Kidney Health and Orthopedic Challenges After Severe Injury

Kidneys and Orthopedics

After a severe car accident, my friend suffered a comminuted fracture in the lower leg, with the bone unable to be fully reconstructed, and there was damage to both blood vessels and nerves.
Due to severe injuries in almost all limbs, a lot of medications are being used.
Currently, the doctor says that the recovery of the muscles and blood vessels in the right leg is going well, but the orthopedic team is concerned about the risk of infection affecting the internal organs and has suggested amputation.
My friend has been unable to urinate and underwent dialysis a few days after the accident, continuing almost daily to assist with urination.
There has been an occurrence of jaundice, but it has improved.
It has been 24 days since the accident.
Last week, it was said that my friend could start eating, and fish soup, porridge, and bird's nest were fed, but after wound cleaning, a catheter was reinserted.
The abdomen is swollen and hard, and normal bowel and urinary functions have not resumed.
The nurse assisted with bowel movements, which helped a little.

I would like to ask if the abdominal condition could be due to hydronephrosis or if it is simply a result of prolonged bed rest causing gastrointestinal motility issues.
Although the nerve and muscle recovery is reported to be good, the doctor is concerned about the risk of bone infection affecting the kidneys.
Is amputation absolutely necessary in this situation? For patients who have undergone dialysis and are just starting to eat again, is it acceptable to consume foods like fish soup? Since this is happening abroad, many conditions and dietary practices differ from those in Taiwan, so I would like to consult your professional medical team for advice and suggestions.
Thank you very much!

pin, 30~39 year old female. Ask Date: 2013/05/13

Dr. Wang Weijie reply Internal Medicine

Dear Pin,
Thank you for your message.
The patient is currently hospitalized, and it is recommended to discuss the condition with the attending physician at the hospital.
If you have any other questions, please feel free to reach out again.

Wishing you safety and health,
Dr.
Wang Wei-Jie
Director, Nephrology Department
Taoyuan Hospital, Ministry of Health and Welfare

Reply Date: 2013/05/13

More Info

The situation you described regarding your friend's severe injuries from a car accident is indeed complex and multifaceted, involving both orthopedic and renal health challenges. Given the severity of the injuries, including multiple fractures and vascular and nerve damage, the management of such cases requires a multidisciplinary approach.

Firstly, regarding the orthopedic concerns, the presence of multiple fractures, particularly in the lower extremities, can lead to complications such as infections, delayed healing, or non-union of the bones. The recommendation for amputation may arise from concerns about the viability of the limb, especially if there is significant vascular compromise or if the risk of infection is high. In cases where the bone cannot be reconstructed adequately, or if the limb is not salvageable, amputation may be considered to prevent systemic complications, including sepsis.

The inability to urinate and the need for dialysis indicate that the kidneys may be under significant stress, possibly due to the trauma or secondary effects from medications or infections. The presence of jaundice suggests liver involvement, which could complicate the overall clinical picture. The abdominal distension could be due to several factors, including fluid retention, bowel obstruction, or even complications related to the kidney function. It is essential to monitor renal function closely, as ongoing dialysis is necessary to manage acute kidney injury or failure.

As for the dietary considerations, introducing soft foods like fish soup and congee is generally acceptable, especially if the patient is stable and can tolerate oral intake. However, it is crucial to ensure that the foods are low in potassium and phosphorus, as these can accumulate in patients with renal impairment. Consulting with a dietitian specialized in renal nutrition would be beneficial to tailor the diet according to the patient's needs.

Regarding the abdominal symptoms, it is essential to differentiate between potential causes such as hydronephrosis (swelling of a kidney due to a build-up of urine) and gastrointestinal issues stemming from immobility. The medical team should perform imaging studies, such as an ultrasound or CT scan, to assess the kidneys and abdominal organs for any complications.

In summary, the management of your friend's condition requires careful coordination among orthopedic surgeons, nephrologists, and possibly other specialists. Regular follow-ups and monitoring are crucial to address any emerging complications and to adjust treatment plans accordingly. It is also vital to maintain open communication with the healthcare team to ensure that all concerns are addressed and that the patient receives comprehensive care.

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