Post-obstructive diuresis

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 [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.