Post-obstructive diuresis: Difference between revisions

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#REDIRECT[[Postobstructive diuresis]]
==Background==
*A rare but potentially lethal complication associated with the relief of (most commonly, chronic) urinary obstruction<ref name="Halbgewachs">Halbgewachs C, Domes T. Postobstructive diuresis. Can Fam Physician. 2015 Feb; 61(2): 137–142.</ref>
*May result in dehydration, electrolyte imbalances, and death if not adequately treated<ref name="Halbgewachs" />
 
==Clinical Features==
* [[Polyuria]] after relief of urinary tract obstruction (frequently Foley catheter placement)
* Some patients may experience hematuria, which is rarely clinically significant <ref>Nyman MA et al. Management of urinary retention: rapid versus gradual decompression and risk of complications. Mayo Clin Proc. 1997;72(10):951</ref>
 
==Differential Diagnosis==
===[[Polyuria]]===
*Osmotic diuresis
**[[Hyperglycemia]]
**[[Mannitol]]
*Drugs: [[diuretics]], [[caffeine]], [[acetazolamide]], [[lithium]]
*[[Hypercalcemia]]
*[[Hypokalemia]]
*[[Diabetes insipidus]]
*[[Cushing's syndrome]], primary hyperaldosteronism
*Inability to concentrate urine (e.g. chronic [[pyelonephritis]], [[sickle cell disease]], [[amyloidosis]]
*[[Post-obstructive diuresis]]
*Early [[renal failure]]
*High fluid intake
**Excess [[IVF]]
**Psychogenic polydipsia
 
==Evaluation==
* Urine is usually hypotonic with large amounts of sodium chloride, potassium, phosphate and magnesium <ref>Jameson et al. Harrison's Principles of Internal Medicine 20th edition. Chapter 313.</ref>
* Urine Output > 125 - 200mL/hour after relief of obstruction for at least 3 consecutive hours<ref>Nyman et al. Management of Urinary Retention: Rapid Versus Gradual Decompression and Risk of Complications. Mayo clinic proceedings. 1997;72:951-956.</ref>
* Urine Osmolarity > 250mosm/kg <ref>Reynard et al. Oxford Handbook of Urology. Chapter 4. 2005. Oxford University Press.</ref>
 
==Management==
* Fluid replacement with care not to perpetuate diuresis
* IV vs. PO replacement is institution and patient specific
 
==Disposition==
*Admit
 
==See Also==
*[[Acute urinary retention]]
*[[Coude Catheter]]
 
==External Links==
 
 
==References==
<references/>
 
[[Category:Urology]]

Latest revision as of 15:42, 18 August 2019

Background

  • A rare but potentially lethal complication associated with the relief of (most commonly, chronic) urinary obstruction[1]
  • May result in dehydration, electrolyte imbalances, and death if not adequately treated[1]

Clinical Features

  • Polyuria after relief of urinary tract obstruction (frequently Foley catheter placement)
  • Some patients may experience hematuria, which is rarely clinically significant [2]

Differential Diagnosis

Polyuria

Evaluation

  • Urine is usually hypotonic with large amounts of sodium chloride, potassium, phosphate and magnesium [3]
  • Urine Output > 125 - 200mL/hour after relief of obstruction for at least 3 consecutive hours[4]
  • Urine Osmolarity > 250mosm/kg [5]

Management

  • Fluid replacement with care not to perpetuate diuresis
  • IV vs. PO replacement is institution and patient specific

Disposition

  • Admit

See Also

External Links

References

  1. ↑ 1.0 1.1 Halbgewachs C, Domes T. Postobstructive diuresis. Can Fam Physician. 2015 Feb; 61(2): 137–142.
  2. ↑ Nyman MA et al. Management of urinary retention: rapid versus gradual decompression and risk of complications. Mayo Clin Proc. 1997;72(10):951
  3. ↑ Jameson et al. Harrison's Principles of Internal Medicine 20th edition. Chapter 313.
  4. ↑ Nyman et al. Management of Urinary Retention: Rapid Versus Gradual Decompression and Risk of Complications. Mayo clinic proceedings. 1997;72:951-956.
  5. ↑ Reynard et al. Oxford Handbook of Urology. Chapter 4. 2005. Oxford University Press.
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