[NBME] Q: No urine output

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[NBME] Q: No urine output

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fongch
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04/20/07 - 02:31 PM

After an uncomplicated laparoscopic cholecystectomy, a 62-year-old man has not had any urine output since the Foley catheter was removed 12 hours ago. During the hour before the operation, the 40 minutes of operating room time, and the 2 hours in the recovery room, his fluid input was 2.5L and urine output was 1L. Since that time, he has been receiving iv 5% dextrose in water w/ 0.45% saline and morphine. He is awake and alert and has a moderate amount of abdominal pain. Preoperative serum studies showed:
Na+ 137mEq/L
K+ 4.2mEq/L
BUN 18 mg/dL
Creatinine 1.2 mg/dL
One hour receiving an iv bolus of 0.9% saline, the patient does not produce any urine. Which of the following is the most appropriate next step in management?
A Increase the dose of morphine
B IV an additional bolus of 0.9% saline
C IV doxazosin
D IV furosemide
E Reinsertion of a Foley catheter

Justice
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04/20/07 - 03:30 PM

Based on the blood chemistry, the man is running some postrenal problems... I would suggest to do (E) first...

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fongch
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04/20/07 - 03:44 PM

Aha, that's exactly what I was thinking. What about A?

Justice
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04/20/07 - 03:50 PM

fongch wrote:
Aha, that's exactly what I was thinking. What about A?

Fongch,
you think the man is in pain?

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fongch
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04/20/07 - 07:42 PM

Justice wrote:

Fongch,
you think the man is in pain?

It is mentioned in the question.

Justice
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04/20/07 - 07:53 PM

fongch wrote:

It is mentioned in the question.

Ouch... Sorry I missed it...

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vradojc1
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04/20/07 - 08:08 PM

pain is result of bladder distension. catheterize and problem solved. if repeated, catheter can be left in.

chemamr
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04/21/07 - 05:45 AM

E

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dr.wad
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04/21/07 - 09:58 AM

i go with E

ValeryAndre
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04/21/07 - 10:07 AM

#10

I would go for E. I think Morphine is to blame. So Cath replacement should be used

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