RENAL PROBLEMS AND CRITICAL CARE Solution 4

Rule 2: Oliguria is hypotension or hypoperfusion until otherwise proven.

There are 3 pieces of information that you must know about this patient

1. What was this patient’s blood pressure pre-operatively (was she hypertensive)?
2. What is this patient’s blood pressure now?
3. What was this patient’s blood pressure in the operating room?

In this patient’s case, it turns out that her blood pressure at the preoperative screening clinic was 165/95 (MAP = 115mmHg). Intra-operatively her pressure was, on average 80/60mmHg (MAP 66mmHg) (she was given multiple boluses of phenylephrine), and her systolic pressure never rose above 90mmHg. Her MAP has been between 65 and 70mmHg. This patient developed acute renal failure and required dialysis.

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