A 40-year-old woman with inflammatory bowel disease has been receiving TPN for over 3 weeks. Workup reveals pelvic abscess. She undergoes exploratory laparotomy, resection of small bowel with anastomosis, and drainage of pelvic abscess. During surgery, TPN is maintained at the original rate of 125 mL/h. In the recovery room, the patient is found to have a urine output of 200 mL/h. CVP is 1, and laboratory results are Na,149;K,3.5;Cl,110;HCO3,18; BUN, 40; and creatinine, 1 mg/dL. Which of the following statements is true regarding this condition?
Hyperosmolar-nonketotic coma is a serious complication seen when an excessive amount of glucose is given, especially in the presence of sepsis, steroids, or inadequate insulin. Furthermore, the combination of surgery and sepsis results in an increased insulin- resistant state. The increased urine output is secondary to osmolar load from blood glucose. Low CVP, hypernatremia, and BUN-to- creatinine ratio over 20 suggest hypovolemia and not fluid overload. Normal creatinine level and BUN-to-creatinine ratio over 20 rules out high-output renal failure. The stress of surgery is characterized by water retention and not diuresis. Management consists of aggressive hydration, discontinuation of TPN, and insulin drip. Insulin drives the potassium intracellularly and potassium must be replaced.
The patient's urine output is secondary to fluid overload during surgery.
The patient is in high-output renal failure.
Hyperosmolar-nonketotic coma will develop if the condition is not aggressively treated.
Diuresis is a normal response to stress of surgery.
Wounds, Tissue Repair & Scars