Following surgery, a patient develops oliguria.. You believe the patient is hypovolemic, but you seek corroborative data before increasing intravenous fluids. The best data is?
When oliguria occurs postoperatively, it is impoant to differentiate between low output caused by the physiologic response to intravascular hypovolemia and that caus ed by acute tubular necrosis. The fractional excretion of sodium (FENa) is an especially useful test to aid in this differentiation. Values of FE < 1% in an oliquric setting indicate aggressive sodium reclamation in the tubules; values above this suggest tubular injury. Calculating the fractional excretion is simple: (urine Na x serum creatinine) + (serum sodium x urinary creatinine). In the setting of postoperative hypovolemia, all findings would reflect the kidney's effos to retain volume: the urine sodium would be below 20 meq/l, the urine chloride would not be helpful except in the metabolically alkalotic pent, the serum osmolality would be over 500 mOsm/kg, and the urine/serum creatinine ratio would be above 40.
Urine sodium of 28 meq/L
Urine chloride of 15 meq/L
Fractional excretion of sodium less than 1
Urinel Serum creatinine ratio of 20