cent, the reduction will not appear until after several minutes, five to thirty. If a reduction does not take place in thirty minutes, it is advisable to let the test stand for from eighteen to twenty-four hours, since traces of sugar show evidence of a reduction of the copper only after several hours, when a small amount of the suboxid will be found in the bottom of the test-tube. Less time is required for the test, if the urine is gently heated previously to its being added to the boiling Fehling's solution. The non-appearance of a suboxid precipitate shows that the urine is free from sugar. Fehling's test, performed in this way, is one of the most delicate and reliable of tests.
2. Trammer's Test.—To a dram of urine in a test-tube add a few drops of a dilute sulphate of copper solution, and then add one dram of liquor potassae. bring this to the boiling point, and. if sugar be present, the copper is reduced, forming the yellow or orange-red suboxid.
3. Bottger's Test.—This test, to be of any value, must have any albumin that may be present removed, which may be accomplished by rendering it acid, boil and filter; to this filtered urine add from one-half to an equal quantity of liquor potassae, and a few grains of bismuth subnitrate. Boil for several minutes, and, if glucose be present, black metallic bismuth will be precipitated.
Prognosis.—This will depend altogether upon the cause. In diabetes millitus, the prognosis will be grave, while in most of the paroxysmal and intermittent forms, the glycosuria disappears with the removal of the cause.
Treatment.—The treatment for glycosuria due to diabetes millitus will be considered under a separate article.
In the temporary form, the treatment will be largely hygienic and dietetic. The patient should be placed on veal, mutton, fish, or chicken, with very little bread. Fruits, except lemons, currants, sour cherries, plums, and the acid fruits, and all saccharine substances, should be avoided. He should avoid all worry, lead an even, temperate life, and be out of doors as much as possible. With improved health, the glycosuria disappears.
From the good report of rhus aromatica in diabetes millitus, we would prescribe the remedy here with all confidence, bearing in mind, however, that with the disappearance of the exciting cause, the sugar also disappears.