Conscious Level and Urine Output

Conscious level may be reduced for a host of reasons in the acutely unwell patient but it is vital to bear in mind that alterations in conscious level may be a result of inadequate cerebral perfusion. The combative drunk should only be assumed to be a combative drunk once other pathologies have been realistically excluded.

Urine output is of little use in initial assessment but any patient who is shocked should be catheterised early—beware of urethral injury in trauma—to provide an indication of the adequacy of resuscitation over time. In some patients, urine output may be misleading; for example, ongoing osmotic diuresis in a patient with diabetic ketoacidosis despite shock.

Learning bite

Don’t be fooled by seemingly normal physiology that may be concealing significant compensated shock.