Another for the Record Books

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7.5L of urine output in 24 hours.

Yes, a little over 300ml of urine every hour.  And this wasn’t a patient with some weird endocrine dysfunction or SIADH, but a patient in decompensated CHF.

He came in with sausages for legs and 3+ pitting edema to his armpits (quite nearly…).  The cardiologists throw some Lasix at him, but according to the Laws of the House of God (lasix dose = age + BUN) it wasn’t even close.  Sure he was peeing, but still edematous.  Start up the ACE inhibitor and a little bit of Coreg, but he’s still wiped out walking to the bathroom and looks like the Michelin Man’s long-lost homeless relative.  So what’s next?  Just a touch of dobutamine.  6 hours later it was like a faucet had been turned on.

By the time we were done with him he had legs again, could stalk the hallways looking for food without being short of breath and leave our fine institution.  I’m sure he’ll be back.

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