(POLYURIA).
=Definition.=—A constitutional disorder in which there is a continued
excessive secretion of urine, free from albumin and sugar. There is
constant thirst.
=Osteopathic Etiology= and =Pathology=.—This disease is more frequent
in males than in females. It occurs most commonly between the ages of
twenty and thirty. It is due to chronic disturbances of the nerves.
The lesions usually found upon osteopathic examination are lateral
derangements of the vertebræ in the renal splanchnic region, (ninth to
twelfth dorsal inclusive) or a slight kyphosis in the same locality.
Such lesions probably affect the central nervous system in the region
of the sympathetic nerves to the kidneys, by a paralysis of the
muscular coat of the renal vessels. The disease may be associated
with other conditions, as injuries and diseases of the nervous system
elsewhere; exposure to cold; prolonged debility and fatigue; cerebral
diseases, as meningitis, paralysis of the sixth nerve, tumor of
the brain, and blows on the head; injuries of the cervical region;
sunstroke; cerebrospinal fever; malaria; syphilis; pregnancy; hysteria;
hereditary influences, and drinking too freely of cold water. There
are many diseases and conditions which may be associated with diabetes
insipidus; and which act as irritants, directly or reflexly, upon the
center in the medulla oblongata (which is just above the diabetic
center), or upon the sympathetic ganglia in the abdominal region. Thus,
there is a vasomotor neurosis, due either to central or reflex lesions.
Second in importance to lesions of the renal splanchnics are lesions
of the upper cervical region. Irritations in the cervical region may
act upon the center in the medulla or the lesions may affect some
of the sympathetic fibres as they pass from the brain to the renal
sympathetics. The pituitary gland may be disturbed. Probably axis and
atlas lesions are factors.
Lesions of the nerve centers and of the sympathetic ganglia have been
found upon post-mortem examination, but they are not constant. Nervous
lesions have been found in the region of the base of the brain. The
kidneys are sometimes congested and enlarged. The tubules may be
dilated.
=Symptoms.=—Great thirst and an enormous secretion of urine of a pale,
watery and slightly acid nature are the characteristic symptoms. The
skin is usually dry and harsh, the bowels are constipated, and the
appetite may be voracious. The health on the whole is quite perfect,
although if the affection is not arrested, considerable loss of flesh
and strength may result. There is a tendency for the disease to become
chronic.
The nervous lesion causing polyuria may be the outcome of a debilitated
condition of long standing or the symptoms may occur suddenly.
Preceding the large flow of urine such symptoms as nervousness,
irritability, headache, sleeplessness, failure of memory, and inability
to concentrate the mind commonly occur. Other symptoms may be present
in addition, as debility, diarrhea, epigastric and lumbar pains, and
impaired sexual function.
=Diagnosis=.—The diagnosis is not difficult. Thirst, polyuria and the
absence of albumin and sugar characterize the disease. In =diabetes
mellitus=, finding of grape sugar in the urine would at once exclude
polyuria. In =paroxysmal diuresis=, the increased amount of urine is
not permanent. In =interstitial nephritis=, there is albumin, casts,
etc.
=Prognosis.=—Depends upon the cause. The disease yields to treatment
much quicker than diabetes mellitus and is without doubt much less
serious. The disease, in a large majority of cases, can be cured. Under
osteopathic treatment most cases will yield good results or be cured in
from a few weeks to six months.
=Treatment.=—The treatment of the disease causing diabetes insipidus is
of first consequence, but frequently such a disease is undiscoverable.
There is often a tendency toward neurasthenia; consequently, habits,
environment, etc., should be carefully attended to. Examine for sexual,
rectal and other reflex irritations.
Correcting lesions of the renal splanchnics is important; in fact, in
a fair number of cases treatment of this locality will entirely cure
the disease. A very effective treatment, in addition to the ordinary
methods of treatment, is to have the patient lie flat upon the back
while the osteopath reaches around the patient on either side, placing
the fingers firmly upon the transverse processes of the lower dorsal
vertebræ and springing the spine forward by lifting upward on the
patient, enough even to raise the patient from the surface he is lying
on. This treatment is especially effective in lessening the increased
amount of urine. Attention should be given to the false ribs on either
side and to the condition of the spine below and above the renal
splanchnics. The cervical vertebræ should be examined carefully for
disorders, and if any are found they should be removed at once, if
possible.
=Hygienic treatment= is of as much importance as in diabetes mellitus.
The clothing should be warm, warm baths taken, and general friction
and care of the skin utilized so that the circulation may be somewhat
diverted from the kidneys. Restriction of water is not always
necessary, except in cases where excessive drinking has become a habit,
as the thirst is caused by the diuresis and not the diuresis by the
large ingestion of water. Regulate the diet and see that the bowels are
acting normally.