Instead, he should be evacuated as expeditiously as possible to a center that possesses an artificial kidney and that is otherwise specially equipped to treat acute renal insufficiency. This measure will cause potassium to be reincorporated into intracellular glycogen and will lower the serum concentration. The concomitant use of insulin may facilitate this process. Sodium, in this setting is used sparingly and only to replace that lost by urinary excretion, gastric suction, or diarrhea. Generally, one-third normal saline is used to replace urine output , and normal saline to replace gastric fluid loss.
Fluid balance is maintained by the use of carefully calculated amounts of the required fluids.
His measured output is thus 200 ml. This amount should be added to the basic allowance of 500 ml to give a total intake for 24 hours of 700 ml. Since some wounded patients develop respiratory alkalosis, monitoring of serum pH is necessary to determine appropriate fluid replacement. Peritoneal and extracorporeal dialyses are effective techniques of treatment but are not usually feasible outside a special center staffed by personnel trained in these techniques. The University of Iowa.