Mrs NS, aged 72 years, weight 56kg, goes to see her GP due t…
Mrs NS, aged 72 years, weight 56kg, goes to see her GP due to a burning sensation when passing urine, she is also feeling a little confused. Past Medical History: Hypertension, Diabetes Mellitus type 2, Iron Deficiency Anaemia, Epilepsy, Osteoporosis Current Medicines: Amlodipine 5mg OD, Perindopril 4mg OD, Atorvastatin 20mg ON, Metformin 1g BD, Gliclazide 80mg BD, Ferrous Sulphate 200mg OD, Sodium Valproate 600mg BD, Alendronic Acid 70mg once a week, Adcal D3 II OD Allergies: NKDA The GP suspects a urinary tract infection (UTI) and asks for a dipstick test. The results are positive for leucocytes and nitrites. a) Explain the relevance of the dipstick findings in relation to the diagnosis (2 marks) The GP decides to empirically prescribe amoxicillin 500mg TDS for 3 days. Mrs NS returns 2 days after completing the course feeling more unwell, confused, pain in her back, a raised temperature of 38.5°C and has not been drinking as much. BP 100/72 mmHg HR 106 bpm RR 18 bpm O2 sats 94% Mrs NS is admitted into hospital. b) What is the most likely diagnosis of the patient’s infection (1 mark) Day 1 – Mrs NS is started on ciprofloxacin 500mg BD for her infection and naproxen 500mg BD for the pain in her back. c) Comment on the choice of therapy and any changes you may make with your rationale (2 marks) Day 3 – Urine cultures and sensitivities return showing an extended spectrum B-lactamase (ESBL) producing E.Coli with sensitivity to ertapenem, fosfomycin and pivmecillinam. The registrar initiates treatment with ertapenem 1g once a day IV. d) Comment on the choice of therapy and any changes you may make with your rationale (2 marks) Day 4 – Blood results: Reference Range Na+ 135 (135 – 145 mmol/L) K+ 5.0 (3.5 – 5.1 mmol/L) Ur 18 (2.5 – 6.7 mmol/L) SCr 256 (50 – 120 umol/L) Blood results 3 months ago: Reference Range Na+ 138 (135 – 145 mmol/L) K+ 4.4 (3.5 – 5.1 mmol/L) Ur 5.5 (2.5 – 6.7 mmol/L) SCr 95 (50 – 120 umol/L) e) What are the potential causes of Mrs NS’s Acute Kidney Injury (AKI)? (2 marks) f) What stage of AKI does Mrs NS have currently? What is the patient’s current creatinine clearance (CrCl)? (2 marks) g) Propose an initial management plan for treating the AKI and rationale (4 marks)