47 year old man with Pyelonephritis
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Here is a case I have seen:
A 47 year old man, farmer, presented to the casualty with the complains of
Reduced urine output since 1 month
Dyspnea at rest 6 days
Burning micturation since 6 days
White colored urine since 6 days
Vomitings 3 episodes yesterday
Hiccups since last night
Patient works as a farmer, got married to a coolie and has 2 sons. The elder one is unemployed while the younger one works as a nurse. He has been consuming alcohol 3 times a week over the last 30 years. Usually consumes 90- 180ml whiskey when he does.Last alcohol consumption was 1 month back.Has been chewing tobacco atleast 2 times per day over the last 30 years.
Wasn't previously admitted in any hospital and hasnt been on any medications.
1 month back he noticed that he has been having reduced urine output.
1 week back he had dyspnea at rest which was sudden in onset along difficulty to pass urine and burning micturation for which he was taken to a local hospital where he was put on foleys catether and admitted. They even noticed he had white colored urine. He was given Inj Doxycycline for 3 days. Since the last 4 days he also has been having fever, high grade, sudden in onset, associated with chills that is 2 days after admission. They were told he needed blood transfusions as his platelet count was low. He was given one SDP tranfusion in the outside hospital.
Since yesterday morning he has had 3 episodes of vomitings which were containing food particles, yellow in color, non bilious, non blood tinged, non foul smelling. Since last night he has been even complaining of hiccups.
He is thin built , appears pale
Pallor +
Icterus +
Temp 103 F
BP 80/50mmhg
PR - 110 bpm
Cvs - S1,S2+
Lungs - Inspiratory crackles in Left IMA
Reduced breath sounds in ISA bilaterally
Abdomen - non tender on palpation
Bowel sounds +
Outside TLC trends
17/8 - 9000
18/8 - 26,000 with a platelet count of 13,000 cells/cumm
22/8 - 30,000
Serum creatinine - 8 mg/dl
His outside cue shows loaded ous cells with the presence of 8-10 epithelial cells and one plus albumin.
ECG
Ultrasound
The patient was given continuous IV fluids and his BP got up to 110/70mmhg by 6am.
He also has been febrile since last night
At 8pm his temperature was 103 F for which he was put on Inj Neomol 100ml IV and at 6am his temperature is 100F. We have been giving him tepid sponging as well.
Day 2:
47 year old man with
Reduced urine output since 1 month
Dyspnea at rest 6 days back
Burning micturation since 6 days
White coloured urine since 6 days
Vomitings since yesterday
Hiccups since last night
Problems:
UTI leading to Acute Pyelonephritis
AKI
Septic shock ( resolved)
Hypoalbuminaemia
Day 3:
47 year old man with Acute Pyelonephritis secondary to UTI
AKI
Unconjugated Hyperbilirubinemia with hypoalbuminaemia
Anemia
Complaining of hiccups
Appetite has improved
No episodes of fever since 1 day
PR - 110bpm
RR at 19 cpm
Bp at 130/70mmhg
Spo2 maintaining at 98%
Grbs -108mg/dl
Cvs - S1,S2 +
Lungs - clear
Good urine out - 1100/1900
Counts have reduced from 19000 yesterday to 15000
Serum creatinine-3.2
Blood urea - 117
Na - 125
TB - 3.2
DB - 1.2
ALP - 386 A
Plan for CT KUB
Will look for studies on effect of 3%NaCl for his hiccups as his sodium is 125.
Day 4:
47 years old man with
Bilateral Hydroureteronephrosis
No fresh compliants
Bowel sounds +
yesterdays counts:
TLC: 13,700
Hb: 8.6
RBC :2.94
PLT: 2.18
Built: Thin
pallor icterus absent
temp: 98.4°F
BP: 110/80mmHg
Pulse: 96bpm
CVS: S1 S2 +
RS: BAE+ NVBS
Abdomen - non tender on palpation
Bowel sounds +
Plan: Plan for discharge .Cystoscopy after 2 weeks of PU catheter for 2 weeks
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