Post-obstructive diuresis: Difference between revisions
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==Background== | ==Background== | ||
*A rare but potentially lethal complication associated with the relief of (most commonly, chronic) urinary obstruction | *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== | ==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== | ==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== | ==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== | ==Management== | ||
* Fluid replacement with care not to perpetuate diuresis | |||
* IV vs. PO replacement is institution and patient specific | |||
==Disposition== | ==Disposition== | ||
*Admit | |||
==See Also== | ==See Also== | ||
*[[Acute urinary retention]] | *[[Acute urinary retention]] | ||
*[[Coude Catheter]] | |||
==External Links== | ==External Links== | ||
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==References== | ==References== | ||
<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
- Osmotic diuresis
- 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 [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
- ↑ 1.0 1.1 Halbgewachs C, Domes T. Postobstructive diuresis. Can Fam Physician. 2015 Feb; 61(2): 137–142.
- ↑ Nyman MA et al. Management of urinary retention: rapid versus gradual decompression and risk of complications. Mayo Clin Proc. 1997;72(10):951
- ↑ Jameson et al. Harrison's Principles of Internal Medicine 20th edition. Chapter 313.
- ↑ Nyman et al. Management of Urinary Retention: Rapid Versus Gradual Decompression and Risk of Complications. Mayo clinic proceedings. 1997;72:951-956.
- ↑ Reynard et al. Oxford Handbook of Urology. Chapter 4. 2005. Oxford University Press.