CRASH Course Resident Recognition General 少尿速成识别一般居民课件.pptVIP

OliguriaCRASH Course Sarah Lord October 25, 2010 Reduced urine volume less than necessary to remove endogenous solute loads In a patient with normal ability to concentrate?urine - less than 400 mL per day or 0.5 mL/kg/h over 2 consecutive hours In a patient with impaired ability to concentrate urine (sp gravity 1.010) - less than 1000 - 1500 mL per day Definition Oliguria is not a diagnosis, but a sign of an underlying problem Simply attempting to restore normal urine output by administering a bolus is inadequate Determine the underlying cause, and treat In the end, a bolus might be all that is needed…. But don’t fall into the trap of assuming Management of the oliguric patient Differential Diagnosis Prerenal Renal Postrenal Decreased effective intravascular volume (sepsis, hepatic failure, anaphylactic shock, neurogenic shock, vasodilators) Glomerulonephritis (poststreptococcal, SLE/other connective tissue disorder, malignant hyperthermia, eclampsia/preeclampsia…) Ureteral obstruction (stone, infection, trauma) Hypovolemia (hemorrhage, GI losses, renal losses, sugery/burns) Acute tubular necrosis (ischemia, antibiotics, radiocontrast, pigment load, heavy metals, solvents) Urethral obstruction (foley, mucus, blood clots) Impaired cardiac function (MI, PE, cardiac tamponade, CHF, mechanical ventilation) Interstitial nephritis (drugs, infection, neoplasm) 34 yo male developed severe acute pancreatitis on holiday in Mexico (too many cervezas) Nearly died in ICU in Mexico Discharged home, returned to Canada, and began to experience early satiety Large pseudocyst, endoscopic cyst-gastrostomy Felt better for a week, then developed spiking temperatures, return of early satiety + vomiting Mr GB Called by ICU nurse at 02:00 on 8th day of admission On AC, Fi02 60%, RR 25, febrile at 38.6° C, tachy at 115 bpm, on TPN, NG output ~ 600 cc/last shift, requiring levophed to maintain MAP 65 mm Hg RN reports urine output dropping – 8 cc over last hour, 14cc over hour previous, and