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Oxford Clinical Cases > Poor Urine Output > Flashcards

Poor Urine Output Flashcards

1
Q

Reduced urine output, what simple thing do you need to check?

A

The trend of reduction

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2
Q

What’s an immediate thing to check with reduced urine output?

A

Blocked catheter

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3
Q

With reduced urine output, what are you worried about?

A

Sepsis

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4
Q

Signs of sepsis

A 
Temperature
Heart rate
RR
O2 sats 
ALL THE BASIC OBS!
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5
Q

Normal urine output for healthy adult

A

1ml/kg/hr

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6
Q

Untreated AKI can result in

A

Hyperkalaemia
Acidosis
Pulmonary oedema
All of these can kill you

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7
Q

What do you check on the fluid balance chart?

A 
Adequate intake (3L/day for a normal person)
The balance, is it positive or negative?
Remember that often, stool and vomit are not accounted for. Also, NG tube may be documented somewhere else.
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8
Q

Drugs that are damaging to the kidneys

A 
NSAIDS
ACEi
Diuretics 
Antibiotics (vancomycin and gentamicin)
IV contrast
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9
Q

What % increase in baseline creatinine constitutes acute kidney injury?

A

50%

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10
Q

Questions to ask a patient with low urine output

A

Do they feel thirsty

Any symptoms of renal disease?

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11
Q

Signs of post-renal obstruction

A

Poor stream
Frequency
Terminal sribbling
Hesitancy

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12
Q

Signs of dehydration

A 
Dry lips
Dry, cracked tongue
Tachycardic
Does the patient feel DIZZY ON STANDING (a good sign of dehydration, as often no postural drop because they compensate)
Cool peripheries and low BP (late stage)
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13
Q

Signs of heart failure

A

Raised JVP
Displaced apex beat
Third heart sound
Bilateral and basal crepitations

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14
Q

Signs of urine retention

A

Palpable distended bladder

BLADDER SCAN!

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15
Q

How does atelectasis present and what causes it?

A

Often caused by surgical anaesthesia
Presents as crepitations
It’s alveolar collapse

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16
Q

What would you expect the trend of urine output to be with a blocked catheter?

A

Sudden drop
But should just flush it anyway to check with low output
GENTLY push 50ml of fluid up the catheter, if there is any resistance this suggests a blockage

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17
Q

Quick way to get potassium measurement

A

VBG

18
Q

Bloods to ask for in AKI

A

Creatinine, urea, Hb

19
Q

Urea raised suggests…

A

Dehydration

20
Q

You reckon there’s hypovolaemia, what should you initially do?

A

Fluid challenge of 250-500ml crystalloid solution stat

Monitor the response!

21
Q

How much glucose/day to avoid starvation?

A

100g

22
Q

How many ml/kg/day in typical patient

A

25ml/kg/day

23
Q

Management of acute urinary obstruction

A

Catheterisation
IV fluids
Assess renal function (monitor urea, creatinine, Hb and electrolytes)
Assess causes = DRE, urine dipstick, ensure not constipated
TWOC in the morning (NOT AT NIGHT, because can go wrong when there are fewer staff) = alpha blocker to relax the sphincter

24
Q

Which scan if you are worried about cauda equina?

A

MRI spine, looking for prolapsed disc or collapsed vertebrae

25
Q

Cause of urine ‘spraying’

A

Urethral stricture

Often as a result of many cystoscopies

26
Q

Patient fluid overloaded, makes pre-renal less likely unless there is obvious pathology, so consider…

A

Renal causes e.g. hypovolaemia in surgery leading to acute tubular necrosis

27
Q

Patient with renal AKI, what do you do?

A

Refer to renal physicians
Assess need for dialysis
STOP nephrotoxic drugs, e.g. NSAIDs

28
Q

Complications of urethral bladder catheterisation

A

Infection
Urethral trauma
Scarring and stricture
Bladder perforation

29
Q

Complications of chronic urinary retention

A

Dribbling
UTI due to stasis
Bladder stones due to stasis
Hydronephrosis

30
Q

Where is renin released?

A

Kidneys

31
Q

What does renin do?

A

Stimulate production of angiotensin 1

32
Q

What converts angiotensin 1 to angiotensin 2?

A

ACE

33
Q

Which nerve controls voluntary micturition?

A

Pudendal nerve

34
Q

Which muscle contracts the bladder?

A

Detrusor

35
Q

How do you treat overactive bladder?

A

Anti-muscarinic = oxybutynin.

These inhibit the parasympathetic activity through the pelvic nerve

36
Q

Which drugs can cause urinary retention

A

Antimuscarinic
Antihistamines
TCA

37
Q

PSA >40 indicates?

A

High risk of metastatic prostate cancer

38
Q

How do you confirm prostate cancer?

A

Transrectal prostate biopsy (painful procedure, involving needles through rectal wall)

39
Q

Management of prostate cancer

A

Active surveillance for low risk

Radical treatment otherwise

40
Q

Patient with clot retention after TURP, which catheter should you use?

A

3-way foley (extra port is for irrigation)

41
Q

New-onset renal failure and seizures

A 
TTP
Microangiopathic haemolytic anaemia (MAHA)
Thrombocytopaenia
Fever
Renal failure
NEUROLOGICAL symptoms

Oxford Clinical Cases (11 decks)

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