Renal function in tetanus.

In twenty-eight patients suffering from tetanus, renal function was evaluated from admission for a period of 2 weeks. Investigations included daily blood urea, osmolality and creatinine and urinary osmolality and sodium. Free water clearance (CH2O) was calculated. The patients were divided into those requiring tracheostomy and sedation alone (Group I) and those with more severe tetanus requiring total muscle paralysis and IPPV (Group II). The latter group also had evidence of sympathetic nervous overactivity (SOA). Daily blood urea, serum creatinine and osmolality showed no significant difference between the two groups except during the phase of uremia. Mean urinary sodium was significantly different between the two groups (p less than 0.001). Four patients in Group II developed an abnormal plasma urea (Group IIb). In one patient the rise in urea followed resuscitation from cardiac arrest and the remaining three patients had in common severe cardiovascular instability associated with SOA. All four patients were non-oliguric during the phase of uremia. Only one patient with renal failure survived, compared with a 75% survival in the patients with SOA without renal failure and a 100% survival in Group I. Tetanus complicated by renal failure has a poor prognosis.