F-CLINICAL ASPECTS OF SPINAL CORD INJURIES
415
IV P
ACt
36
y
5
/
6 —^
5HR*
5HR*
bHK
\
I
1
m
i -
r
UIKIICOIL
DIALYSIS
54 HOURS
I
i
770
7/Mf - A4V*1
FIG. 180. Chart showing plasma ureas, plasma potassiums and urine volumes of
patient W.P. during period of acute renal failure. From Mitchell (1965)
Paraplegia
2, 254.
levels and improving the biochemical changes of uraemia the gastrointestinal bleeding
continued. An attempt was made to maintain the biochemical improvement by continuous
haemodialysis using a 'MinicoiP (Lawson
et al.,
1962) and to keep pace with the blood
loss by transfusion until it became obvious that the condition was irremediable. The
patient died 24 September. Fig. 180 shows plasma ureas, plasma potassiums and urine
volumes during dialyses.
Postmortem
examination showed fracture dislocation of the
body of the third lumbar vertebra, fractures of the pelvis and of the 8th to nth ribs and
lateral processes of the 2nd and 3rd lumbar vertebrae, extensive haemorrhage into the
para-spinous and psoas muscles, diffuse gastroenteritis, pre-pyloric peptic ulcer, bilateral
renal tubular necrosis with focal renal cortical necrosis, and necrosis of the lower lumbar
cord.'
These observations indicate the great value of dialysis as an early renoprotective and
life-saving therapeutic procedure in the immediate stage of spinal cord injuries associated
with multiple injuries of the body. Dialysis should be considered if oliguria does not
improve within a few hours following blood transfusions and mannitol infusion, and the
blood urea shows a tendency to rise. In order to prevent early irreversible damage of
renal tissues, it is safer to transfer the patient to the nearest Dialysis Unit before the blood
urea has reached the 150-200 mark.
