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A man in his 60s with a history of hypertension, atrial fibrillation for which he received therapeutic anticoagulation with warfarin, and amyloidosis resulting in stage II diastolic heart failure and nephrotic syndrome presented to the emergency department with nausea, lightheadedness, and hypotension (blood pressure in the 60s/30s mm Hg) within days of starting irbesartan treatment for persistent proteinuria. He was initially admitted to the medical intensive care unit due to the need for vasopressor support with norepinephrine. During his initial care in the emergency department, a Foley catheter was placed for the documented indication of critical illness with a need for accurate urine output assessment. The patient was noted to be a good historian at the time of presentation, with no evidence of delirium on physical examination and no history of obstructive urinary symptoms or urinary retention.
Bregman J, Iams W, Theobald C. Urethral Trauma After Foley Cather PlacementA Teachable Moment. JAMA Intern Med. Published online September 19, 2016. doi:10.1001/jamainternmed.2016.5438