Monday, May 15, 2006

Urine Output

Dear Lisa

My 11 month old son has been diagnosed with gastroenteritis. He is having a lot of diarrhea. My doctor told me that he could become dehydrated and I have to count how many times he urinates. I use disposable diapers and it’s too hard to tell if they are wet. How do I tell if there’s urine in the diaper?

“Worried about dehydration in N.J.”

Dear “Worried about dehydration”,

Disposable diapers are so absorbent that it is very hard to tell if there is urine in them. One option is to put a folded paper towel inside the diaper, adjusting it towards the front of the diaper over the spot where your baby usually urinates. When you check the diaper for urine, the paper towel should be wet with urine.

Another option is to look at the inside contents of the diaper. When you change the diaper you can pull apart the inside of the diaper near the area where there is usually urine, using gloved fingers. The inside of the diaper will look like tiny balls of gel. If your child urinated the gel like beads will look wet, yellow and smell like urine. You might want to pull apart a dry diaper first so you have something to compare it to. The trick is to check the diaper frequently. If your child has diarrhea, it can mix with the urine and it will be too hard to tell what is urine and what is diarrhea.

Determining urine output is always a challenge for pediatric nurses in the hospital. One of the tricks that I learned was to weigh only the diaper, before and after a child is diapered, checking the diaper at least every two hours. I would take the difference in weight and convert it to milliliters. For example, if the diaper weighed 30 grams before diapering and 60 grams after diapering, I would subtract 30 from 60, and know that the child urinated 30 ml, which is equal to one ounce. Unfortunately, this technique may not work in the home setting because most bathroom scales are not that accurate and do not have the ability to measure such small amounts (most dry diapers only weight 30 grams).

In general, your child should urinate 6 times in a 24 hour period. If this is not the case or if you are not sure, you should bring him back to your doctor to have him checked for dehydration.

Lisa Kelly R.N, P.N.P., C.
Certified Pediatric Nurse Practitioner

Pediatric Advice for Parents with Sick Children

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