A Case of Emphysematous Pylonephritis
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Transcript of A Case of Emphysematous Pylonephritis
PROF.DR.NOORUL AMEENPANDICHELVAN
M4 UNIT
50 yrs old lady came withc/o Breathlessness – 2 days sudden onset not progressive not related with exertionh/o Fever – 2 days low grade fever not associated with chills and rigorh/o Cough with sputum production – 2 days
h/o Swelling of both legsh/o Decreased urine outputno h/o Vomitingno h/o loose stoolPast history K/C/O – SHT -18 yrs DM -18 yrs taking treatment pt recovered from DKA 1 wk ago
GENERAL EXAMINATION Concious Oriented Afebrile Dyspneic Mildly dehydrated Pallor BPPE Not icteric No cyanosis ; No clubbing; No LNE
VITALS PR 90/min BP 130/80 mmhg RR 28/min
CVS S1 S2 Heard
RS NVBS Heard B/L creps B/L wheeze
P/A Soft Tender No free fluid No Organomegaly BS Heard CNS NFND
PROVISIONAL DIAGNOSIS DM2
SHT
SEPSIS
UTI
? DKA
INVESTIGATIONUrine R/E Albumin-nil Sugar - + Deposit 4-6cells/hpfBlood Urea- 44 FBS – 202
mg/dl Cr -0.9 PPBS -306
mg/dl Sugar -286Urine Ketone – Negative
24 hr urine proetinuria – 150 mg
Complete Blood HaemogramHb -10.5TC-10500DC-P70;L28;E2ESR 10/20PLC-1.4 LACPCV-27%MCV-78MCH-31MCHC-30
MP PS /QBC- NegativeWIDAL –NegativeMSAT- Negative
Serum electrolytes NA- 123 K -3.9 CL -96 HCO3-20ECG - Normal
CXR - Normal
ECHO- No regional wall motion abnormality EF-73%
ABG- High anion gap metabolic acidosis
USG ABDOMEN- Increased echo texture in liver Cirrhosis Splenomegaly Lt renal cortical cyst Focal hypoechoic leison in upper
pole of left kidney LFTTB-0.8SGOT-36SGPT-31SAP-73TP-5.9ALP-3.2 PT-13.2APTT-30.4INR-1.2
Viral markers HBSAG - Negative ANTIHCV - Negative HIV ELISA - Non reactiveANA- Negative
MGE Opinion: DM2/UTI/CLD/NAFLD
Urine C/S on 16/8/11
Pseudomonas growth in culture Sensitive to Cephalosporin;
GM;Amikacin Sputum C/S -No growth
Blood C/S -No growth
TREATMENT
Inj. Cefatoxime Inj.Insulin IVF Syp Kcl Anti hypertensives
On 25/8/11 Urine C/S- No Growth
Two days later patient
c/o fever
c/o abdominal pain
temp 102 ^ f
COMPLETE BLOOD HAEMOGRAMHB-8.9TC-12100DC-P78;L22ESR-25/69PCV-28MCV-78MCH-31.8MCHC-30PLC-60000
Urine C/S 30/8/11 E.coli growth in culture Sensitive to Cefotaime and Amikacin
DIAGNOSIS
DM2
SHT EMPHYSEMATOUS
PYELONEPHRITIS CLASS 3B Pt transferred to Urology