GENITOURINARY DISORDERS - Medicine for Mountaineering and Other Wilderness Activities - page 294

acute renal failure. Urinary retention is usually accompanied by a strong urge to urinate as
well as by pain in the bladder or lower abdomen. (If urethral catheterization discloses the
bladder to be empty, urinary retention can be ruled out.) Following bladder rupture, evid-
ence of an abdominal or pelvic injury, including abdominal pain and tenderness, is usually
obvious( Chapter 10:Abdominal Injuries ) .However,acute renal failure canalsobeassoci-
ated with an injury in which the bladder is ruptured.
Evacuation is urgent for renal failure. Only wellequipped medical centers would have
the dialysis (artificial kidney) facility required to keep someone with acute renal failure
alive formore than afewdays.Duringevacuation fluid intake must becarefully controlled
to prevent overloading with water. To establish the diagnosis of acute renal failure the per-
son's previous state of hydration must be determined. If the person appears dehydrated,
enough fluids must be given to correct that situation. If renal output does not return, subse-
quent fluids must be administered very carefully. Each day's fluid intake should be limited
to one quart plus a quantity roughly equal to the urine volume. Unusual fluid losses caused
by vomiting, sweating, or high elevation must also be replaced ( Chapter 2: Basic Medical
Care ) .
If nausea and vomiting, which are usually present after the third day, prevent taking flu-
ids orally, intravenous fluids must be administered. The quart of water, the previous day's
urinary output, and any unusual losses through the lungs should be replaced with a 5 or
10 percent glucose solution. Fluids lost through vomiting and excessive sweating should
be replaced with a balanced salt solution. To ensure that the volume replaced matches the
amounts that have been lost, urine volume, losses from other sources, and oral or intraven-
ous intake must be measured and recorded.
While able, the individual should be encouraged to eat sweets, such as hard candy or
glucose tablets. However, citrus fruits and fruit juices must be avoided because they con-
tain potassium, which can be toxic for a person with reduced renal function.
Medications should be avoided because the kidneys excrete most drugs. In the absence
of renal excretion, their concentration can rapidly build to toxic levels.
URETHRAL CATHETERIZATION
With acute urinary retention, most commonly caused by drugs or an enlarged prostate in
older males, but also occurring following prolonged periods of unconsciousness or after
severe trauma, particularly injuries in which the lower portion of the body is paralyzed, the
urinary bladder may be severely distended. Due to stretching of the bladder muscles and
pressure against the opening of the bladder, the individual may be unable to void. As the
bladder becomes more distended, it becomes painful. To relieve the distension a catheter
must be inserted into the bladder through the urethra. The discomfort from this procedure
is surprisingly small, usually much less than that from a distended bladder.