Urine output

Among one of the more unusual side effects noticed as the use of the sulfonamides became widespread was the increased urine output of many patients treated with these drugs. The fact that the urine was unusually alkaline led to the suspicion, later (Confirmed by independent means, that these agents were responsible for partial inhibition of the enzyme carbonic anhydrase. Inhibition of this enzyme causes increased excretion of sodium and bicarbonate ions as well as water, in effect bringing about diure-... 

Most drag s act on the body by altering cellular function. A drug cannot completely change the function of a cell, but it can alter its function. A drug that alters cellular function can increase or decrease certain physiologic functions, such as increase heart rate, decrease blood pressure, or increase urine output. 

Nephrotoxicity may occur with the administration of these drugs Early signs of this adverse reaction may become apparent by a decrease in urine output. The nurse should measure and record the fluid intake and output and notify the primary health care provider if the output is less than 500 mi/d. Any changes in the fluid intake-and-output ratio or in the appearance of the urine may indicate nephrotoxicity. 

DRUGS USED FOR GOUT. The nurse encourages a liberal fluid intake and measures the intake and output. The daily urine output should be at least 2 liters. An increase in urinary output is necessary to excrete the urates (uric acid) and prevent urate acid stone formation in the genitourinary tract. 

Hyperkalemia (increase in potassium in the blood), a serious event, may be seen with the administration of potassium-sparing diuretics. Hyperkalemia is most likely to occur in patients with an inadequate fluid intake and urine output, those with diabetes or renal disease tiie elderly, and those who are severely ill. In patients taking spironolactone, gynecomastia (breast enlargement in tiie male) may occur. This reaction appears to be related to both dosage and duration of therapy. The gynecomastia is usually reversible when therapy is discontinued, but in rare instances, some breast enlargement may remain. 

OSM OTIC DIURETICS. Mannitol is administered only via the IV route The nurse inspects the solution carefully before administration because when exposed to low temperatures, mannitol solution may crystallize If crystals are observed, the bottle is warmed in a hot water bath, a dry heat oven, or autoclave to dissolve the crystals. The solution must be cooled to body temperature or lower before administering. The rate of administration and concentration of the drug is individualized. The nurse must monitor the urine output hourly. The rate of administration is adjusted to maintain a urine flow of at least 30 to 50 mL/h. 

Instructs to notify primary health care provider if urine output is low, urine appears dark or concentrated during the daytime, or symptoms do not improve after 3 to 4 days. 

The nurse notifies the primary health care provider if die patient fails to drink extra fluids, if the urine output is low, or if the urine appears concentrated during daytime hours. The urine of those drinking 2000 mL or more per day will appear dilute and light in color. 

Maintain intravascular volume status and urine output with normal saline... 

Continue for at least 6 h after the procedure ° Target urine output around 150 mL/h... 

Two types of diuretics are used for volume management in HF thiazides and loop diuretics. Thiazide diuretics such as hydrochlorothiazide, chlorthalidone, and metolazone block sodium and chloride reabsorption in the distal convoluted tubule. Thiazides are weaker than loop diuretics in terms of effecting an increase in urine output and therefore are not utilized frequently as monotherapy in HF. They are optimally suited for patients with hypertension who have mild congestion. Additionally, the action of thiazides is limited in patients with renal insufficiency (creatinine clearance less than 30 mL/minute) due to reduced secretion into their site of action. An exception is metolazone, which retains its potent action in patients with renal dysfunction. Metolazone is often used in combination with loop diuretics when patients exhibit diuretic resistance, defined as edema unresponsive to loop diuretics alone. 

Dopamine is most commonly reserved for patients with low systolic blood pressures and those approaching cardiogenic shock. It may also be used in low doses (less than 3 mcg/kg per minute) to improve renal function in a patient with inadequate urine output despite high filling pressures and volume overload, although this indication is controversial. 

Upon stabilization, placement of a pulmonary artery (PA) catheter may be indicated based on the need for more extensive cardiovascular monitoring than is available from non-invasive measurements such as vital signs, cardiac rhythm, and urine output.9,10 Key measured parameters that can be obtained from a PA catheter are the pulmonary artery occlusion pressure, which is a measure of preload, and CO. From these values and simultaneous measurement of HR and blood pressure (BP), one can calculate the left ventricular SV and SVR.10 Placement of a PA catheter should be reserved for patients at high risk of death due to the severity of shock or preexisting medical conditions such as heart failure.11 Use of PA catheters in broad populations of critically ill patients is somewhat controversial because clinical trials have not shown consistent benefits with their use.12-14 However, critically ill patients with a high severity of illness may have improved outcomes from PA catheter placement. It is not clear why this was... 

