Favorite Quotes
"For every complex problem, there is a solution that is simple, neat, and wrong." - HL Mencken
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"I hear and I forget. I see and I remember. I do and I understand." - Confucius
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"The good physician treats the disease; the great physician treats the patient who has the disease" - Sir William Osler
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" The best test of a person's character is how he or she treats those with less power." - Bob Sutton
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"Those are my principles, and if you don't like them - well, I have others." - Groucho Marx
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"The difference between genius and stupidity is that genius has its limits." - Albert Einstein
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"It is hard enough to remember my opinions, without also remembering my reasons for them" - Friedrich Nietzsche
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"Anyone can make the simple complicated. Creativity is making the complicated simple." - Charles Mingus
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"Not everything that can be counted counts, and not everything that counts can be counted." - Albert Einstein
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"A foolish consistency is the hobgoblin of little minds, adored by little statesman and philosophers and divines. With consistency a great soul has simply nothing to do." - Ralph Waldo Emerson
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"This ain't no party, this ain't no disco, this ain't no fooling around." - Talking Heads, Life During Wartime
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"What is hateful to you, do not do to your neighbour. This is the whole Torah; all the rest is commentary. Go and learn it." - Hillel, Talmud, Shabbath 31a
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"You will never understand bureaucracies until you understand that for bureaucrats procedure is everything and outcomes are nothing." - Thomas Sowell
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"An idealist is one who, on noticing that a rose smells better than a cabbage, concludes that it will also make better soup." - HL Mencken
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"If you only have a hammer, you tend to see every problem as a nail." - Abraham Maslow
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"A great teacher is one who realizes that he himself is also a student and whose goal is not to dictate the answers, but to stimulate his students creativity enough so that they go out and find the answers themselves." - Herbie Hancock
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"There are no facts, only interpretations." - Nietzsche
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"An education isn't how much you have committed to memory, or even how much you know. It's being able to differentiate between what you do know and what you don't." - Anatole France
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"In character, in manner, in style, in all things, the supreme excellence is simplicity." - Henry Wadsworth Longfellow ====
Nov - 15
Dec - 19
Jan - 21
Feb - 8
Mar -
17 days at the VA – day 14
28 Nov2009
Yesterday we focused on the oliguric patient. I will provide the essence of that chalk talk.
For the purpose of this talk, we define oliguria as < 500 cc / day or 20 cc / hr
- Always consider obstruction first. Pass a urinary catheter. If small amount of urine, remove it. You still need to consider a renal ultrasound. I have seen a patient with bilateral painless kidney stones.
- Once obstruction is excluded, please send urine Na and creatinine. If the patient has received a diuretic also order a urine urea.
- If you want to try things – diuretics or volume, you may – if you have sent off the urine values already.
- Calculate FeNa &/or FeUrea (see previous note) I like Nephromatic for the calculations.
- If low FeNa, then the patient is prerenal. The possibilities include volume contraction, CHF, cirrhosis, or …
- If the numbers are prerenal and none of the above is obvious think more broadly. Glomerulonephritis can cause prerenal numbers. Renal artery obstructions can do it – think aortic aneurysm or clot.
- If the FeNa is high, then the patient likely has ATN – call renal.
The most important things to remember are:
r/o obstruction
send urine chemistries
You cannot afford to miss obstruction. If you get the numbers prior to trying treatments, then you can always reconstruct the etiology.
Related posts:
- 17 days at the VA – day 13
- 17 days at the VA – day 17
- 15 days at the VA – day 2
- 15 days at the VA – day 6
- Increased creatinine
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