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Oliguria with fatigue and thirst


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Abbreviations: ABG = Arterial blood gases, BUN = Blood urea nitrogen, CBC = Complete blood count, CT = Computed tomography, CRP = C – reactive protein, ECG = Electrocardiogram, ESR = Erythrocyte sedimentation rate, IVP = Intravenous pyelography, KFT = Kidney function test, GI = Gastrointestinal, GFR = Glomerular filtration rate, MRI = Magnetic resonance imaging, PT = Prothrombin time

Etiology Clinical manifestations Paraclinical findings Comments
Symptoms and signs Lab findings Imaging
Fatigue/

Lethargy

Thirst Dizziness/

Confusion

Muscle weakness/

cramp

Somatic/

visceral pain

Vomiting Diarrhea Tachypnea Edema Blood indices Renal Funtion test Electrolytes Urine analysis ABG Other Ultrasound X-ray CT MRI Other
Prerenal causes Cholera[1][2][2][3] +/- + – – – +/- + – – Leukocytosis, ↑HCT ↑BUN, ↑Cr ↓Na, ↑Ca, ↑Mg Not applicable ↑Lactate, ↓HCO3 Stool PCR, Stool culture, Serotyping Not applicable Not applicable Not applicable Not applicable – –
Dehydration[4][5] + + – +/- – +/- +/- – – Not applicable ↑BUN, ↑Cr ↓Na, ↑K, ↓Cl Ketones and glucose, ↑Urine specific gravity ↑Lactate, ↓HCO3 Hypoglycemia Not applicable Not applicable Not applicable Not applicable – –
Diarrhea and/or vomiting[6][7] +/- +/- – – – + + – – Leukocytosis with predominant neutrophilia, ↑ ESR Not applicable Not applicable Ketones, Organic acids, Porphobilinogen, Aminolevulinic acid Not applicable Stool anion gap, Stool pH < 5.5, Stool culture, Serotyping, Enzyme immunoassay (rotavirus or adenovirus), LFT, Amylase, Lipase Normal Not applicable Not applicable Not applicable – –
Drugs/toxins[8][9] +/- +/- +/- +/- +/- +/- +/- +/- +/- Not applicable ↑BUN, ↑Cr, ↑CK ↑K, ↓Mg, ↓Ca, ↓P Ingested drug, Glucose, Aminoacid, Phosphate, Ketone, Hyaline cast, RBC ↑Lactate, Metabolic acidosis Toxicology, Rapid immunoassay Nephropathy Radioopaque substances, Ingested drug packets Not applicable Not applicable – –
Shock[10] +/- +/- +/- +/- +/- +/- – +/- – ↑HCT, ↑PT and aPTT, Eosinophilia, Leukocytosis ↓GFR, ↑BUN, ↑Cr Not applicable Not applicable ↑Lactate LFT, ↑BNP, ↑Troponin, D-dimer, Fibrinogen Pulmonary embolism, Pericardial effusion, Cardiac tamponade, Pneumothorax, Thoracic or abdominal aortic aneurysm in RUSH (Rapid Ultrasound for Shock and Hypotension) Pneumonia, Pneumothorax, Pulmonary edema, Widened mediastinum, Free air under the diaphragm Traumatic brain injury, Stroke, Spinal injury, Pneumonia, Pneumothorax, Ruptured aneurysm, Aortic dissection, Pulmonary embolism Not applicable – –
Toxic megacolon[11] +/- +/- +/- – + + +/- – – Leukocytosis, Anemia, ↑ESR and CRP ↑BUN, ↑Cr ↓Na Not applicable Not applicable Loss of haustra, Hypoechoic and thick bowel walls, Dilated colon > 6cm, Dilatation of ileal loops Dilated colon, Free intraperitoneal air Bowel perforation, Abscess Not applicable Not applicable Endoscopy and colonoscopy –

References

  1. ↑ Weil AA, Khan AI, Chowdhury F, Larocque RC, Faruque AS, Ryan ET, Calderwood SB, Qadri F, Harris JB (November 2009). “Clinical outcomes in household contacts of patients with cholera in Bangladesh”. Clin. Infect. Dis. 49 (10): 1473–9. doi:10.1086/644779. PMC 2783773. PMID 19842974.
  2. ↑ 2.0 2.1 Cash RA, Music SI, Libonati JP, Snyder MJ, Wenzel RP, Hornick RB (January 1974). “Response of man to infection with Vibrio cholerae. I. Clinical, serologic, and bacteriologic responses to a known inoculum”. J. Infect. Dis. 129 (1): 45–52. PMID 4809112.
  3. ↑ Harris JB, Ivers LC, Ferraro MJ (June 2011). “Case records of the Massachusetts General Hospital. Case 19-2011. A 4-year-old Haitian boy with vomiting and diarrhea”. N. Engl. J. Med. 364 (25): 2452–61. doi:10.1056/NEJMcpc1100927. PMID 21696312.
  4. ↑ Steiner MJ, DeWalt DA, Byerley JS (June 2004). “Is this child dehydrated?”. JAMA. 291 (22): 2746–54. doi:10.1001/jama.291.22.2746. PMID 15187057.
  5. ↑ Vega RM, Avner JR (June 1997). “A prospective study of the usefulness of clinical and laboratory parameters for predicting percentage of dehydration in children”. Pediatr Emerg Care. 13 (3): 179–82. PMID 9220501.
  6. ↑ Carpenter DO (February 1990). “Neural mechanisms of emesis”. Can. J. Physiol. Pharmacol. 68 (2): 230–6. PMID 2178747.
  7. ↑ Bresee JS, Marcus R, Venezia RA, Keene WE, Morse D, Thanassi M, Brunett P, Bulens S, Beard RS, Dauphin LA, Slutsker L, Bopp C, Eberhard M, Hall A, Vinje J, Monroe SS, Glass RI (May 2012). “The etiology of severe acute gastroenteritis among adults visiting emergency departments in the United States”. J. Infect. Dis. 205 (9): 1374–81. doi:10.1093/infdis/jis206. PMID 22454468.
  8. ↑ Toto RD, Mitchell HC, Lee HC, Milam C, Pettinger WA (October 1991). “Reversible renal insufficiency due to angiotensin converting enzyme inhibitors in hypertensive nephrosclerosis”. Ann. Intern. Med. 115 (7): 513–9. PMID 1883120.
  9. ↑ Bismuth C, Gaultier M, Conso F, Efthymiou ML (1973). “Hyperkalemia in acute digitalis poisoning: prognostic significance and therapeutic implications”. Clin. Toxicol. 6 (2): 153–62. doi:10.3109/15563657308990513. PMID 4715199.
  10. ↑ Vincent JL, De Backer D (October 2013). “Circulatory shock”. N. Engl. J. Med. 369 (18): 1726–34. doi:10.1056/NEJMra1208943. PMID 24171518.
  11. ↑ Jalan KN, Sircus W, Card WI, Falconer CW, Bruce CB, Crean GP, McManus JP, Small WP, Smith AN (July 1969). “An experience of ulcerative colitis. I. Toxic dilation in 55 cases”. Gastroenterology. 57 (1): 68–82. PMID 5305933.

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