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One day after an emergency repair of a ruptured AAA, a 66yo man has a ur output of 35mL over a 4 hr period; a foley catheter is still in place. He received 14 units of blood during the operation. His temp is 100, p 126, and bp 104/68. Exam shows diffuse peripheral edeam. Heart sounds are normal. the lungs are clear to auscultation. there is no JVD. The abdm is soft. Las show:
hct 27%
serum Na 143
serum K 5.0
Ur Na 6
Which of the following is the most likely cause of the oliguria?
a)heart failure
b)hypovolemia
c)occluded foley
d)renal art thrombosis
e)transfusion rxn
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mira, could u explain your answer? that is the coffect answer..... but i just don't get it.
what is the definition of hypovolemia? and he had 14 units of blood, so i don't get why he's hypovolemic.
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The correct answer is B. This patient has lost a large volume of blood, and has low blood pressure with compensatory tachycardia, laboratory values consistent with prerenal oliguria, and no jugular venous distention.
Heart failure (choice A) would present with signs of cardiogenic shock that include hypotension, decreased peripheral circulation, jugular venous distention, and a possible heart murmur.
An occluded Foley catheter (choice C) would present with suprapubic tenderness and no urine output.
Renal artery thrombosis (choice D) could result from this type of operation; however if the other kidney was functioning, urine output should be normal. The patient may develop flank pain due to the thrombosis.
Transfusion reactions (choice E) present with hypotension, fever, a rash, and oliguria. They usually present during or shortly after transfusion (not a day later).
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hi mira,could u please explain why he had per.edema?
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prerenal oliguria-kidney is normal, has capacity to retain natrium toghether w/ H20=edema(urine natrium less than 10 mEq/l)
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thank u mira. u seem to know your stuff well. good luck to u.
