Altered
Renal & Urinary System
0
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S24_F1.jpg"}},{"insert":"\n\n"},{"insert":"It\u0027s one o\u0027clock, and your lunchtime has just started. You can finally catch your breath after a busy day!\n\nA few minutes after you start tucking into your lunch, the pager beeps. It\u0027s the on-duty nurse, informing you of a new patient.\r\n\r\nSighing, you toss your mostly-uneaten lunch into the trash, before proceeding to the emergency room.\n"}]}
1
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S24_F2.jpg"}},{"insert":"\n\n"},{"insert":"In the ER, you are introduced to Maria, a 3 year old girl accompanied by her mother.\r\n\r\nMaria has had fever and abdominal pain since late last night. She also vomited once, around two hours ago. No urinary, bowel, or respiratory symptoms were present.\n\nHer mother tried to give her something for the fever, but she couldn\u0027t keep anything down.\n"}]}
2
{"ops":[{"insert":"Maria was toilet trained at 2 years of age. She has no history of constipation, irregular bowel movements, or enuresis.\n"}]}
3
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S24_F4.jpg"}},{"insert":"\n\n"},{"insert":"Her medical history is unremarkable except for two urinary tract infections at the ages of 1 and 2 years respectively, and several episodes of the common cold each winter, all of which were managed by her pediatrician.\r\n\r\nAll vaccinations are up to date.\n"}]}
4
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S24_F5.jpg"}},{"insert":"\n\n"},{"insert":"On examination, Maria is visibly ill. Her vital signs are as follows:\r\n\r\nTemp.: 102.2 F (39 C).\r\nBP: 80\/40 mm Hg (systolic: 70-100mmHg, diastolic: 30-60 mmHg)\r\nPulse: 104 bpm, regular\r\nRR: 15\/min\r\n\r\nHer height and weight are 70th percentile for her age.\n\nThere is mild tenderness over the abdomen. The remainder of the examination, including scrutiny of the external genitalia, is unremarkable.\n"}]}
5
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S24_F6.jpg"}},{"insert":"\n\n"},{"insert":"You order a panel of basic investigations, and also send Maria for an abdominal ultrasound.\n"}]}
6
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S24_F7.jpg"}},{"insert":"\n\n"},{"insert":"A short while later, both mother and baby are back in front of you.\r\n\r\nThe ultrasound report is normal. You proceed to review the laborary test results.\n"}]}
7
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S24_F8.jpg"}},{"insert":"\n\n"},{"insert":"WBC: 19,000 (6000-17000)\r\n N: 84% (35-45%)\r\n L: 12 % (35-65%)\r\nHb: 12.1 g\/dl (11.5-13)\r\nHCT: 37% (34.0-40%)\r\nPLT: 320,000 (150,000-400,000)\n\nBUN: 8 mg\/dl (3-20).\r\nCreatinine: 0.5 mg\/dl (\u003C0.7).\r\n\r\nALT: 14 U\/L (5-45).\r\nAST: 17 U\/L (5-60).\r\nPT: 12 seconds (11-14). \r\nNa: 141 mEq\/L (135-145).\r\nK: 3.9 mEq\/L (3.5-5.0).\n\nCRP: 27.8 mg\/L (0-10)\n"}]}
8
{"ops":[{"insert":"Urinalysis:\r\n\r\nColor: deep yellow \r\nTurbidity: slightly cloudy \r\npH: 5.5 (4.5-8) \r\nSpecific gravity: 1.025 (1.005-1.025)\r\nProteins: trace\r\nRBCs: 40-50\/hpf ( 3) \r\nWBCs: 80-90\/hpf ( 2-5)\n\nUrinalysis (contd.):\r\n\r\nEpithelial cells: 10\/hpf ( 15-20)\r\nCasts: 3-4 hyaline casts\/hpf (0-5)\r\nCrystals: occasional\r\nLeukocyte esterase: Positive\r\nNitrites: Positive\r\n\r\nGlucose, ketones, urobilirubin, bilirubin: Negative\n"}]}
9
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S24_F10.jpg"}},{"insert":"\n\n"},{"insert":"You inform Maria\u0027s mother that her child most likely has acute pyelonephritis, and stress on the need for urgent antibiotic therapy.\r\n\r\nShe nods, and asks if Maria will need to be admitted, or if she can be treated as an outpatient.\n"}]}
10
{"ops":[{"insert":"what is your answer?\n"}]}
1. "No need for admission for now, but we will need reassess her within 48 hours"
2. "I'm afraid she will have to be admitted"
12
{"ops":{"insert":"\n"}}
13
{"ops":{"insert":"\n"}}
11
{"ops":{"insert":"\n"}}
