Fluid balance and continence care
Barbara Smith, Linda Field in Nursing Care, 2019
Certain abnormalities occur in the production and the elimination of urine: Polyuria: this is the production by the kidneys of abnormally high amounts of urine, sometimes as much as several litres per day. Polyuria is usually associated with diseases such as diabetes mellitus, diabetes insipidus and chronic nephritis (inflammation of the nephrons within the kidney).Oliguria: this is decreased urine output, usually less than 500 mL a day or 30 mL an hour. Oliguria often indicates impaired blood flow to the kidneys or impending renal failure and should be dealt with immediately.Anuria: this is the absence of urine production. Anuria is a serious medical condition that usually follows oliguria. It must be treated immediately in order to prevent death from renal failure. Renal dialysis is used when the kidneys are no longer able to filter blood.
Genitourinary problems
Janet M Rennie, Giles S Kendall in A Manual of Neonatal Intensive Care, 2013
Most babies pass urine at or immediately after birth; 97% have done so within 24 hours and all normal babies have passed urine within 48 hours. Breast-fed infants, who have a relatively low intake for the first 24–48 hours, pass little urine during this period. Following this, 40–60 mL/kg/24 h is produced. Passing less than 12 mL/kg/24 h (0.5 mL/kg/h) on day 1 and less than 24 mL/kg/24 h (1 mL/kg/h) thereafter is certainly abnormal and requires investigation. The most common cause of oliguria is pre-renal failure (Table 24.1). Polyuria is defined as more than 7 mL/kg/h of urine flow. Polyuria can be caused by a reduced antidiuretic hormone (ADH) concentration (diabetes insipidus) or resistance to ADH in the renal tubules (nephrogenic diabetes insipidus) but is more commonly seen in the polyuric phase of renal failure or in the diuretic phase of respiratory distress syndrome (RDS). Babies can concentrate their urine to about 500 mosmol/L (preterm) and 700 mosmol/L (term), but this is much less than the adult value of 1400 mosmol/L. The reasons are a shorter loop of Henle, reduced tonicity of the medullary interstitium, and reduced expression of aquaporins. Providing there is no glycosuria, proteinuria or haematuria, this corresponds to a specific gravity of 1002–1030. The pH of neonatal urine is usually between 5 and 8. For more information on neonatal renal function see p. 80.
Pre-eclampsia
Leroy C Edozien in The Labour Ward Handbook, 2010
If the woman is not hypovolaemic (see below) and not bleeding: Provided that there are no signs of fluid overload and that fluid input in the last 24 hours has not exceeded output by >750 mL, give 200 mL IV fluid (colloid) over 30 minutes. If urine output does not improve, give furosemide 10 mg IV.If fluid input exceeds output by >750 ml, do not give colloid infusion; give furosemide 10 mg IV.If oliguria persists, consult a renal physician.
Intraabdominal pressure as a marker for physiologic and pathologic processes in pregnancy
Published in Hypertension in Pregnancy, 2022
Kavita Narang, Amy L. Weaver, Ramila A. Mehta, Vesna D. Garovic, Linda M. Szymanski
PreE is a heterogenous disease and can increase both maternal and fetal morbidity and mortality. As previously hypothesized and discussed, IAP appears to be both a cause and result of PreE. Clinical consequences of severely elevated IAP in the setting of PreE may result in ACS. This may present as signs and symptoms of oliguria and multiorgan dysfunction and may warrant more urgent intervention, than in typical PreE patients. There are two case reports (24,32) describing overt ACS in the setting of PreE/HELLP syndrome where the patient presented with oliguria (24) and hepatic rupture (32). Another case report (33) describes unusual presentation of acute renal failure necessitating emergency Cesarean delivery in a twin pregnancy complicated by HELLP syndrome, suggesting a possible undiagnosed ACS. The renal function gradually and spontaneously returned to baseline within 72 hours postpartum.
Leptospirosis in the elderly: the role of age as a predictor of poor outcomes in hospitalized patients
Published in Pathogens and Global Health, 2019
Elizabeth De Francesco Daher, Douglas de Sousa Soares, Gabriela Studart Galdino, Ênio Simas Macedo, Pedro Eduardo Andrade de Carvalho Gomes, Roberto da Justa Pires Neto, Geraldo Bezerra da Silva Junior
AKI was defined according to the ‘Kidney Diseases Improving Global Outcomes’ (KDIGO) criteria, which is the currently most accepted definition and classification for AKI [8]. The occurrence of metabolic acidosis was evidenced when pH <7.35 and serum bicarbonate <20 mEq/L, and severe metabolic acidosis when pH <7.10. Tachypnea was defined as a respiratory rate higher than 25 per minute. Oliguria was defined as urine output <0.5 ml/kg/day after 24 h of effective hydration. Hypotension was defined as mean arterial blood pressure (MAP) <60 mmHg. Therapy with vasoactive drugs was initiated when MAP remained lower than 60 mmHg despite the use of endovenous fluids. Azotemia was defined as serum urea >120 mg/dL, which represents an elevation three times higher than the normal range. Hyponatremia was defined as serum sodium <135 mEq/L.
Fatal intoxication with N-ethylpentylone: a case report
Published in Journal of Community Hospital Internal Medicine Perspectives, 2018
Chisom Ikeji, Charmian D. Sittambalam, Lyn M. Camire, David S. Weisman
Toxicology screening was positive only for cannabinoid and revealed an ethanol level of 12 mg/dL. Special testing for synthetic cannabinoid metabolites and 25I-NBOMe (5-HTA2 receptor agonist) was negative. Computed tomography of the head showed no abnormalities. However, magnetic resonance imaging of the brain showed bilateral restricted diffusion in the posterior parietal and occipital regions suggesting profound cerebral hypoxia. During the hospital course his lactic acidosis improved to 3.2 mmol/L with intravenous fluids, but his kidney function continued to worsen and creatinine kinase rose to 451,126 IU/L. On day 2, the patient was started on continuous renal replacement therapy due to oliguria and rising creatinine levels. Despite supportive treatment, he developed hypothermia with a temperature of 34.3°C, persistent hypocalcemia, and disseminated intravascular coagulation. On day 3, he developed severe hypotension requiring vasopressors for hemodynamic support. Approximately 72 hours after admission he went into cardiac arrest. Cardiopulmonary resuscitation was performed for 30 minutes and the patient was pronounced dead. Lab results during his hospitalization confirmed profound organ dysfunction and metabolic derangement in a previously healthy individual (Table 1).
Related Knowledge Centers
- Dehydration
- Hyperosmolar Hyperglycemic State
- Hypovolemic Shock
- Kidney Failure
- Urinary Retention
- Urinary Tract Infection
- Urine
- Diabetic Ketoacidosis
- Multiple Organ Dysfunction Syndrome
- Pre-Eclampsia