Some time ago, I was consulted on a patient because of excessive urination. The patent was putting out 4 or 5 five liters a day and nobody knew why. I checked out all the usual suspects, diabetic ketoacidosis, hyperglycemia, diabetes insipidus, etc. and all the medications listed on his chart. No diuretics. Finally, at my wit’s end, I entered the ICU room and noticed a number of med bags, some full, some empty hanging there on the IV pole. I checked each and discovered a bag labeled "dopamine” slowly dripping in.
I went to the nurse and asked how long the patient had been on dopamine. She said "He's not on dopamine." I said, "Come with me" and showed her that he was in fact getting low dose dopamine, a drug that behaves like a diuretic.
Unbeknownst to those "taking care" of him, he had been on dopamine for no one knows how long. The next day I got a call from the head of nursing informing me that it was not nursing's fault. Perhaps the IV team or the pharmacy was responsible. I agreed with her. I did not want to be accused of being mean to the nurses. Anyway, according to the computer printout and the nursing notes, he was NOT on dopamine. Maybe a relative sneaked in and hung the drug. No one was faulted. The problem resolved. No "root cause analysis” was undertaken. Why bother?
This reminded me of a polyuria story of my own. One weekend, I was covering for another surgeon and rounded on a postop patient whose urine output had been increasing over the last several days. The labs were OK, and he had no obvious reason for his 3500-4000 mL/day outputs. I looked at the intake and output records [this occurred back in the day when such things could easily be found at the bedside] and saw that he was getting more and more IV fluid every day. I called a resident and asked him what was going on. He told me they had been increasing the IV fluid rate every day to keep up with the losses in the urine.