A 80 yr old male with FEVER and BURNING MICTURITION

80 year old male patient came with the complaints of fever and chills since 8 days 

Decreased appetite, generalised weakness and burning micturition since 5 days

HOPI:

Pt was apparently asymptomatic 8 days back then he c/o fever a/w chills , intermittent without any diurnal variation

No H/O vomitings or loose stools,cough,cold,SOB,rashes

H/O scrotal swelling( hydrocoele) since childhood 

H/O difficulty in passing micturition ?BPH 

?TURP done 1 year back(no records)

H/O DM since 5 years on Tab.glimipiride 5mg and Tab.metformin 500mg

H/O hypertension since 2 years on tab atenolol 50mg


Personal history:

Diet: mixed

Appetite: decreased

Sleep: decreased

bowel movements: irregular

addictions: tobacco smoking 

burning micturition present

S:

General examination:

Pt is C/C/C

BP: 130/80 mmHg

PR: 74 bpm

Temp : 98.6F

GRBS : 170mg/dl 

Pt has icterus

no pallor,  cyanosis, clubbing, lymphadenopathy, pedal oedema


Physical examination:

CVS:S1S2 +NO MURMURS 

RS :BAE +, NVBS 

P/A- soft, NT

CNS-NFD



Investigations

:Diagnosis:

UROSEPSIS(CUE -30-40pus cells,alb+)

With AKI(creat 1.7)

Dyselectrolytemia (hypotonic hyponatremia improving with 0.9%NS Na 123 at presentation improved to 128,Hypokalemia 2.7 at presentation -after correction 2.9)

Acute liver injury


Treatment:

INJ PIPTAZ 2.25 gm / IV | ICD

IVF NS@100ml/hr

INJ. KCL 2amps in 500 mL NS Slow iv @ 50ml/hr

TAB  DOXY 100 mG / PO/ BD

INJ PAN 40 mG PO/OD

INJ HAI SC / TID / premeal/ acc to GRBS

monitor vitals


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