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  #1  
Old 03-13-2012
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Urine Sample How to manage this postoperative anuria!

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 alert 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 doxazosin
D) Intravenous administration of furosemide
E) Reinsertion of a Foley catheter
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  #2  
Old 03-13-2012
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E?
he has bun/crt of 15 that means ATN. but he is not producing ANY urine...must be mechanical prob...
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  #3  
Old 03-13-2012
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may be this patient's pain may cause him to have urinary retention. so i will take ans A.
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Old 03-13-2012
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i think ans is e. due to anesthesia effect may be...

Pain is moderate amount so i think not a.....not fluid overload so no diuretics
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Old 03-13-2012
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E... if at all it was due to blood loss and Pre-renal azotemia ... then the NS would have given benefit...

plus its laproscopic...minimal blod loss

plus anesthesia effect ...mostly epidural could cause urinary retention

so best ans IS "E"
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tyagee (03-13-2012)
  #6  
Old 03-13-2012
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so ur saying the patient have bladder atony due to anasthesia? its makes sense .so ans E.
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  #7  
Old 03-13-2012
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Correct Answer

yes... classic question !!
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