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 post op oligouria?  

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


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


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.....


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


challenge him with iv fluids


practical experience - 90% hypovolumic

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


Check to see if the foley is patent first.


- 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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