Have you ever seen this before?

Published

Have you ever seen a patient receive 80 of lasix IV push and not make one drop of urine? The patient did have renal failure but still...I always thought lasix worked no matter what. I am a new nurse but I have never seen this, and none of the experienced nurses I worked with have ever seen it either. One even asked me "Are you sure you gave the lasix???"

Can anyone give me a quick explanation of how this could happen? It's really bothering me and I can't find any information anywhere. I am so curious about what could have happened.

Specializes in Emergency, Trauma, Critical Care.

I've had 200 mg of lasix IVP not work as well as a lasix gtt not work. As the other posters have said, lasix won't work if the kidneys don't. Time for dialysis!!!

Up Vote Up Vote ×
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

did the patient have a foley and was it patent?

Up Vote Up Vote ×

In some instances, with a patient who had previously had output but was on lasix for multiple doses, you could have just dehydrated pt to the point of no response to lasix. Read recent article related to new onset renal insufficiency and subsequent renal damage from low output or anuria. Review pt record. If this is a pattern of no output I would call dr and report. Doesn't make sense to give lasix if pt not having respose to it.

Up Vote Up Vote ×
Specializes in PCU.

We have had that occur in a few patients. Depending on I&O trends, level of ARF, vital signs, our docs would use low dose dopamine drip for renal perfusion in conjunction w/IVF. If issue continued then possible nephro consult for anuria, based on lab values, benefit vs risk to patient.

Up Vote Up Vote ×
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

what are the labs? what is the bun? creatinine? what's the i/o? how much lasix and for how long? what's the gfr? abg's?

acute (sudden) kidney failure is the sudden loss of the ability of the kidneys to remove waste and concentrate urine.

http://www.ncbi.nlm.nih.gov/pubmedhealth/pmh0001530/

if the engine is broke no mattter how much gas is in it it won't run.....

renal failure or kidney failure (formerly called renal insufficiency) describes a medical condition in which the kidneys fail to adequately filter toxins and waste products from the blood. the two forms are acute (acute kidney injury) and chronic (chronic kidney disease) a number of other diseases or health problems may cause either form of renal failure to occur.

renal failure is described as a decrease in glomerular filtration rate. biochemically, renal failure is typically detected by an elevated serum creatinine level. problems frequently encountered in kidney malfunction include abnormal fluid levels in the body, deranged acid levels, abnormal levels of potassium, calcium, phosphate, and (in the longer term) anemia as well as delayed healing in broken bones. depending on the cause, hematuria (blood loss in the urine) and proteinuria (protein loss in the urine) may occur. long-term kidney problems have significant repercussions on other diseases, such as cardiovascular disease.

https://docs.google.com/viewer?a=v&q=cache:it_hv6ceglaj:staff.washington.edu/angwick/capstone%2520ii/stuart%2520luo.ppt+&hl=en&gl=us&pid=bl&srcid=adgeesjvqlqjdlwlf9eh14skj0pygk2pualifh7edciplu0lxfwx_twmo01jxtes68v3kwx80ps-hfnb_1w9hlrsagacb00v72ugx8s3olegp0avgspeixaosyo4mrw1dhg-bhbfvy2i&sig=ahietbram_cgqticgebyiizq9weyjqljhw&pli=1

http://ether.stanford.edu/urology/furosemide.pdf

Up Vote Up Vote ×

That is why this is still bothering me. I am a new nurse. The patient was in end stage chronic renal failure. The charge nurse literally told me this was not possible and that I must have neglected to actually push the lasix. (hello! I may be new but I am not incompetent!)The foley was ordered when I called the doc after 3 hours of no output and no urge to urinate, so yes it was brand new and patent. Still, NO urine. (again, I the new nurse, could not possibly have placed the foley correctly)...The CT showed no obstruction and a dry bladder. Again what bothers me is that we had her for a week. My shift couldn't possibly have been the first time ever that she was anuric. Her B/P was very low (70's on low 40's) but again I was told that this is normal for this patient and not the cause of the anuria. Very frustrating to be a new nurse sometimes.

Up Vote Up Vote ×

Sounds like she got a good nurse - you.

