Imagine that you admit a patient with septic shock. You resuscitate the patient as best you can with inopressors, fluids, and antibiotics. An adequate blood pressure is achieved. A reasonable amount of fluid is administered.

Despite all these measures, the urine output remains minimal. What should you do next?

• Do nothing, sit on your hands and wait for the patient to improve.
• See if a volume challenge will improve urine output.
• Attempt a vasopressor challenge (e.g. raise the MAP, see if this improves urine output).
• Attempt an inotrope challenge (e.g. administer dobutamine, see if this improves urine output).
• Perform a furosemide stress test.

The crux of this problem is difficulty sorting out the following possibilities.

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