Reduced Urine Output in Child

First actions / assessment

• Assess ABCDE first and decide whether the child is dehydrated, shocked, septic, obstructed, or metabolically unwell. Clarify age, normal urine pattern, number of wet nappies/voids, when the child last passed urine, fluid intake, vomiting, diarrhoea, fever, reduced feeding, weight change, abdominal pain, dysuria, haematuria, constipation, edema, breathlessness, polyuria preceding oliguria, and drug exposure including NSAIDs or other nephrotoxins. Ask about recent gastroenteritis, bronchiolitis, diabetes symptoms, renal history, congenital urinary tract problems, and bloody diarrhoea. Examine vitals, capillary refill, pulse volume, hydration status, mucous membranes, tears, fontanelle where relevant, weight if available, edema, blood pressure, abdominal/bladder distension, flank tenderness, rash, and mental state. Bedside glucose is important in any unwell child. Consider urinalysis, CBC, U&E/creatinine, blood gas, cultures if septic, and ultrasound when obstruction is suspected or no cause is clear.