A 68-Year-Old Man with No Previous History of Renal Disease

A 68-year-old man with no previous history of renal disease is evaluated in the postoperative unit due to decreased urine output.  The patient was admitted due to severe abdominal pain, fever, and vomiting.  Evaluation revealed perforated sigmoid diverticulitis, and the patient underwent urgent sigmoid resection.  Postoperatively, he has received maintenance intravenous fluids and piperacillin/tazobactam.  In the day since surgery, the patient has had 200 mL of urine output.  Temperature is 37.1 C (98.8 F) , blood pressure is 100/70 mm Hg, and pulse is 96/min.  The lungs are clear to auscultation, and heart sounds are normal.  The abdomen shows postoperative changes with sluggish bowel sounds.  The patient has no skin rash.  Laboratory results are as follows: Urinalysis reveals no sediment, and bladder scanning reveals no urine.  Which of the following is the best next step in management of this patient?

A) Bolus of isotonic saline
B) Discontinuation of antibiotics
C) Dopamine infusion
D) Intravenous furosemide
E) Intravenous mannitol
F) Intravenous urography

Correct Answer:

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