Play Dr. House

So "hypothetical" situation

Pt was s/p abd surgery POD > 5 when they stopped producing urine. Less than 10cc/hr x 24hrs. Pt had a foley cath, was bladder scanned, negligent amount of urine in the bladder. multiple fluid boluses failed to produce any result, CT was negative as to the fluid being in abd/pelvis, pt was not overly edematous, lung sounds were diminished but clear, BUN/Creatnine were mildly elevated, but nothing serious, majority of other labs were WNL, only major change was an elevated phos. VS were hypotensive-normal, tachycardic, afebrile, resp even, shallow, regular. Pt had previously had no renal problems.

Pt was on a lot of narcotics for pain issues (the only thing that was changed within 48 hours) and was somewhat sedated.

Ideas/Input/Interventions??
What is the patient's BP?

Let's say it ranged from 90/45 - 120/70

Oliguria resulting from low renal perfusion. The kidneys are reacting to ischemia.

Did the patient have a chest xray? If so how did it look? Any pleural effusions?What was the HR?

Did anyone pull out the old microscope for visual urinalysis?

It is hard to tell what is going on without any labs to go on. If the patient is dry then they definitely need fluids to increase perfusion to the kidneys. I would also like to know how old this patient is. Do they have a hx of CHF? Need so many more details. Like what kind of abd surgery did they have, could they be septic, what is the WBC? Hgb? BUN/Ct?

CXR showed only possible atelectasis, no hx of CHF, Creatnine was 1.9 BUN 18, WBC 11.0 no increase in bands. Pt is middle age, Hgb was 10-11.No results on UA/Urine lytes although they were sent

When was the CT? If contrast dye was used that could be causing kidney problems? Diabetic? Did he take glucophage within 48 hours after?

Avoid vasodilators (did you know Heparin is a vasodilator?) Avoid NSAIDs and other nephrotoxins, avoid diuretics (no mannitol, etc..)Make sure there is no evidence of internal bleedingTo me it still looks like "acute renal success" where patient experienced significant loss of blood. (Unless this was a liver transplant or emergent AAA.)I'm expecting to see Urine results as benign + possible hematuria / hyaline casts...

What was the response to renal dose dopamine?What is the uric acid levels Blood and urine?I would like to know also the renal ultrasound result and what the blood flow to the kidneys show.

You stated that the patient was not "overly edematous." 1. What about prealbumin and albumin results?2. Some patients cannot tolerate a low HCT. Hgb 10-11 = Hct 30-33 (usually).3. Third spacing occurs after abd surgery. Kidneys are often compromised. 4. Sounds like invasive monitoring might be in order.

Eh, my money's on intra-abdominal hypertension/abdominal compartment syndrome.