What is the most appropriate next step in managing a patient who is anuric after admission with symptoms of dehydration?

In managing a patient who is anuric and presents with symptoms of dehydration, the most appropriate next step is to consider the need for renal replacement therapy, such as hemodialysis. Anuria indicates a critical reduction in kidney function, which can be a consequence of significant dehydration, acute kidney injury, or other underlying kidney pathologies.

In this scenario, when the kidneys are not producing urine, it suggests a potentially severe disturbance in fluid and electrolyte balance, which may lead to complications such as hyperkalemia or acidosis. Hemodialysis serves as a life-saving intervention that can effectively remove waste products and excess fluids from the body, particularly in cases where there is a rapid deterioration of renal function.

While other options like administering dopamine, furosemide, or insulin and glucose may have roles in specific contexts, they do not address the underlying necessity for renal support in an anuric patient. Dopamine, historically considered for renal perfusion, has more recent evidence suggesting it may not be beneficial in preventing or treating acute kidney injury. Furosemide, a loop diuretic, is primarily indicated for fluid overload and can be ineffective in an anuric patient as there is no urine output to facilitate diuresis.