Order Oliguria and Polyuria Discussion
Order Oliguria and Polyuria Discussion
1. A previously healthy 18-year-old woman presents to the emergency department 4 hours ago
with headache and photophobia. Her parents state that her symptoms began as a mild fever and
headache, and today, she appears to be a bit confused and has been urinating a lot. On physical
examination, she is alert and oriented but slow to answer questions. There are no focal
neurological signs. Her labs reveal elevated leukocytosis and hypernatremia. Blood cultures
were sent. What is the next BEST step in management?
A. Start broad-spectrum antibiotics
B. Obtain urine sodium, chloride, creatinine, and osmolality
C. Obtain spinal fluid sample
D. Obtain CT scan of head
Order Oliguria and Polyuria Discussion
2. A 45-year-old man is admitted for urgent laparoscopic cholecystectomy for severe
cholecystitis. His medical history was significant for chronic kidney disease and moderate to
severe pulmonary hypertension which is being treated with continuous epoprostenol infusion at
home. Intraoperative transesophageal echocardiogram showed depressed right ventricular
systolic function. Intraoperative course was complicated by blood loss, requiring 2 units of
packed red blood cells and 500 mLof lactated ringer. Postoperatively, he remained sedated and
intubated and transferred to the intensive care unit (ICU) for close monitoring. His home-dose
IV epoprostenol was continued intraoperatively and in the ICU. During his first postoperative
day, he made minimal urine. Oxygen saturation is 100%, and estimated pulmonary artery
pressure is at baseline, however, central venous pressure has increased.
Which of the following is the next BEST step in management?
A. Repeat transesophageal echocardiogram to reassess the right ventricular function
B. Obtain a nephrology consult to start continuous renal replacement therapy
C. Switch intravenous epoprostenol to inhaled epoprostenol
D. Administer a bolus of albumin in to improve the urine output
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