Retention, pitting edema, extreme oliguria

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I'd Rather Be Riding
Regular Member


Date Joined Apr 2010
Total Posts : 149
   Posted 4/8/2011 9:36 PM (GMT -7)   

My best friend has been having bladder/kidney issues. She has had 7 major abdominal surgeries due to colonic inertia and rectal inertia (total colectomy, loop ileostomy, reversal, K-pouch and revision, and finally an end ileostomy and then moving it to the other side). Her urologist found that her bladder does not contract and he feels this is due to all the surgeries. She has been very thirsty- drinking about 90 oz a day, yet will only void 200 cc a day (if that) of very concentrated urine. She is holding fluid in her tissues- pitting edema in arms and legs. She is on vacation with her family out of state and had to go to an ER there last night. They managed to get a pediatric catheter in, but not much urine came out. She was already on 20 mg Lasix and they had her double that dose. Even with 40 mg Lasix and a catheter, she only has about 11 cc of urine out an hour. She called her urologist who said to get home and get admitted for a nephrology consult, which she will be doing. Has anyone experienced anything like this? Basic labs are normal (BUN, creatinine, electrolytes), glucose is normal, but she is clearly not fine. She also has a lot of pain with urination, but that has increased with each surgery. The newest problem is this rapid reduction in the amount of urine her body is producing and the edema (probably 15+ pounds worth).

 

Last summer she was on TPN because she couldn't eat. As soon as they started it, she had a ton of edema and her fluid balance never seemed to go back to normal after that. TPN was discontinued July/August 2010. She was on tube feeds briefly at the beginning of this year, but for the most part has been able to eat on her own. She gets plenty of protein in, but if she's not absorbing it and her albumin is low, I know that can cause fluid in the vascular space to leech into the interstitial space.

 

Any thoughts are greatly appreciated! Thank you!

 

Allie


Life-long GI problems.
- 2004: Motility problems completely took over my life (I was 18). Tons of doctors later... 
- July 2007: Diagnosed with colonic inertia, small bowel dysmotility, delayed gastric emptying, rectal dyssynergia at the Mayo Clinic
- November 2007: Total colectomy with ileorectal anastomosis; IV lipids, PICC TPN
- Post-op: Better, initially. Motility slowed again 8 months after surgery. I currently have chronic debilitating pain due to a small bowel dysmotility.
- September 2008: Barium study shows dilated small bowel loops (4.9cm), indicative of partial obstructions
- May 2010: Doctors suspect worsening rectal dysmotility; manometry inconclusive; rectal biopsies normal
- June 2010: Biofeedback (entire pelvic floor in full spasm...PT has quite the project on her hands!)
 
Currently trying to figure out what my physical abilities will allow me to do career-wise. Psalm 73:26 - My flesh and my heart may fail, but God is the strength of my heart and my portion forever.
 
 
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