case 9. 75 F WITH BURNING MICTURITION

DOA 4/11/23

DOD 14/11 /23

Diagnosis

1.UROSEPSIS

2.TYPE 2 DM

3.RENAL AKI ON CKD STAGE 4

4.HFPEF ( EF-53%) SECONDARY TO CAD (S/P-CABG)

5.K/C/O , HTN , HYPOTHYROIDISM

6.?TRANSITIONAL CELL CARCINOMA

Case History and Clinical Findings

COURSE IN THE HOSPITAL

70 YEARS FEMALE A K/C/O DM SINCE 20 YEARS USING INJ HUMAN MIXTARD 30/70 15U(BBF)

10U(BD), K/C/O HTN SINCE 20 YEARS USING TAB METOPROLOL 50MG OD , K/C/O CAD WITH

CABG DONE 8 YEARS BACK USING ANTIPLATELETS, K/C/O HYPOTHYROIDISM SINCE 8

MONTHS USING THYROXINE 50MCG OD, K/C/O CKD SINCE 2 MONTHS ON CONSERVATIVE

MANAGEMENT WITH HISTORY OF LEFT MASTECTOMY 3O YEARS BACK CAME TO HOSPITAL

WITH COMPLAINTS OF FEVER SINCE 2 DAYS AND ON FURTHER EVALUATION WAS

PROVISONALLY DIAGNOSED TO HAVE UROSEPSIS WITH RENAL AKI ON CKD WITH

HFpEF(EF : 53%) RELEVANT INVESTIGATIONS AND BLOOD AND URINE CULTURE SENT AND

INITIATED ON APPROPRIATE ANTIBIOTICS(INJ PIPTAZ AND INJ LINEZOLID). NEPHROLOGY

OPINION WAS TAKEN I/V/O AKI ON CKD AND SEPSIS AND ADVISED FOR DIALYSIS WITH

PRBC TRANSFUSION . 5 SESSIONS OF HEMODIALYSIS WAS DONE WITH 2 UNITS OF PRBC

TRANSFUSION URINE CULTURE SHOWED PSEUDOMONAS AUREUGINOSA GROWTH AND

SENSITIVE FOR MEROPENEM AND OFLOXACIN AND HENCE INITIATED ON INJ MEROPENEM

AND TAB OFLOXACIN. AND SUPPORTIVE TREATMENT WAS GIVEN WITH SOLUBLE INSULIN,

ANTIPLATELETS, DIURETICS, ANTI HYPERTENSIVES, AND MULTIVITAMINS. PATIENT WAS

ON OXYGEN SUPPORT AND SATURATION WAS MAINTAINED .

PULMONOLOGY REFFERAL WAS TAKEN IN V/O XRAY CHANGES AND ADVISED FOR HRCT

CHEST AND IT SHOWED MODERATE TO SEVERE BILATERAL PLEURAL EFFUSIONS AND

SEGMENTAL ATELECTASIS IN LEFT LUNG LOWER LOBE AND ANVISED FOR NEBULISATIONS

WITH IPRAVENT AND BUDECORT.

SURGERY REFERAL DONE I/V/O NOT PASSING STOOLS SINCE 5 DAYS MICROLITHS IN GALL

BLADDER AND ADVISED TO

1.X RAY ABDOMEN SUPINE AND LATERAL DECUBITUS POSITION

2. REPEAT USG ABDOMEN AND PELVIS

UROLOGY REFERRAL DONE I/V/O RIGHT MODERATE HYDROURETERONEPHROSIS AND

ADVISED TO

1. NCCT KUB ( FINDINGS: RIGHT MODERATE TO SEVERE HYDRONEPHROSIS , DILATED

RIGHT URETER UP TO MID PORTION WITH MILD THICKENING AND IRREGULARITY OF

MID/DISTAL PORTION OF RIGHT URETER- TO RULE OUT STRUCTURE/ TRANSTIONAL CELL

CARCINOMA.

40X36 MM SOFT TISSUE DENSITY IN URINARY BLADDER AROUND THE CENTRAL TUBE OF

FOLEYS? SPECIALISED FOLLEYS BULB? MASS LESION. SUGGEST CYSTOSCOPY).

SLUDGE/CALCULI IN GALL BLADDER.

AND ADVISED FOR BIOPSY UNDER CYSTOSCOPY

ON EXAMINATION

AFEBRILE

BP:110/70MMHG

PR:88BPM

RR:18CPM

GRBS:170

CVS: S1 S2 +, NO MURMURS

CNS: NFND

RS:BAE+

NVBS HEARD

P/A: SOFT, NON TENDER

Investigation

9/11/23: 10/11/23 11/11/23 12/11/23 14/1/23

HB : 9.2 GM/DL 10.4 GM/DL 10.7 9.5 9.7

TLC : 17,100 CELLS /CUMM 19,200CELLS /CUMM 15,500 12,600 10900

PLATELET COUNT : 3.41 LAKHS/ CUMM 3.63 LAKHS / CUMM 3.78 3.15 2.63

FBS -114 mg/dl

PLBS -180 mg/dl

Hba1C-6%

RFT

UREA : 196 MG/DL

CREATININE : 4.7 MG/DL

URIC ACID: 2.3 MG/DL 4.8 5.2 6.0 4.7

CALCIUM : 9.6 MG/DL 9.7 9.6 9.0 9.5

PHOSPHORUS : 4.6 MG /DL 5.6 6.1 6.3 4.0

SODIUM : 134MEQ/L 137 132 132 133

POTASSIUM : 3.5 MEQ/L 4.1 4.3 3.6 3.7

CHLORIDE : 97MEQ/L 101 94 97 97

ABG : PH : 7.48

PCO2 : 34.8 MMHG

PO2 64.9 MMHG

HCO3 25.6 MMOL/L

O2 SAT : 93.5

Advice at Discharge

1. TAB ECOSPRIN AV 75/20 HS 0-0-1

2. TAB CLOPIDOGREL 75MG HS 0-0-1

3. TAB THYRONORM 50MCG OD BBF 1-0-0

4. INJ HUMAN ACTRAPID INSULIN S/C TID BEFORE MEALS 6U-6U-6U

5. TAB METOPROLOL 50MG OD 1-0-0

6. TAB NIFEDIPINE 20MG TID 1-1-1

7. TAB NODOSIS 1GM TID 1-1-1

8. TAB TORSEMIDE 100MG BD 1-0-1

9. TAB METAZOLONE 5MG OD 0-1-0

10. TAB NICORANDIL 5 MG 1-0-1

11. TAB SORBITRATE 5MG 1-0-1

12. TAB LORAZEPAM 5MG 0-0-1

13. TAB FAROPENEM 200 MG 1-0-1 FOR 7 DAYS

14. TAB OFLOXACIN 200 MG 1-0-1 FOR 10 DAYS

FOLLOW UP AFTER 3 MONTHS

FBS 123mg/dl

PLBS 150 mg/dl

HBA1C 6.0 %

FOLLOW UP AFTER 6 months

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