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Urinary retention causing delirium and AKI — SCE Acute Medicine MCQ

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HardMedicine in the ElderlyUrinary retention causing delirium and AKISCE Acute Medicine

An 84-year-old man is admitted with agitation and lower abdominal pain. He has not passed urine for 18 hours after starting amitriptyline for neuropathic pain. Creatinine is 240 micromol/L from baseline 90, potassium is 5.6 mmol/L and bladder scan shows 980 mL. What is the most appropriate next step in management?

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Correct answer: D — Insert a urinary catheter and monitor post-obstructive diuresis

Acute urinary retention causing obstructive AKI requires prompt catheterisation and monitoring for post-obstructive diuresis. Anticholinergic drugs can precipitate retention and delirium in older men. Antibiotics are not indicated without evidence of infection. The pearl is that bladder scanning is a low-risk, high-yield delirium and AKI investigation.

Reference: NICE CKS urinary retention; NICE CG169