Adult Medical Emergency Handbook - Scottish Intensive Care Society

• Examine the urine: proteinuria and haematuria may indicate
glomerulonephritis and urgent renal referral is obligatory. Look for
skin rash, nail changes, arthralgia and history of rigors.
• Don’t delay referral as early diagnosis and appropriate treatment
such as immunosuppression/plasma exchange may save renal
function. GN bloods include anti-nuclear factor, anti neutrophil
cytoplasmic antibody, anti-glomerular basement membrane
antibody, rheumatoid factor.
• Fluid balance: once volume depletion corrected, and in the
absence of fluid overload, give previous hour’s output (urine and
other losses) plus insensible (about 20-40ml/hr).
186 adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11