73 year old patient comes into micu after entering ER for sob. In ER pt has coarse rales and receives 80mg iv lasix. Pt comes up to Micu. Pt also has positive troponins and is placed on heparin drip. EKG showing only mild st depression and icu resident states pt will be transported out in am.
I begin my assessment. Stable vitals besides spo2 93L oxidizer. Pt still has coarse rales up to her neck although appearing no distress. Icu resident notified and additional 40mg iv lasix andbipap ordered. Pt voided 1500ml urine in ER and additional 400ml for myself at 11pm. A few marginal hours of urine output at 30ml were quickly followed by the pt not making any urine despite making great blood pressures. I called the icu resident and asked for some light hydration maybe at 40ml an hour after the 250ml fluid challenge he ordered failed to produce urine. He declined and said he was trying to achieve persistent azotemia which is a term i an unfamiliar with. Pts serial labs only showed a creatinine jump from 1.2 to 1.34. After 3 additional hours of no urine output he finally orders d5nss at 40ml an hour.
So to make a long story short i just thought this patient was completely handled wrong. I think we dried her out too much and instead of helping her out we cause acute tubercular necrosis. Im not back for a few days but i can't help but think that the patient will have a great of 2. Has anyone else heard of a physician purposefully causing such hypovolemia that the pt doesn't make urine?