A pt with overactive bladder



Disclaimer:This is a HIPAA de-identified open-online-patient-record with patient information posted here after collecting informed patient consent.

72 yr old male retired teacher... his story begins with...  he fell down from bicycle and sustained injury (in 1992)
At that time he had Difficulty in micturition and passing stools, and also difficulty in walking
Later he Lost sensations in lower limbs. It was diagnosed to be paraparesis.
After 10 days he underwent spinal surgery
He slowly started recovering for 1 yr (1993)
Meanwhile he developed Intermittent symptoms of Precipitancy, hesitancy, urgency... he has urge to pass urine but by the time he reaches restroom he used to pass urine
He had h/o urinary retention 3 times in one yr which required draining by foley's catheter...he was diagnosed with T2DM and HTN and on metformin since then.
In 2017 he developed dyspnea which was gradually progressive from grade 1 to 3 (NYHA). No h/o orthopnea, PND. No h/o pedal edema
Cardiology opinion was taken and he was diagnosed as a c/o Rheumatic Heart Disease with severe MS and AS and was operated. Bivalvular replacement was done.  10 days back he had h/o fever, vomitings, and diarrhoea for which he had symptomatic treatment and later developed constipation and abdominal distension, no guarding and rigidity.. he was brought to hospital with altered sensorium yesterday afternoon. Pt was tachycardic, tachypneic and was in sepsis ?urosepsis due to urinary retention ?GIsepsis due to suspected on account of his initial vomiting and diarrhea)
also diagnosed to be having hyponatremia (116mEq/lit), urea 46mg/dl and creatinine 1.3mg/dl, GFR:57.7 ml/min/m2 with Fasting blood sugars 125mg/dl and random blood sugars 138mg/dl
 and was given 0.9% NaCl and ultrasound revealed no fluid and enema was given and pt passed stools.. his counsiousness improved by today and is also able to walk but still his sodium levels were persistently low. Also diagnosed anaemia (Hb:8.1gm%) and total counts were also raised which is under evaluation.

on 5/3/19




ECG

review scan impression: cholelithiasis with chronic cholecystitis, no cholangitis.

xray abdomen and pelvis in erect position


chest xray PA view


serum sodium levels on 7/3/19

fever charting on 7/3/19


on 7/3/19
Hb: 9.2gm%
peripheral smear: RBCs- mild anisocytosis, 
                                                                          predominant normocytic normochromic
                                    few hypochromic.
         neutrophilic leucocytosis


on 8/3/19

TO BE DISCUSSED...

What was the reason for his altered sensorium? Is it because of hyponatremia?
If so, what was the reason for hyponatremia? Is it because of diarrhoea or any drug intake? or is it because of SIADH? how come we get to about his volume status?
what could be the reason for his bladder symptoms?? Does this fit under failed back surgery syndrome?
Why did he land up in sepsis?
?Uro sepsis ?GI sepsis


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