Low urine output

Normal urine output

- typically at least 0.5 cc/kg/hr. 
- Oliguria: urine output < 400cc/day
- Anuria : urine output < 100cc/day 

Do you believe the numbers? 

- If patient has foley, flush tubing to make sure it is not clogged. 
- If no foley, ask about urine output, look at daily weights, etc. 

 Examine patient bedside.

- Assess volume status: mucous membranes, skin pallor/dryness, edema, complaints of thirst, neck veins (assess CVP), crackles in lungs (pulmonary edema), bladder palpable on exam, prostate exam, etc. 

Check a post-void residual by bladder scan. 

- If volume > 300cc, then insert foley (In and out). If consistent > 300cc, keep foley in. 

 Causes of urinary retention: 

- BPH, anticholiergic medication, side effect of medication:narcotics/benadryl/anestetics

Assess for renal failure (AKI) 

- Prerenal, renal, postrenal causes. 
- Look for fluid overload (CHF), and obstruction (renal US). 
- If both negative, then fluid challenge is acceptable: 500cc L bolus. (Go to AKI for further management). 

CHF/Volume overloaded? Initiate diuresis:

- Working kidneys: lower IVF rate and self-diuresis
- CHF/symptomatic: use lasix 20mg - 80mg IV 
- Renal failure: Dialysis? If kidneys still working, can try high dose lasix - 160mg- 240mg IV Lasix.