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Obtain urinalysis
14%
1/7
Place a new urinary catheter
0%
0/7
Administer IV fluid bolus
57%
4/7
Obtain bilateral renal ultrasonography
29%
2/7
Initiate emergent hemodialysis
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This patient has experienced postoperative acute kidney injury (AKI), a common complication. His lab results and clinical picture are consistent with pre-renal azotemia, so administering IV fluids is the next best step. AKI is typically divided up into pre-renal, intrinsic renal, and post-renal causes. In this clinical situation, common etiologies will include pre-renal, from fluid shifts and decreased PO intake; medication effects, such as from perioperative antibiotics; and urinary retention or kinking of the Foley catheter. This patient's BUN:creatinine ratio is >20, suggesting pre-renal etiology. IV fluids are the next best step in management. Incorrect Answers: Answer 1: Although urinalysis is frequently obtained to evaluate AKI, the first immediate step is to rule out obstruction at the bedside. Answer 2: Urinary catheter obstruction was ruled out, so placing a new catheter is not indicated unless a malfunction develops. Answer 4: Renal ultrasonography would be a subsequent study to obtain in evaluating AKI after ruling out obstruction and checking routine labs. Answer 5: There is no indication for hemodialysis in this patient currently.
4.6
(14)
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