75 YEAR OLD FEMALE WITH C/0 FEVER , BURNING MICTURATION SINCE 4 DAYS



 A 75 year old female came to the medicine opd with c/o fever and burning micturition since 4 days 

Hopi : patient was apparently normal 4 days back then she developed fever which is of low grade , intermittent associated with chills and rigor not relieved by medication . Subsided now . 

C/o burning micturition since 4 days 

and c/o generalized weakness since 4 days

C/o swelling of both lower limbs 2 days back pitting type , extending up to knee joint , reduced now .c/o dryness of tongue , c/o pain in the lower abdomen .

No c/o decreased urine output ,SOB , chest pain , loose stools , orthopnea , PND , constipation. 

Past history: N/K/C/O DM , HTN , asthma , epilepsy , cva , cad , thyroid disorders.


Personal history:-

Diet - Mixed

Appetite - Normal

Bowel and bladder - regular

Sleep - adequate

No addictions

No H/o food and drug allergies


Family history:-

Not significant 


General examination:-

Patient Patient is conscious, coherent, cooperative ,moderately built and nourished

Pallor is present . No signs of icterus, cyanosis, clubbing, generalised lymphadenopathy

Oedema of both feet present 


Temp-98.7

BP-160/100mmHg

PR-  108 bpm

RR - 20cpm

SpO2- 98%

GRBS - 177mg/dl 


Systemic examination :

CVS- S1;S2 + , no murmors

RS- BAE+ NVBS heard

P/A- Soft non tender, no organomegaly

CNS :- Patient is arousable , no focal and neurological deficits


Provisional diagnosis: AKI secondary to UTI



Daily routine of patient : 

6:00am -wakes up 

6:00am -7:00am : fresh up

7:00am -9:00am : house work (dish washing , laundry etc..)

9:00am : Breakfast ( Rice and dal )

10:00am -12:00pm : sleep 

12:00pm-1:00pm : walking 

1:00pm : Lunch (Rice with curry and curd ) 

2:00pm-4:00pm : Hose work and watches tv)

5:00pm -6:00pm : walking and talks with neighbors 

7:00pm : Dinner ( Rice or Roti with curry or dal )

7:00pm -9:00pm : watches tv 

9:30pm : sleep









Investigations: 

On 2/11/23

RBS - 154mg/dl







2D ECHO:



Chest X-ray PA View:  




3/11/23








On 4/11/23






On 5/11/23




On 6/11/23






Revised diagnosis: AKI on CKD with sepsis secondary to UTI .


Treatment: 

1.IV fluids (NS AND RL) 100ml/hr

2.Inj.ceftriaxone 2gm/IV/BD

3.Inj.lasix 20mg/IV /BD 

4.Inj.pan 40mg /IV /BD 

5. Inj. Buscopan 1amp IM/sos

6.Inj Neomol 1gm/IV / SOS 

7.syp.Citralka 10ml in 1 glass of water po /TID 



Osce questions : 

1. Is it bacterial or viral infection? 

Ans : as the total counts are increased it is most likely to be bacterial . Total counts are 27,000

Usually in viral infection Total counts are not increased .



2. What are the differential diagnosis ? 

Ans : pyelonephritis is one of the differentials which can explain her  burning micturition, fever associated with chills , pain in the lower abdomen . Other differential is congestive heart failure, but patient 2d echo is normal which can rule out CHF .

3. Why does her Hb count decreased 10.7 to 9.0 g/dl? 

Ans : Usually in the cases of pyelonephritis there is damage to the kidney which results in the decreased production of erythropoietin levels . Which can explain her drop in Hb count . 

4. What is most common cause UTI ? 

Ans : most common is the bacterial infection in which E.coli bacteria is most common cause . 


5. List all the complaints of the patient with respect to the history and relevant clinical data and mention the treatment plan for each listed problem and mention treatment plan stating it's efficacy in relevance to patient relief and better outcome. 


Ans : C/o burning micturition since 4 days and c/o fever which is now resolved.

and c/o generalized weakness since 4 days

C/o swelling of both lower limbs 2 days back pitting type , extending up to knee joint , reduced now .c/o dryness of tongue , c/o pain in the lower abdomen .

Treatment advised : 
1.IV fluids address the dehydration. 
2. Inj. Ceftriaxone is given to treat UTI 
3.Lasix manages the fluid overload and reduces pedal edema 
4. Pan and buscopan produces gastric and pain relief . 
5.antipyretic is to reduce fever . 
6. Syp citralka makes urine less acidic and restricts the bacterial growth . 

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