VS BP 80/40 mm Hg, pulse 130/minute, respiratory rate 22 beats per minute, temperature 35°C (95°F), urine output none since catheterization 10 minutes ago. 

Organ dysfunction reversal evident by increased urine output to greater than 0.5 mL/kg per hour (1.0 mL/kg per hour in pediatrics), return of mental status to baseline, and normalization of skin color and temperature over the first 24 hours ... 

Acute renal failure (ARF) is a potentially life-threatening clinical syndrome that occurs primarily in hospitalized patients and frequently complicates the course of the critically ill. It is characterized by a rapid decrease in glomerular filtration rate (GFR) and the resultant accumulation of nitrogenous waste products (e.g., creatinine and urea nitrogen), with or without a decrease in urine output. A recent consensus statement... 

Urinary catheterization (insertion of a catheter into a patient s bladder an increase in urine output may occur with postrenal obstruction)... 

There is significant controversy over the role of loop diuretics in the treatment of ARE Theoretical benefits in hastening recovery of renal function include decreased metabolic oxygen requirements of the kidney, increased resistance to ischemia, increased urine flow rates that reduce intraluminal obstruction and filtrate backleak, and renal vasodilation.6 Theoretically, these effects could lead to increased urine output, decreased need for dialysis, improved renal recovery, and ultimately, increased survival. However, there are conflicting... 

Prolonged administration of loop diuretics can lead to a second type of diuretic resistance. Enhanced delivery of sodium to the distal tubule can result in hypertrophy of distal convoluted cells.17 Subsequently, increased sodium chloride absorption occurs in the distal tubule which diminishes the effect of the loop diuretic on sodium excretion. Addition of a distal convoluted tubule diuretic, such as metolazone or hydrochlorothiazide, to a loop diuretic can result in a synergistic increase in urine output. There are no data to support the efficacy of one distal convoluted tubule diuretic over another. The common practice of administering the distal convoluted tubule diuretic 30 to 60 minutes prior to the loop diuretic has not been studied, although this practice may first inhibit sodium reabsorption at the distal convoluted tubule before it is inundated with sodium from the loop of Henle. 

Goals of therapy are to maintain a state of euvolemia with good urine output (at least 1 ml/kg per hour), to return serum creatinine and BUN to baseline, and to correct electrolyte and acid-base abnormalities. Vital signs, weight, fluid intake, urine output, BUN, creatinine, and electrolytes should be assessed daily in the unstable patient. 

Develop a plan to provide symptomatic care of complications associated with ARF, such as diuretic therapy to treat volume overload. Monitor the patient s weight, urine output, electrolytes (such as potassium), and blood pressure to assess efficacy of the diuretic regimen. 

Fluid restriction is generally unnecessary as long as sodium intake is controlled. The thirst mechanism remains intact in CKD to maintain total body water and plasma osmolality near normal levels. Fluid intake should be maintained at the rate of urine output to replace urine losses, usually fixed at approximately 2 L/day as urine concentrating ability is lost. Significant increases in free water intake orally or intravenously can precipitate volume overload and hyponatremia. Patients with stage 5 CKD require renal replacement therapy to maintain normal volume status. Fluid intake is often limited in patients receiving hemodialysis to prevent fluid overload between dialysis sessions. 

The preferred route of administration is intraperitoneal (IP) rather than IV to achieve maximum concentrations at the site of infection. Antibiotics can be administered IP intermittently as a single large dose in one exchange per day or continuously as multiple smaller doses with each exchange. Intermittent administration requires at least 6 hours of dwell time in the peritoneal cavity to allow for adequate systemic absorption and provides adequate levels to cover the 24-hour period. However, continuous administration is better suited for PD modalities that require more frequent exchanges (less than 6-hour dwell time). The reader should refer to the ISPD guidelines for dosing recommendations for IP antibiotics in CAPD and automated PD patients.49 The dose of the antibiotics should be increased by 25% for patients with residual renal function who are able to produce more than 100 mL urine output per day. 

Acid-base status—pH, HC03y PC02, /3-hydroxybutyrate Renal function (creatinine, urine output)... 

Kidney Fever, graft tenderness and swelling, decreased urine output, malaise, hypertension, weight gain, edema Increased SCr, BUN, leukocytosis, renal biopsy positive for lymphocytic infiltration... 

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