08-08-2006, 05:12 AM
After an uncomplicated laparoscopic cholecystectomy, a 62-year-old man has not had any urine output since the Foley catheter was removed 12 hours ago. During the hour before the operation, the 40 minutes of operating room time, and the 2 hours in the recovery room, his fluid input was 2.5 L and urine output was 1 L. Since that time, he has been receiving intravenous 5% dextrose in water with 0.45% saline and morphine. He is awake and alter and has a moderate amount of abdominal pain. Preoperative serum studies showed:
Na+ 137 mEq/L
K+ 4.2 mEq/L
Urea nitrogen (BUN) 18 mg/dL
Creatinine 1.2 mg/dL
One hour after receiving an intravenous bolus of 0.9% saline, the patient does not produce any urine. Which of the following is the most appropriate next step in management ?
A) Increase in the dose of morphine
B) Intravenous administration of an additional bolus of 0.9% saline
C) Intravenous administration of doxazocin
D) Intravenous administration of furosemide
E) Reinsertion of a Foly catheter
Na+ 137 mEq/L
K+ 4.2 mEq/L
Urea nitrogen (BUN) 18 mg/dL
Creatinine 1.2 mg/dL
One hour after receiving an intravenous bolus of 0.9% saline, the patient does not produce any urine. Which of the following is the most appropriate next step in management ?
A) Increase in the dose of morphine
B) Intravenous administration of an additional bolus of 0.9% saline
C) Intravenous administration of doxazocin
D) Intravenous administration of furosemide
E) Reinsertion of a Foly catheter