Polyuria Hot Case
GENERAL APPROACH
Causes
- Alcohol induced diuresis
- Osmotic diuresis (mannitol therapy)
- Cerebral salt wasting
- Diabetes insipidus
- Hypertonic saline administration
- Hypertensive diuresis
- Appropriate response to fluid therapy
- Hyperglycaemia
Volume status
Complications
Treatment
INTRODUCTION
CUBICLE
INFUSIONS
- inotropes/vasopressors to maintain CPP
- IVF boluses
- hypertonic saline
- osmotherapies
VENTILATOR
- oxygen requirement
- PEEP
MONITOR
- CVP: number, waveform
- ECG: tachycardia
- arterial trace (pressure, wing)
EQUIPMENT
QUESTION SPECIFIC EXAMINATION
- hands -> head -> chest -> abdo -> feet -> back
-> cardiovascular
-> respiratory
-> abdominal
-> compartments
- neurological
-> paralysed
-> unconscious (brainstem interrogation)
-> conscious
- urine output over last 8 hours
- urine dipstick and microscopy
- paired serum and urinary electrolytes
- urinary electrolytes
- treatment with mannitol, strong salt and DDAVP
RELEVANT INVESTIGATIONS
Bedside
- ABG: metabolic and electrolyte derangements
Laboratory
- electrolytes: Na+ and osmolality
- urea and creatinine
OPENING STATEMENT
- Multi-factorial!
- List causes and give clinical signs
- Complications
- Management
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC