Oliguria with diarrhea

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  | Alcohol poisoning[1][2] | \+  | \-  | +/-  | \-  | +/-  | \+  | +/-  | \-  | \-  | ↑PT | ↑BUN, ↑Cr (isopropyl alcohol)  | ↓Na | Not applicable  | ↓HCO3 | LFT | Not applicable  | Not applicable  | Not applicable  | Not applicable  | \-  | Thiamine must be given to prevent Wernicke's encephalopathy
Cholera[3][4][4][5] | +/-  | \+  | \-  | \-  | \-  | +/-  | \+  | \-  | \-  | Leukocytosis, ↑HCT | ↑BUN, ↑Cr | ↓Na, ↑Ca, ↑Mg | Not applicable  | ↑Lactate, ↓HCO3 | Stool PCR, Stool culture, Serotyping  | Not applicable  | Not applicable  | Not applicable  | Not applicable  | \-  | \-
Congestive heart failure (CHF)[6][7] | \+  | \-  | \-  | \-  | \-  | \-  | \+  | \-  | \+  | Anemia, Leukocytosis | ↑BUN, ↑Cr | ↓Na, ↑K | Not applicable  | ↑Lactate, ↓HCO3,  | ↑BNP, ↑Troponin | Cardiomegaly, Pulmonary hypertension, Pleural effusions | Pulmonary edema | Not applicable  | Valvular heart disease | Decreased ejection fraction in echocardiography, Heart function and damage in nuclear imaging  | \-
Dehydration[8][9] | \+  | \+  | \-  | +/-  | \-  | +/-  | +/-  | \-  | \-  | 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[10][11] | +/-  | +/-  | \-  | \-  | \-  | \+  | \+  | \-  | \-  | 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[12][13] | +/-  | +/-  | +/-  | +/-  | +/-  | +/-  | +/-  | +/-  | +/-  | 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  | \-  | \-
Peritonitis[14][15] | +/-  | \-  | +/-  | \-  | +/-  | +/-  | +/-  | \-  | \-  | Leukocytosis | Not applicable  | Not applicable  | Not applicable  | Not applicable  | Ascitic fluid neutrophil count > 500 cells/µL  | Not applicable  | Not applicable  | Not applicable  | Not applicable  | \-  | \-
Toxic megacolon[16] | +/-  | +/-  | +/-  | \-  | \+  | \+  | +/-  | \-  | \-  | 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 | \-
Renal causes  | Acute interstitial nephritis[17][18] | +/-  | \-  | +/-  | \-  | +/-  | +/-  | +/-  | +/-  | +/-  | Eosinophilia | ↑BUN, ↑Cr, ↑FENa | Not applicable  | Eosinophiluria, Sterile pyuria, Microscopic hematuria, Proteinuria | Not applicable  | ↑Total IgG, ↑IgG4 | Normal-sized kidneys | Not applicable  | Not applicable  | Not applicable  | \-  | History of long term analgesic use
Hemolytic uremic syndrome[19][20][21] | +/-  | \-  | +/-  | +/-  | +/-  | \+  | \+  | \-  | +/-  | Severe anemia, Thrombocytopenia, ↑ aPTT | ↑BUN, ↑Cr | Not applicable  | Mild proteinuria, Red blood cells, Red blood cell casts  | Not applicable  | Schistocytes, ↑FDP and D-dimer, ↑ Bilirubin, ↑LDH, ↓Haptoglobin, Stool culture (for E coli 0157:H7 or shigella), ↓ADAMTS-13 activity  | Ruling out obstruction | Not applicable  | Not applicable  | Not applicable  | Diffuse thickening of the glomerular capillary wall, Swelling of endothelial cells, Fibrin thrombi in renal biopsy | \-

## References

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1. ↑ Pletcher MJ, Maselli J, Gonzales R (December 2004). "Uncomplicated alcohol intoxication in the emergency department: an analysis of the National Hospital Ambulatory Medical Care Survey". Am. J. Med. 117 (11): 863–7. doi:10.1016/j.amjmed.2004.07.042. PMID 15589492.
2. ↑ Cherpitel CJ (March 1989). "Breath analysis and self-reports as measures of alcohol-related emergency room admissions". J. Stud. Alcohol. 50 (2): 155–61. PMID 2927129.
3. ↑ 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.
4. ↑ 4.0 4.1 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.
5. ↑ 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.
6. ↑ Solomon SD, Dobson J, Pocock S, Skali H, McMurray JJ, Granger CB, Yusuf S, Swedberg K, Young JB, Michelson EL, Pfeffer MA (September 2007). "Influence of nonfatal hospitalization for heart failure on subsequent mortality in patients with chronic heart failure". Circulation. 116 (13): 1482–7. doi:10.1161/CIRCULATIONAHA.107.696906. PMID 17724259.
7. ↑ Fonarow GC, Adams KF, Abraham WT, Yancy CW, Boscardin WJ (February 2005). "Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis". JAMA. 293 (5): 572–80. doi:10.1001/jama.293.5.572. PMID 15687312.
8. ↑ 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.
9. ↑ 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.
10. ↑ Carpenter DO (February 1990). "Neural mechanisms of emesis". Can. J. Physiol. Pharmacol. 68 (2): 230–6. PMID 2178747.
11. ↑ 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.
12. ↑ 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.
13. ↑ 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.
14. ↑ Such J, Runyon BA (October 1998). "Spontaneous bacterial peritonitis". Clin. Infect. Dis. 27 (4): 669–74, quiz 675–6. PMID 9798013.
15. ↑ Runyon BA (October 1990). "Monomicrobial nonneutrocytic bacterascites: a variant of spontaneous bacterial peritonitis". Hepatology. 12 (4 Pt 1): 710–5. PMID 2210672.
16. ↑ 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.
17. ↑ Schwarz A, Krause PH, Kunzendorf U, Keller F, Distler A (September 2000). "The outcome of acute interstitial nephritis: risk factors for the transition from acute to chronic interstitial nephritis". Clin. Nephrol. 54 (3): 179–90. PMID 11020015.
18. ↑ Praga M, González E (June 2010). "Acute interstitial nephritis". Kidney Int. 77 (11): 956–61. doi:10.1038/ki.2010.89. PMID 20336051.
19. ↑ Noris M, Remuzzi G (April 2005). "Hemolytic uremic syndrome". J. Am. Soc. Nephrol. 16 (4): 1035–50. doi:10.1681/ASN.2004100861. PMID 15728781.
20. ↑ Goodship TH, Cook HT, Fakhouri F, Fervenza FC, Frémeaux-Bacchi V, Kavanagh D, Nester CM, Noris M, Pickering MC, Rodríguez de Córdoba S, Roumenina LT, Sethi S, Smith RJ (March 2017). "Atypical hemolytic uremic syndrome and C3 glomerulopathy: conclusions from a "Kidney Disease: Improving Global Outcomes" (KDIGO) Controversies Conference". Kidney Int. 91 (3): 539–551. doi:10.1016/j.kint.2016.10.005. PMID 27989322.
21. ↑ Loirat C, Fakhouri F, Ariceta G, Besbas N, Bitzan M, Bjerre A, Coppo R, Emma F, Johnson S, Karpman D, Landau D, Langman CB, Lapeyraque AL, Licht C, Nester C, Pecoraro C, Riedl M, van de Kar NC, Van de Walle J, Vivarelli M, Frémeaux-Bacchi V (January 2016). "An international consensus approach to the management of atypical hemolytic uremic syndrome in children". Pediatr. Nephrol. 31 (1): 15–39. doi:10.1007/s00467-015-3076-8. PMID 25859752.