management - continuing

Last reviewed 01/2018

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.