Low urine output

1. Normal urine output

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

2. 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.  

3. 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.  

4. Check a post-void residual by bladder scan. 
 

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

5. Causes of urinary retention: 
 

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

6. 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).  

7. CHF/Volume overloaded? Initiate diuresis:

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