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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What causes diuresing condition with normal creatinine level?

Hi there, I am an nursing student working as an ESN (Employed Student Nurse) in an acute medical unit. Today I worked with a pt who was 78yrs old with fluid overload. His admitting diagnosis was urosepsis. He had a pacemaker, and had a CABG done in 1982. When I came on shift his IV was running NS at 100cc/hr. As the day progressed, his breathing became wheezy, his lungs full of crackles on auscultation, and he appeared pale. I suspected fluid overload. I notified the doctor, and the doctor ordered discontinue IV, and give lasix 40 mg IV push. 30 minutes passed, and patient was not diuresing. The doctor ordered another 40 mg to be given IV, and for foley to be inserted. Again, patient is not diuresing. Latest lab work showed normal GFR, normal Creatinine. In total, the patient received about 260 mg Lasix today, and only outputting 125cc of urine through foley. We did a random bladder scan, and the scan showed 15cc of urine in the bladder. Blood pressure throughout the day was normal, heart rate was 80 to 105, Resp was 36, Temp was 37.2, and O2 sat was 82% on high flow oxygen (100% O2). The doctor also ordered morphine 2.5 - 5mg SC q1h PRN, and atropine q4h prn. Comfort measures the declared by doctor. My question is: why is the patient not diuresing after given a lot of lasix when his GFR and Creatinine levels are normal? Thanks, SP
Mon, 19 Aug 2019
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General Surgeon 's  Response
Hello,

* The patient is in critical cardiac condition and the low urine output is secondary to hypoperfusion of the kidneys.

* No urine formation after multiple Lasix injections is due to pre-renal azotemia affecting the kidney perfusion.

* Normal creatinine is a transient feature of early prerenal azotemia, over a period of time, it will hamper the kidney functions and creatinine, GFR, and other parameters will also be deranged within the very short time span.

Hope I have answered your query. Let me know if I can assist you further.

Take care

Regards,
Dr Bhagyesh V. Patel, General Surgeon
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