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66 yo male undergoes repair of a ruptured AA. His urine output over is 35ml over 4hrs. A foley is in place. He received 14unitls of blood during the operation. temp is 100, pulse is 126 and bp is 104/68. exam shows diffuse peripheral edema. Heart sounds are normal. Lungs are clear. No JVD, soft abdomen. Labs:
Hct 27%
Serum Na 143
K 5
Urine Na 6mEq/L
What is the cause of the oliguria?
a- Heart failure
b- Hypovolemia
c-Occluded Foley
d- Renal artery thrombosis
e- Transfusion reaction
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d- Renal artery thrombosis
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b
urinary Na suggest prerenal cause ---usually hyovolemia
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now i feel its not b ....
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leosum is one smart cookie!
Ok so even though BP is not that low and he has peripheral edema which means he's volume overloaded - we still assume it's due to hypovolemia? Is the peripheral edema from all the colloids he got?
did you pick B based on the urine Na alone? or are there other factors that helped you pick it?
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He have no raised jvp+clear lungs and no other sign to suggest fluid overload like 3rd space fluid ---except peripheral edema. This simply means low oncotic pressure or high capillary permeability or high IV water contents compared to proteins. but bottom line is Intravascular volume is either euvolemic or low not high. as Renal output is low with U. Na low so its prerenal . and as its a big operation with much blood loss so option b. so if you see options except b no other options has its clinical features provided.
