F- CLINICAL ASPECTS OF SPINAL CORD INJURIES
413
of dietary protein and electrolytes should be restricted and a carbohydrate diet of 1,000-
1,500 g be given during the stage of oliguria. Gastric suction, which may be necessary
in acute dilatation of the stomach and vomiting should be used with care as severe
alkalosis may develop. If these conservative measures fail and anuria and uraemic symp
toms develop, the patient should be immediately transferred to a hospital where haemo-
dialysis or peritoneal dialysis are available, which may constitute a life-saving measure.
This happened just recently in one of our traumatic paraplegics, a man aged 23 who,
having fallen from a scaffolding (40 ft), sustained, in addition to a fracture dislocation of
L2 resulting in an initially complete paraplegia below Ti2/Li, a right Colles fracture,
a fracture of right scaphoid, dislocation of right elbow, fracture of right pubic ramus,
butterfly haematoma at the perineal region and haematoma of right hip. He was trans
ferred to Stoke Mandeville one day after injury (i December 1970) severely shocked but
conscious (BP 110/80, temp. 97°F). Blood urea rose from 108 to 125 mg per cent,
potassium 7-3 mEq/1 (he had vomited 200 ml blood-stained fluid, while in the ambulance,
and 10 ml blood-stained fluid were aspirated on admission). As intravenous mannitol
treatment (20 g in 250 ml saline) did not result in any improvement of the severe oliguria,
he was immediately transferred to the Dialysis Unit at the nearby R.A.F. Hospital,
Halton, where the blood urea rose on the same day to 145 mg per cent, white cells
15,900. He received altogether 17 dialyses, the last on n December 1970. Diuresis
started on n December 1970, reaching iL by the i6th and 4L by the 22nd. He was
readmitted to Stoke Mandeville on 29 December 1970 with a blood urea of 104 mg per
cent which by 18 January 1971 had decreased to 42 mg per cent; potassium and chlorides
normal. The patient has made some motor recovery, especially in the right leg and also
some sensory recovery.
Mitchell (1965) of the Dialysis Unit at Halton described 5 cases who were previously
transferred from our Spinal Centre. Three of them had acute renal failure following
traumatic shock and 2 were in acute failure of chronic renal deficiency. Two of the cases
with acute renal failure resulting from post-traumatic shock due to multiple injuries may
be quoted here from Mitchell's paper.
'Thirty-four year old male (G.S.) was admitted to hospital on 29 July 1962 following
an accident in which a tractor toppled over on him. He sustained a fracture of the nth
thoracic vertebra and fractures of the right I2th rib, the transverse processes of the 2nd,
3rd and 4th lumbar vertebrae and the right ulnar styloid process. He had burns of the
fingers and right palm. He was transferred to the National Spinal Injuries Centre the
following day, during which he developed a left hemiplegia. Parietal burr holes showed
bruising of the brain but no collection of blood.
'Oliguria had been present since the accident and on 2 August he was admitted to
the Renal Unit with a plasma urea of 550 mg per cent and a plasma potassium 6-0 mEq/1.
At the beginning of dialysis later the same day the plasma urea was 610 mg per cent and
plasma potassium 5-8 mEq/1. Six hours dialysis continuing into the early hours of the
morning lowered the plasma urea to 255 mg per cent and the plasma potassium to
4-3 mEq/1. The plasma urea and potassium and the urine volume is illustrated in Fig.
179. Three dialyses with one- and two-day intervals respectively were required to control
the biochemical disturbances. Diuresis began on the nth day and thereafter the blood
