遅発性急性腎不全を発症した多発外傷の1例 [in Japanese] A CASE REPORT OF LATE PRESENTATION OF ACUTE RENAL FAILURE AFTER TRAUMATIC MULTI-ORGAN INJURY ASSOCIATED WITH DIC [in Japanese]
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An 82-year-old man met a traffic accident, and was diagnosed as having multiple costal and pelvic fractures and pancreas injury with shock at another hospital. The patient got over the acute phase with conservative treatments. Disseminated intravascular coagulation (DIC) developed on day 2, which was medically treated with a successful outcome, and the patient so recovered that could have per os. Unfortunately, however, aspiration pneumonia develolped after misswallowing, and his general condition was gradually worsened, resulting in oliguria on day 25, when the patient was transferred to our department. No response to a water challenge test with diuretics and catecholamines was observed, and hemodialysis (HD) was commenced, from which the patinet could be weaned on day 68. The mechanism of the late presentation of acute renal failure (ARF) as 2 weeks after the recovery from DIC was considered as follows: The first attack by multi-organ injury, shock, and DIC could be scarcely endured, but the second attack by prolonged catabolic state with pneumonia and water imbalance might clinically manifest acute renal failure in a multiplicative way. It is stressed upon that a meticulous care should be continued after the recovery from the acute phase for aged patients, whose functions of many organs can be latently depressed.
- The journal of the Japanese Practical Surgeon Society
The journal of the Japanese Practical Surgeon Society 58(5), 1099-1103, 1997-05-25
Japan Surgical Association