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 post op oligouria?  



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Author8 Posts
  #1

70 kg man Post op urinary output in three consecutive hours 12cc, 17cc, 9cc. Whats the next step in dx?




  #2

check urinary sodium to differentiate between dehydration and renal failure. Dehydration can cause low urinary sodium.


  #3

or maybe even check Fe Na+ which shld be <1 in patients with Pre-renal cause or > 1 in Intra-renal failure.....

and in the meantime while at it i think it is right to send blood for BUN and creatinine.... to actually see if patient does have azotemia.....

Plus.....maybe insert a catheter to exclude an obstructive cause.....


  #4

yes u r both right
first u can check urinary Na+ conc. if pt's kidney is good, it will hold on to Na+ and H2O so if Na+ is less than 20, tx is fluids
n if kidney is problematic, it wont b holding on to Na+ so for Na+ above 20, cut back on fluids.
Also u can use FeNa+ if more than 1, failure of kidney
If FeNa+ less than 1, not enough fluids


  #5

challenge him with iv fluids


  #6

practical experience - 90% hypovolumic

fluid challenge and bladder scan...........
plus creatinine for ARF..


  #7

Check to see if the foley is patent first.


  #8

Experience
- First check for ballon (vesical) maybe catheter obst
- no obstruct, IV cahllenge, Na fluid (if a central line placed check level)
- check electrolites, ABG





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