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Thu Dec 21 11:32:27 GMT 2006

Charles

We use a simple "loss per day plus 500ml" regime, which is replaced as the urine is lost - i.e. continually. U&e based additives to the .45% saline as required (Ca++ / K+ / Phosphate)

The polyuric phase usually only lasts around three days and then the kidneys "relearn" how to concentrate the urine and everything goes back to normal.

The KISS principle I suppose!

Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
ATLS  instructor and DSTC Cape Town Course Director
Intern program Coordinator: Surgery
M.Med (Emergency Medicine) Executive Committee member
Clinical Head (Director): Diana Princess of Wales Trauma Unit
Division of Surgery (General) Room 4064
Department of Surgical Sciences
Tygerberg Hospital / University of Stellenbosch
PO Box 19063
Tygerberg 7505
Western Cape
South Africa
e-mail: tch at sun.ac.za
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Krin135 at aol.com
Sent: Wednesday, December 20, 2006 8:22 PM
To: trauma-list at trauma.org
Subject: Re: Crush and tourniquets

In a message dated 12/20/2006 8:26:23 AM Central Standard Time,  
tch at sun.ac.za writes:

The  incidence of chronic renal dysfunction in this group is surprisingly 
small  from what my renal unit colleagues, who follow these patients longterm, 
tell  me. If they reverse the renal dysfunction (usually within around three 
weeks)  they seem to have good functional outcomes with a small group having  
persistant hypertension at five years. the trick is to not let them get  
dehydrated during the inevitable polyuric phase of  recovery.

Tim:

What protocol do your renal chaps use to keep up with the  polyuria? While my 
experience with post traumatic/post crush polyuria is a bit  limited, I did 
train long enough ago that we had frequent episodes of acute post  bladder neck 
obstruction polyuria, something that we don't see as much any more  here in 
the States, due to a combination of more aggressive catheterization, new  
medications to reduce prostate size and a long history of aggressive prostate  
surgery.

Our technique 'back in the day' was to do hourly outputs, and replace 60 to  
70% of the last hour's output with 0.2% saline, with associated dextrose and  
electrolytes (usually D5 1/4 NS with 10 mEq K as citrate or bicarb) over and  
above any needs that the patient otherwise required.

ck
Charles S. Krin, DO FAAFP
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Crush and tourniquets