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DRUGS THAT ACT UPON THE URINE; URINARY ANTISEPTICS
85
CHAPTER
XII
DRUGS T H A T A C T U P O N T H E U R I N E ; URINARY ANTISEPTICS DRUGS may act upon the urine either : (I) By altering its reaction ; ( 2 ) By rendering it antiseptic ; or ( 3 ) By increasing its volume. 1. Altering the Reaction.— a. Drugs which Reduce urinary Acidity.—The soluble alkalis (Bicarbonates) and the vegetable salts of potash (especially Potassium Citrate). The action of these has been described under 'lithontriptics' (p. 8 3 ) . They are also used in the acute stage of infection with the Bacillus coli : not that an alkaline urine is hostile to the latter, but because alkalis have, in some way not clearly understood, the power of neutralizing the toxins of the bacillus and abolishing their constitutional effects (fever, etc.). Very large doses of alkalis are sometimes required for this purpose. b. Drugs which Increase Urinary Acidity.—Acid Sodium Phosphate and Ammonium Benzoate. Acid Sodium Phosphate is the natural acid of the urine, and the best agent for raising the acidity artificially. I t is easily soluble in water, and is given in doses of 1 0 to 3 0 gr. three times daily
86
ELEMENTS
OF MEDICAL
TREATMENT
after meals. In large doses it is apt to cause slight diarrhoea. Ammonium Benzoate increases acidity by the liberation of hippuric acid. It is rather unpleasant to take, but may be administered as follows :— R
Ammon. Benzoat. Tinct. Lavand. Co. A q . Dest.
gr. xv Π\χχ ad
Mitte Jviij. Sig. : Two tablespoonfuls three times daily after meals.
2. Urinary Antiseptics.— a. Actively Antiseptic in Acid Urine.—The formaldehyde group, the best example of which is Hexamine (hexamethylenetetramine), a condensation product of ammonia and formaldehyde. In the presence of acid it decomposes and liberates the antiseptic formaldehyde, 10 gr. of Hexamine given thrice daily being sufficient to convert the urine into a 1-5000 formaldehyde solution. Hexamine is given in Tablet form (5 gr. t.d.s., rapidly increased to 15 or 20 gr.) on an empty stomach so as not to be decomposed by the gastric juice. I t should never be prescribed in an acid mixture, as it would decompose in the bottle, and is useless if the urine is alkaline. In the latter event, Acid Sodium Phosphate should be given after meals to render the urine acid, and the Hexamine separately from it before meals. Hexamine is specially useful as an antiseptic against those organisms which thrive in an acid
DRUGS
THAT
ACT
UPON
URINE
87
urine (B. coli and the bacilli of typhoid and tuberculosis). In large doses it may irritate the kidneys and bladder and cause skin rashes. b. Active even in an Alkaline Urine.—These include such drugs as Boric Acid, Salol, Acriflavine, and the volatile oils contained in Buchu, Uva Ursi, Sandal Wood, Cubebs, and Copaiba. Boric Acid is an efficient antiseptic, especially when the urine is ammoniacal, but in large doses is apt to cause dyspepsia. I t should be given well diluted and after meals. Β
Acid. Borici gr. x - x v Tinct. Hyoscyami ÎT^xx Glycerini 3J Inf. Buchu ad g 3 Sig. : Two tablespoonfuls in water three times daily after food.
(The basis here is Boric Acid used as an antiseptic ; Hyoscyamus is given as a sedative to the urinary passages ; Glycerin as a flavoure ; and Infusion of Buchu (or of Uva Ursi) as an adjuvant vehicle.) Sandal Wood Oil is the volatile oil most often used. It is given in capsules (5 to 10 min.) after food, and is specially useful in coccal infections. 3. T h e Volume of the Urine is Increased, and it is rendered more dilute, by 'forced diuresis', which is best brought about by the drinking of large quantities of one of the natural diuretic waters (Vittel, Contrexéville, Vichy) ; but any bland fluid in sufficient quantity has a very similar effect, especially if an alkali is given at the same time.
