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Lactate osmolality in plasma quotient of urine and plasma osmolality osmolar clearance and free water clearance in multiple trauma patients


, : Lactate osmolality in plasma quotient of urine and plasma osmolality osmolar clearance and free water clearance in multiple trauma patients. Intensivbehandlung 12(2): 43-52

In the present prospective study 106 polytraumatized patients.sbd.20 patients in short sequences of time.sbd.were investigated. Lactate and colloid osmotic pressures were determined, osmolality in plasma and urine were calculated as well as analyzed at certain periods of time. Compared with three phases of acute respiratory insufficiency after Horovitz there was no correlation between arterial oxygen tension and lactate. Only the group of seriously traumatized patients with typical signs of shock lung, lactate correlates with arterial oxygenation (r = -0.68). Although lactate initially showed an increase to higher pathologic values with return to normal state later on, without any changes of pH and PaO2. Also lack of concentrating ability of the kidneys in polytrauma indicates an increased risk of the patients on the first day of treatment. This statement derives from the quotient of urine and plasma osmolality. An acute renal failure can be predicted 24 to 48 hours before occurring by calculating free water clearance, as it is possible with the help of normally measured parameters like creatinine and urea nitrogen in plasma and excretion of natrium in urine. Values of free water clearance of +0.25 ml/min or -0.25 ml/min can be regarded as the turning-points to acute renal failure. In our patients, values of the quotient of urine and plasma osmolality as well as values of free water clearance (CH2O) were in the lower normal range. The total of our investigated parameters facilitates the estimation of polytraumatized patients especially in the first hours, for prognosis of further course the valuation is recommended by the severity of traumatizing.

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