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Discussion

patient question

I recently had a patinet that came to us from the nursing home. she had been obtunded for 6 hours, BP 50/30, diabetes.

comes to the icu, blood sugar 110, b/p 90/50. foley placed-hardly anything out. had to pull with syringe and then like vanilla pudding. urosepsis dx. - arf - etc...

u/o 320 over next 12 hours then nothing for 2 days. irrigate x6 with 60 mls. pt repositioned hourly. iv filuds going at 125 with bolus for 2 days then 30. After 2 days of nothing for u/o, soaked bed & 1300 out. b/p back up and continued to put out. End result death after 5 more days.

:confused:any thoughts on the copious amount of urine??

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  • Author

serum osmolality 305

sounds like the diuretic phase of renal failure, where the kidneys have recovered somewhat from the renal insult, but are still unable to concentrate urine because the nephrons are not yet fully functional.

the kidneys are able to excrete wastes, but not able to concentrate the urine.

hope this helps :)

I agree with the diuretic phase, also she could have been extremely dehydrated and her body needed all that fluid for two days before she peed ( I forget what normal serum osmol is, but I'm thinking 305 is high and that means dehydration ). Also, the bed being soaked implies something was wrong with that foley cath, either clogged or the balloon wasn't inflated enough. When she got those 60cc foley flushes, did the 60 come back down to the bag? Why so many flushes?

  • Author

her tank was full, we bolused her for the pressure originally and the decrease in urine. normal osmal is 275 to 295 so the 305 not really to far away from normal. flushes were with every shift and we did get the 60 back. is there a reference for the diurectic phase, i am looking and cannot find any info.

thanks

i got the information from my text book. i had a feeling this was the answer to your question and remembered the info. i tried looking for it online, b/c i was too lazy to dig up my book, but couldnt find it... so i just read the section on it and typed up the highlights.

http://www.us.elsevierhealth.com/isbn/9780323036900/MedicalSurgical-Nursing-Single-Volume

not that edition... lol, mine is a little older. but i got the info from the renal chapter.

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