CHAPTER
XII
DRUGS T H A T A C T U P O N T H E U R I N E ; URINARY ANTISEPTICS DRUGS may act upon the urine either : (I) By altering its reaction ; ( 2 ) By rendering it antiseptic ; or ( 3 ) By increasing its volume. 1. Altering the Reaction.— a. Drugs which Reduce urinary Acidity.—The soluble alkalis (Bicarbonates) and the vegetable salts of potash (especially Potassium Citrate). The action of these has been described under 'lithontriptics' (p. 8 3 ) . They are also used in the acute stage of infection with the Bacillus coli : not that an alkaline urine is hostile to the latter, but because alkalis have, in some way not clearly understood, the power of neutralizing the toxins of the bacillus and abolishing their constitutional effects (fever, etc.). Very large doses of alkalis are sometimes required for this purpose. b. Drugs which Increase Urinary Acidity.—Acid Sodium Phosphate and Ammonium Benzoate. Acid Sodium Phosphate is the natural acid of the urine, and the best agent for raising the acidity artificially. I t is easily soluble in water, and is given in doses of 1 0 to 3 0 gr. three times daily
86
ELEMENTS
OF MEDICAL
TREATMENT
after meals. In large doses it is apt to cause slight diarrhoea. Ammonium Benzoate increases acidity by the liberation of hippuric acid. It is rather unpleasant to take, but may be administered as follows :— R
Ammon. Benzoat. Tinct. Lavand. Co. A q . Dest.
gr. xv Π\χχ ad
Mitte Jviij. Sig. : Two tablespoonfuls three times daily after meals.
2. Urinary Antiseptics.— a. Actively Antiseptic in Acid Urine.—The formaldehyde group, the best example of which is Hexamine (hexamethylenetetramine), a condensation product of ammonia and formaldehyde. In the presence of acid it decomposes and liberates the antiseptic formaldehyde, 10 gr. of Hexamine given thrice daily being sufficient to convert the urine into a 1-5000 formaldehyde solution. Hexamine is given in Tablet form (5 gr. t.d.s., rapidly increased to 15 or 20 gr.) on an empty stomach so as not to be decomposed by the gastric juice. I t should never be prescribed in an acid mixture, as it would decompose in the bottle, and is useless if the urine is alkaline. In the latter event, Acid Sodium Phosphate should be given after meals to render the urine acid, and the Hexamine separately from it before meals. Hexamine is specially useful as an antiseptic against those organisms which thrive in an acid
DRUGS
THAT
ACT
UPON
URINE
87
urine (B. coli and the bacilli of typhoid and tuberculosis). In large doses it may irritate the kidneys and bladder and cause skin rashes. b. Active even in an Alkaline Urine.—These include such drugs as Boric Acid, Salol, Acriflavine, and the volatile oils contained in Buchu, Uva Ursi, Sandal Wood, Cubebs, and Copaiba. Boric Acid is an efficient antiseptic, especially when the urine is ammoniacal, but in large doses is apt to cause dyspepsia. I t should be given well diluted and after meals. Β
Acid. Borici gr. x - x v Tinct. Hyoscyami ÎT^xx Glycerini 3J Inf. Buchu ad g 3 Sig. : Two tablespoonfuls in water three times daily after food.
(The basis here is Boric Acid used as an antiseptic ; Hyoscyamus is given as a sedative to the urinary passages ; Glycerin as a flavoure ; and Infusion of Buchu (or of Uva Ursi) as an adjuvant vehicle.) Sandal Wood Oil is the volatile oil most often used. It is given in capsules (5 to 10 min.) after food, and is specially useful in coccal infections. 3. T h e Volume of the Urine is Increased, and it is rendered more dilute, by 'forced diuresis', which is best brought about by the drinking of large quantities of one of the natural diuretic waters (Vittel, Contrexéville, Vichy) ; but any bland fluid in sufficient quantity has a very similar effect, especially if an alkali is given at the same time.