PSUN235 Dopamine-induced polyuria

Abstract

Abstract Background Dopamine acts on dopamine-1 receptors in the renal vasculature at a low dose, resulting in natriuresis and diuresis. Polyuria is a rare condition found in patients who receive dopamine infusion. We report a young female hospitalized for ovarian torsion who underwent several surgical procedures had been infected with gram-negative bacteremia. She received a dopamine infusion for hypotension with relative bradycardia. Subsequently, she developed polyuria. Case presentation A 25-year-old female was referred to UMC hospital for acute diverticulitis with micro-perforation from the sigmoid colon. She presented to the outside hospital with abdominal pain, fever, nausea, and vomiting for four days. On arrival, she had a fever of 101.9F. Initial laboratory showed leukocytosis and lactic acidosis. CT abdomen at UMC revealed 16×11cm mass in the left lower quadrant, potentially originating from the left ovary. The patient was treated with IV Zosyn for acute diverticulitis. On day 5 of admission patient remained to have abdominal pain, fever, and worsening lactic acidosis. She was taken to OR for exploratory laparotomy with dissection of left salpingo-oophorectomy for torsion of adnexal mass resection. On day 91 of admission, the patient developed low-grade fever (100.7F) and hypotension (BP 63/30) with the MAP of 40. IV NS 1L was administered. CT abdomen revealed no intra-abdominal or pelvic abscess or fluid collection. For possible septic shock, the patient was started on empirical IV antibiotics. Despite IV fluid resuscitation, blood pressure remained low, vasopressin and norepinephrine were initiated. Day 92, she developed new-onset bradycardia, EKG showed third-degree AV block. IV dopamine infusion was started at the rate of 5mcg/kg/min. During dopamine infusion, the patient voided between 400-600mL/h. Over the 12-h period, the urine output was about 5L. Endocrinology was consulted for polyuria. Laboratory studies showed urine osmolality 384mOsm/kg, urine electrolytes were UNa 130mmol/L, UK 20.1mmol/L, UCl 115mmol/L, BUN/Cr 28/1.0. Approaching polyuria, the diuresis was associated with high urine osmolality and sodium, which exhibited characteristic features of solute diuresis with natriuresis. The diuretic phase of acute renal injury could not be implicated in this patient since she has stable renal function without azotemia. There was no evidence of urinary tract obstruction to suggest post obstruction diuresis. Central or peripheral diabetes insipidus was ruled out by the lack of characteristic water diuresis. It was suspected that the diuresis was related to the dopamine infusion. Thus, dopamine infusion was discontinued. The urine output dropped within a few hours. The patient's urine output stabilized to 0.8-1.0ml/min. The striking drop in urine output after discontinuity of dopamine is consistent with the role of dopamine in this patient's diuresis. Conclusion This is a rare case report of dopamine-induced polyuria in septic shock patient. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.