Up Vote Up Vote ×
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
that is why this is still bothering me. i am a new nurse. the patient was in end stage chronic renal failure. the charge nurse literally told me this was not possible and that i must have neglected to actually push the lasix. (hello! i may be new but i am not incompetent!)the foley was ordered when i called the doc after 3 hours of no output and no urge to urinate, so yes it was brand new and patent. still, no urine. (again, i the new nurse, could not possibly have placed the foley correctly)...the ct showed no obstruction and a dry bladder. again what bothers me is that we had her for a week. my shift couldn't possibly have been the first time ever that she was anuric. her b/p was very low (70's on low 40's) but again i was told that this is normal for this patient and not the cause of the anuria. very frustrating to be a new nurse sometimes.

well she's not very smart. the new piece of information is the b/p.70/40????......renal patients don't usually have a low b/p. hypertension is their calling card...usually. was the patient symptomatic of hypotension? dizzy? diaphorectic? weak, fatigued? if the b/p was that low.....why did you give the lasix? you mentioned the ct showed anasarca....was the patient edematous? what are the co-morbidities?

something isn't adding up......without knowing all the details we can't possibly give you answers to your questions other than yes you can give a ton of lasix and get no output....a sure sign dialysis is the next step. the administration of lasix is not a guarentee of output.....

renal failure

http://www.webmd.com/hypertension-high-blood-pressure/guide/hypertension-related-kidney-disease

http://www.medicinenet.com/kidney_disease_hypertension-related/article.htm

https://www.google.com/search?sourceid=navclient&ie=utf-8&rlz=1t4ggll_enus413us413&q=renal+failure

esrd is when the [color=#045fb4]kidneys stop working well enough for you to live without [color=#045fb4]dialysis or a [color=#045fb4]transplant. this kind of kidney failure is permanent. it cannot be fixed. most cases of esrd are caused by [color=#045fb4]diabetes or high [color=#045fb4]blood pressure. some problems you are born with, some reactions to medicines, and some injuries can also cause esrd. if you have esrd, you will need dialysis or a kidney transplant to live.

http://www.kidneyfund.org/kidney-health/kidney-failure/end-stage-renal-disease.html

end-stage kidney disease is the complete, or almost complete failure of the kidneys to function. the main function of the kidneys is to remove wastes and excess water from the body

http://www.umm.edu/ency/article/000500.htm

i hope this helps.

Up Vote Up Vote ×
Specializes in PCU.
That is why this is still bothering me. I am a new nurse. The patient was in end stage chronic renal failure. The charge nurse literally told me this was not possible and that I must have neglected to actually push the lasix. (hello! I may be new but I am not incompetent!)The foley was ordered when I called the doc after 3 hours of no output and no urge to urinate, so yes it was brand new and patent. Still, NO urine. (again, I the new nurse, could not possibly have placed the foley correctly)...The CT showed no obstruction and a dry bladder. Again what bothers me is that we had her for a week. My shift couldn't possibly have been the first time ever that she was anuric. Her B/P was very low (70's on low 40's) but again I was told that this is normal for this patient and not the cause of the anuria. Very frustrating to be a new nurse sometimes.

Wow. ESRD? Wonder what a review of urine output would have shown? BP that low I have never seen called "normal" on any patient I have ever had. Usually get put on drips/IVF and possible PO meds for elevating BP. Isn't it necessary to have a certain minimal BP in order to effectively perfuse kidneys and protect them? I thought at such low BP kidneys at high risk for damage. She might have benefited from a nephrology consult, imo.

Definitely would love to know comorbidities, infections, etc. for a clearer pic...sounds like one sick lady :(

Up Vote Up Vote ×

if this is truly esrd (and it sounds like it def is), then expect the end to be near.

i'd expect uremia, making pt more somnolent, less responsive.

you may or may not see skin changes from salts coating skin (look up uremic frost), but generally speaking, it's a peaceful death.

now, this is if there aren't any med'l interventions ordered.

fwiw, anuria is a predictable outcome...not understanding any surprise.

if pt becomes comfort care, hospice consult would be ideal.

so to answer your question, yes, i've seen this before.

i'm glad you're asking questions.:)

keep us updated?

leslie

Up Vote Up Vote ×
Specializes in Cardiac, PCU, Surg/Onc, LTC, Peds.

Interesting case...you have one important trait of a competent nurse, you seek answers and ask why when things don't add up. Nephrology should be on board unless the pt is not wanting to persue further tx.

I can't believe how long that pt has been on your unit. and no one has questioned her lack of treatment.

Up Vote Up Vote ×

I really appreciate all of the kind words, links and information provided. This patient is one sick puppy. She has all of the comorbidities you might imagine and then some, CHF, uncontrolled diabetes, bilateral pleural effusions, possible PE. She did have hemo the following day and a thoracentesis just the other day that pulled off a massive amount of fluid. She is elderly (although not THAT elderly) and she seems to be close to the end at this point. Thank you to everyone who was interested and shared posts with me. I am always grateful for the information I receive here!

Up Vote Up Vote ×
+ Join the Discussion