Treatment of Uremia
IN the presence of acute anuric uremia and in chronic uremia, regardless of the cause, several principles should guide treatment. These are: 1. maintenance of body fluid and a certain electrolyte balance, 2. maximal suppression of protein metabolism, 3. avoidance of infection and 4. elimination of retention products ordinarily removed by the kidneys.
1. Control of Fluids and Electrolytes
Unfortunately many patients with oliguria and acute uremia are over-treated with water and saline in the hope that diuresis will occur, but no amount of fluid will induce urine formation if the uremia is due to parenchymal renal disease. Conversely, if given to patients in whom urine formation does not occur, salt and water will lead to the development of edema greatly endangering the ultimate prognosis. To avoid such unnecessary complications during periods of urinary suppression the daily intake of fluid should be rigidly limited to 750 cc., while fluid lost with vomiting and diarrhea may be counterbalanced.
Correct control of electrolytes can be accomplished only if their concentration in the blood and body fluids is known, hence frequent measurements of CO2 combining power, sodium chloride and potassium levels in the blood plasma are part of the management of acute uremia. Moderate depression of sodium chloride may be an advantage since it reduces the blood pressure, and diminishes the risk of convulsions and congestive heart failure. Vomiting and diarrhea however can cause excessive sodium and chloride loss. Such states will further depress urine formation and lead to more severe azotemia.
Careful. . .