Management - continuing

Continuing low output:-

• fluid challenge - normal saline by preference since is retained in the circulation. Run in the rest of the bag - up to 500ml - less in little old lady.
• a dry patient should be given a colloid - haemaccel, gelofusion or albumin, which persists in circulation for longer - two to eight hours for haemaccel, and also causes and osmotic diuresis. However it is expensive, worsens heart failure, and in one in 80,000 there is anaphylaxis
• may do second fluid challenge Then:-
• diuretic - eg frusemide 20mg - young - 80mg - old. Background chronic renal failure - 120mg. These doses are given intravenousely, over a minute or two.
• might respond to repeat dose. Most serious problems are in patients with underlying renal disease, or who have had very major surgery.

Reference

1. Romagnoli S, Ricci Z, Ronco C. Therapy of acute kidney injury in the perioperative setting. Curr Opin Anaesthesiol. 2017 Feb;30(1):92-99.