Persistent oliguria

Attempts to increase urine output with diuretics may follow the above measures if oliguria persists. Furosemide is given in a dose of 5-10mg intravenously with higher increments at 30min intervals to a maximum of 250mg. Higher doses may be needed if the patient has previously received diuretic therapy. A low dose infusion may be started (1-5mg/h IV). Mannitol (20g intravenously) may be considered although failure to promote a diuresis may increase oedema formation. Failure to re-establish urine output may require renal support in the form of dialysis or haemofiltration. There is no point in continuing diuretic therapy if it is not effective; loop diuretics in particular may be nephrotoxic. Indications for renal support include fluid overload, hyperkalaemia, metabolic acidosis, creation of space for nutrition or drugs, persistent renal failure with rising urea and creatinine, and symptomatic uraemia.

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