Decrease urine output
question
vital signs, why admitted
abdominal pain?bladder distension?
UO in 24 hr?
recent K+?
(有無foley?)<400 ml, <20ml/hr 代表oliguria
order
- 20-30 ml NS flush catheter 確保有通
2.K>5.5 mmol/L hyperK--->renal insufficiency
3.HCO3<20 mmol--->renal insufficiency
4.serum urea, CRE
thoughts
prerenal
renal
Major threat
renal failure
hyperkalemia
A & vital: postural rise in HR>15, SBP下降15mmHg
quick look
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restlessness-->distended bladder
ill--> renal insufficency
postrenal
reduced CO: CHF,constrictive pericarditis,cardiac tamponade
drug induced effective glomerulor perfusion下降
volume depletion
hepatorenal syndrome
diuretics, ACEI, NSAID, cyclosporine
arterial vasodilation
low systemic vaso resistant
effective arterial不夠
刺激vasoconstriction
留鈉排鉀
severe renal vasoconstriction
tube
vascular
glomeruler
Acute GN, SBE, SLE
interstitial
renal artey thrombosis
emboli
SLE
drug
nephrotoxin
hypotension
exo:AABCC aminoglycoside, amphotericin B,contrast, chemotherapy
endo:myoglobin, bence johns, amyloid, oxalate, uric acid
aortic atheroma, SBE, left sideed heart thrombi
BOO
blocked foley
bilateral ureteric obstruction