Prolonged Anuria Complicated by Epileptiform Fits

Abstract

SEPT. 13, 1958 The dietary and fluid restrictions imposed on patients with anuria has been fully described (Bull et al., 1949;Merrill, 1955). The occurrence of severe convulsions late in the course of treatment is not a generally recognized complication. The patient whose case is described below had very severe epileptiform fits on her 17th day of anuria, and recovered. The management and aetiology of the fits, as well as the nature of the residual renal lesion and its effect on child-bearing, are discussed.Case History A primigravida aged 26 was first seen on March 25, 1955, at the 25th week of pregnancy. Her blood pressure was 130/80 mm. Hg; there was no proteinuria or past history of renal disease. During the 29th week of gestation she was admitted to hospital complaining of abdominal pain, vomiting, absence of foetal movement, and anuria for some hours. She was pale and anxious, and her blood pressure was 140/90. There had been no vaginal bleeding. A small quantity of urine was obtained from the bladder by catheter, and there was no proteinuria.On examination the uterus was hard and tender, and foetal parts could not be palpated nor the foetal heart heard. Two pints (1,100 ml.) of blood was given, and three hours after admission uterine contractions were felt, so the forewaters were ruptured. Eight hours later a stillborn foetus was expelled, with 5 pints (2,840 ml.) of blood clot and the placenta. A further 2 pints (1,100 ml.) of blood was transfused. No fall in blood pressure had occurred since she was admitted to hospital.After delivery no further obstetrical complication arose, but complete anuria persisted for the first 11 days, and oliguria for another six (see Table and was treated on conventional lines at first, with 400 g. of glucose, 100 g. of peanut oil, emulsified to 1 litre of water (Bull et al., 1949). As the anuria persisted the quantity of fluid was reduced to 800 ml. a day, given by mouth as 50% glucose with adequate vitamins. Excessive vomiting occurred on the eighth day, and the fluid was then given by intragastric drip: further attacks of vomiting necessitated changing to 40% glucose, given by caval drip (de Keyser et al., 1949;Bull, 1952;Russell et al., 1954). The electrolyte balance of the patient was followed at frequent intervals, and on the 12th day the serum potassium had risen to 7.6 mEq/l. This was reduced to 4.2 mEq/l. by giving 100 g. of " zeo-carb. 225/Na," suspended in 1 litre of water, administered in five divided doses over two days. The anaemia was twice treated by transfusion of concentrated red blood cells, 2 pints (1,100 ml.) on the sixth day and 1 pint (550 ml.) on the eleventh day. Epileptiform Fits.-On the 17th day, just as renal function was returning, a series of epileptiform fits occurred, and at the first fit a blood pressure of 220/90 was recorded (a blood pressure of 170/100 had been recorded earlier in the day, a slight rise over the 160/80 of the day before) (see Chart). These fits were not controlled by the prompt administration of 4{ gr. (0.3 g.) of phe...

Recovery of Renal Function After Acute Renal Failure

“…IN general, all patients who survive after an episode of acute renal failure make a good clinical recovery and subsequently enjoy normal health. Occasionally individual patients show proteinuria, nitrogen retention and markedly diminished clearances values, which persist many months after the acute illness (Redman and Parsons, 1958). There is an extensive literature on acute renal failure, reviewed by Merrill (1955), but apart from reports of individual case3 there is very little information dealing with the later prognosis after recovery (Lowe, 1952;Finkenstaedt et alii, 1953).…”