1 / 13

Post-Operative Oliguria

Post-Operative Oliguria. Definitions. Oliguria - <0.5 cc/kg per hr in adult About 30-70 cc/hr Children less than 10kg: <1 cc/kg per hr Anuria - <100cc/24hrs Acute renal dysfunction – oliguria and increase in Creatinine (>1 mg/dl from baseline). Case Presentation.

wendi
Download Presentation

Post-Operative Oliguria

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Post-Operative Oliguria

  2. Definitions • Oliguria - <0.5 cc/kg per hr in adult • About 30-70 cc/hr • Children less than 10kg: <1 cc/kg per hr • Anuria - <100cc/24hrs • Acute renal dysfunction – oliguria and increase in Creatinine (>1 mg/dl from baseline)

  3. Case Presentation • 65y M w PVD, POD#0 s/p RLE bypass • Called by the ICU for UOP 20mL over 2hrs

  4. General Approach • Go see patient, talk with nursing staff, get flowsheet • ABC (evaluate mental status) • Resuscitate - does pt have adequate IV access, does the pt need Foley, NGT, continuous monitoring? • H&P • Physical examination • Order appropriate labs/tests • Diagnose and treat • Communicate plan with team and patient

  5. Case: Assessment & Resuscitation • AAOx3, afebrile, P 105, BP 100/60, O2 sat 96% RA • Tachycardic, oliguric = hypovolemia • Ensure adequate IV access • Fluid bolus • While pt is receiving bolus, continue the evaluation What are potential causes? What exam findings/tests will help you make a diagnosis?

  6. DDx • Pre-renal (2/2 ↓ renal perfusion) • Dehydration, bleeding • Shock 2/2 sepsis, cardiogenic • Abdominal compartment syndrome • Renal artery stenosis • Post-renal (obstructive) • Obstructed Foley catheter • Extrinsic compression on ureter, bladder, urethra (BPH, CA, hematoma) • Stone • Intrinsic renal • ATN (contrast, prolonged pre-renal, toxins, rhabdomyolysis) • AIN (drugs i.e. antibiotics) • Less common in surgical population: • Vascular (Wegener’s, HUS, TTP, embolism) • Glomerular • Nephritic (red cells, red cell casts) • Nephrotic (proteinuria, edema, HTN)

  7. H&P • Focused history: time since surgery, surgical complications, anesthesia history (any periods of hypotension during surgery?), recent medications, recent h/o contrast, check fluid balance (include operative period and even pre-operative period) • Physical: signs of bleeding, signs of dehydration, look at urine • Tip: Flush the Foley (catheter obstruction)

  8. Labs • Initial labs: • CBC - ?bleeding? • BMP, urine Na & Cr, U/A • Note: if pt has been on diuretics, send for urea instead of Cr • Additional studies: Urine Eos, CPK, Urine myoglobin, Renal U/S • As suspected: septic workup, MI workup • Interpretation of FeNa: • Pre-renal: UNa<20, FeNa<1%, BUN/Cr >20 • ATN: UNa>40, FeNa>1%

  9. FeNa Calculation • FENa = UNa * PCr/ PNa * UCr x 100 • Online calculators

  10. Studies • Renal Ultrasound – evaluate renal blood flow • Central catheter to evaluate CVP, Swan-Ganz catheter • Bladder pressures (for Abd Compartment Syndrome) • Via foley, >20 abd HTN, >40 requires intervention • Bladder US or IV pyelogram

  11. Post-Op Oliguria: Treatment • Pre-renal: resuscitation, improve CO • Post-renal: fix the obstruction • New foley, suprapubic tube, nephrostomy tube • Sepsis: resuscitate & broad-spectrum abx • Contrast-induced nephropathy: IVF, N-acetylcysteine, +/- bicarbonate • Nephrotoxin or AIN: stop the agent

  12. Indications for Hemodialysis • Acidosis (pH < 7.10) • Electrolytes (for example, hyperkalemia) • Ingestion (toxins) • Overload (fluid overload) • Uremia

  13. Take Home PointsWhat to do when you’re called with low UOP • Go see the patient • Always start with your ABCs • Resuscitate • Oliguria ddx: pre-renal, post-renal, intrinsic • Look for bleeding • FeNa can help

More Related