Mrs. Huda, a 48-year-old housewife is admitted late in the evening with high fever and delirium to the emergency department. Her symptoms started two days ago with urgency and suprapubic discomfort.
Presenting complain:
fever, rigor, nausea and generalized weakness since this morning.
Past medical history:
She had two episodes of urinary tract infection (UTI) in the past 2 years, which was treated with antibiotics.
She gives history of diabetes mellitus (DM) on oral medication for the past 10 years.
She has three children, and her last child birth was 15years ago.
Her menstrual cycles are irregular and heavy lately. Her last menstrual period (LMP) was 10days ago.
Family history:
Her father has DM and the remainder of the family history is noncontributory.
Physical examination:
Her skin is warm and dry.
Her vital signs show a temperature of 410C; respiratory rate of 28breaths/minute; a pulse rate of 120 beats/minute and blood pressure of 80/50 mm Hg.
Obese lightly confused, and in mild discomfort, but cooperative.
Further examination reveals acute tenderness in the right renal angle.
Other systemic examination findings are within normal limits.
Tests:
Blood and urine samples are taken for laboratory investigations.
Her blood sugar measured using point of care glucose monitor (bed side) is 237 mg/dL.
Treatment:
administered intravenous fluids, dopamine, and intravenous amoxicillin-clavulanic acid
She is being monitored for fluid intake, urinary output Central Venous Pressure (CVP) and glycemic control (with insulin). After Six hours, the blood pressure continues to be at 80/50 mm Hg and the total volume of urine collected is 50 ml.
E. coli was isolated both from blood and urine.