8/12 Morning Report with JZ and Dr. Goo: Obstructive Renal Failure Complicated by Post-Obstructive Diuresis

An elderly gentleman with a hx of BPH who presented to ED with an elevated creatinine, abdominal distention, and new-onset nocturia and dribbling with urination.  2 L of urine came out with straight cath.  His course was complicated by hematuria and a drop in hemoglobin secondary to rapid bladder decompression.  He required foley catheter placement and eventually placement of a three way foley.  Obstruction was ultimately deemed to be due to his longstanding BPH and he underwent TURP with relief of his symptoms.

Pearls:

-Hematuria can be a complication of rapid bladder decompression.  This patient’s Hb dropped from 11 -> 8!

-Post-obstructive diuresis is a very significant complication and these patients need to be monitored for electrolyte imbalances, severe dehydration, and hypovolemic shock

-Make sure you keep these patient’s hydrated with fluids while they are undergoing post-obstructive diuresis!!

-When a foley catheter becomes clotted, placement of a 3-way Foley is placed which allows for continuous bladder irrigation

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s