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Surgery Essay

Discuss the management of oliguria

Oliguria is the passage of less than 300mL of urine per 24


hours. Post-operatively the monitoring of urine output is of vital
importance as it gives the medical personnel an idea of the
fluid balance.

The initial step to the management includes not only the


monitoring of urine output, but also monitoring of other losses.
Examples include the amounts drained from NG tubes, wound
drains, and fistulae. By adding up the urine output, these other
losses and considering approximate values for insensible
losses: in sweat, lungs and faeces, one would know the
negative water balance and hence the amount to fluid to
replace. . In a patient pos-op, these losses may be increased by
pyrexia for example. Each 1 degree rise in body temperature
will require a 10% increase in body fluids administered. More
fluid is needed in the case of vomiting or diarrhoea, and if the
patient has just undergone an ileostomy, the amount of fluid
lost should also be put in the fluid balance equation. Simply
put, fluid intake must equal fluid output.

Also, monitoring of U&E is important, because it is rarely the


case were water alone is lost. Monitoring these results will give
the doctor an idea of the serum electrolytes and should be used
as a guide to treatment. Monitoring U&E is another way to
check for renal function, to exclude renal causes of oliguria.
Haematocrit should also be monitored.
Surgery Essay

Depending on the amount lost per day, the same amount of


fluid must be given. One of the best solutions for fluid
replacement is dextrose solution 5%. This solution is hypotonic,
meaning it will be distributed throughout the fluid
compartments, such that dextrose solution is equivalent to
administering water, which distributes rapidly and evenly
throughout the entire body fluid compartments. A dextrose
saline solution can be administer to replace some of the lost
sodium, depending on the U&E. Potassium, although lost, does
not need to be replaced post-op as the serum concentration is
high due to damaged cells.

The loses should be monitored at all time, to correct as needed


the intravenous fluids given. Also clinical examination will
reveal signs of dehydration, such as dry lips and mouth.
Monitoring weight is also a good idea.

31/01/09