Travel Reference
In-Depth Information
The individual should drink large quantities of fluids. Fluid intake and urinary output
should be recorded. Evacuation from altitudes above 14,000 feet (4300 m) is desirable.
Antibacterial therapy is important. Ciprofloxacin (Cipro®) should be given. If symp-
toms persist after three days of drug therapy, the medication should be changed. TMP-
SMXisanacceptablealternativebutrequiresalongercourseoftreatment.Individualswith
repeated episodes of pyelonephritis should consult a physician because irreversible kid-
ney disease can result. In addition, an underlying disorder such as kidney stones may be
present.
Acute Urinary Retention
The most common cause for cessation of urinary output in men older than forty or fifty
years is acute urinary retention, which almost always is caused by an enlarged prostate.
Urinary retention is usually accompanied by a strong urge to urinate along with pain in the
bladderorlowerabdomen.Thediagnosisisestablished bycatheterization, whichdiscloses
a large quantity of urine in the bladder.
Sometimes a man with urinary retention is able to void again after a single catheteriza-
tion, but more typically an indwelling Foley catheter must be inserted, and the person must
be evacuated for care by a urologist. While the catheter is in place the person should be
treated with ciprofloxacin (Cipro®) or TMP-SMX to prevent infection.
Acute Renal Failure
Renal failure, a drastic reduction or total cessation of kidney function, occasionally fol-
lows a severe injury, particularly if the person is in shock for several hours or longer. Cer-
tain poisons, drug reactions, and other disorders can also cause acute renal failure. If the
person can be kept alive through the period of reduced renal function, which may last from
a few days to several months, complete recovery is usually possible.
The principal manifestation of renal failure is reduced urinary output. Dehydration may
alsocausealowurinaryoutput,butwhenadehydratedindividualisgivenfluidtheurinary
volume increases. An individual with acute renal failure cannot increase urinary output, no
matter how much fluid is given. With dehydration the urine is concentrated and has a deep
yellow or orange color; with acute renal failure, the small amount of urine produced is typ-
ically dilute. Any adequately hydrated person with a urinary output of less than 400 ml per
day of dilute urine following a severe injury should be considered to be in renal failure.
Usually few symptoms related to diminished renal function are present for the first two
or three days. However, weakness becomes apparent on about the third day, and loss of
appetite, nausea, vomiting, diarrhea, muscle twitching, confusion, convulsions, and even-
tually coma appear sometime later during the three to ten days following injury.
Urinary retention and rupture of the urinary bladder simulate renal failure because ur-
inary output ceases. However, such complete cessation of urinary output is not typical of
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