CYSTITIS WITH K/C/O TYPE 2

DIABETES MELLITUS WITH K/C/O

CHRONIC KIDNEY DISEASE
• WHAT IS CYSTITIS ?
CYSTITIS IS AN INFECTION OF THE BLADDER AND URETHRA THAT AFFECTS MAINLY WOMEN AND
GIRLS FROM 2 YEARS OF AGE. ESCHERICHIA COLI IS THE CAUSATIVE PATHOGEN IN 70% TO 95%
OF CASES.
OTHER PATHOGENS INCLUDE PROTEUS MIRABILIS, ENTEROCOCCUS, KLEBSIELLA SP.
THIS INFECTION HAPPENS WHEN THE BACTERIA GETS INTO THE BLADDER AND MULTIPLY AND
ALSO SEEN IF THE BLADDER IS NOT EMPTIED PROPERLY.
IT IS MORE COMMON IN THE CASE OF FEMALES AS THE URETHRA IS CLOSER TO THE ANUS
WHEN COMPARED TO MALES
• WOMEN WHO ARE GOING THROUGH MENOPAUSE ARE MORE LIKELY TO HAVE
AN INCIDENCE OF CYSTITIS, THIS IS DUE TO THE THINNING OF THE LINING OF
THE URETHRA AND BLADDER DUE TO THE DECREASED LEVELS OF ESTROGEN.

• THIS CONDITION IS MORE PRONE TO THE PATIENT WHO ARE SUFFERING FROM
LONG-TERM DIABETES AND RENAL DISORDERS.
 CLASSIFICATION OF UTI

• CYSTITIS:IT IS DUE TO THE INFLAMMATION

OF THE URINARY BLADDER. IT IS OFTEN
CAUSED BY INFECTION AND IS USUALLY
ACCOMPANIED BY FREQUENT PAINFUL
URINATION.
• PYELONEPHRITIS: IT IS DUE TO THE
INFLAMMATION OF BOTH THE LINING OF THE
RENAL PELVIS AND THE PARENCHYMA OF
THE KIDNEY ESPECIALLY DUE TO BACTERIAL
INFECTION.
• URETHRITIS: IT IS THE INFLAMMATION OF THE URETHRA, THE TUBE THAT
LEADS FROM THE BLADDER TO THE OUTSIDE OF THE BODY. URETHRITIS CAN
HAVE A NUMBER OF CAUSES, INCLUDING IRRITATION AND SEXUALLY
TRANSMITTED DISEASES SUCH AS CHLAMYDIA.
• BASED ON THE LOCATION OF THE INFECTION, IT IS CLASSIFIED INTO 2 TYPES:
• THE UPPER URINARY TRACT IS COMPOSED OF THE KIDNEYS AND
URETERS. INFECTION IN THE UPPER URINARY TRACT GENERALLY AFFECTS THE
KIDNEYS (PYELONEPHRITIS), WHICH CAN CAUSE FEVER, CHILLS, NAUSEA,
VOMITING, AND OTHER SYMPTOMS.
• THE LOWER URINARY TRACT CONSISTS OF THE BLADDER AND THE URETHRA.
INFECTION IN THE LOWER URINARY TRACT CAN AFFECT THE URETHRA
(URETHRITIS) OR THE BLADDER (CYSTITIS).
• RECURRENT URINARY TRACT INFECTION (UTI) REFERS TO ≥2 INFECTIONS IN
SIX MONTHS OR ≥3 INFECTIONS IN ONE YEAR
PATHOGENESIS OF UTI
 INVESTIGATIONS
• COMPLETE BLOOD PICTURE.
• RENAL FUNCTION TEST.
• ULTRASOUND SCANNING.
• FASTING BLOOD GLUCOSE.
• HBA1C.
• POSTPRANDIAL BLOOD GLUCOSE.
CLINICAL FEATURES
• DYSURIA.
• URGENCY.
• ABDOMINAL PAIN.
• PAINFUL VOIDING.
• FEVER AND CHILLS.
• NAUSEA
• VOMITING
• PELVIC DISCOMFORT.
• PYURIA.
 PATIENT PROFILE
• NAME : MRS.X
• AGE:59YEARS.
• SEX:FEMALE
• DEP: GENERAL MEDICINE.
• IP.NO:1545158
• DOA:17/4/19
• DOD:23/4/19
• CHEIF COMPLAINTS:
THE PATIENT COMPLAINTS OF FEVER, ABDOMINAL PAIN, DECREASED APPETITE
,BURNING MICTURITION AND 2-3 EPISODES OF VOMITINGS SINCE 6DAYS.
HISTORY OF PRESENT ILLNESS:
THE PATIENT IS APPARENTLY NORMAL 6DAYS BACK AND DEVELOPED FEVER
ASSOCIATED WITH CHILLS ,RIGORS , ABDOMINAL PAIN AND VOMITINGS.
HISTORY OF PAST ILLNESS:
THE PATIENT WAS AN K/C/O TYPE 2 DIABETES SINCE 10YEARS AND CKD SINCE 2YEARS.
 DAY:1
(17/4/19)
DRUGS PRESCRIBED:
• TEMP:AFEBRILE.
• IVF NS @50ML/HR
• PR:80BPM.
• INJ.MAGNEX FORTE (1.5GM) (IV) (BD).
• RR:25CPM.
• TAB.DOLO (650MG) (SOS).
• BP:110/80MMHG.
• SYP.CITRALKA (5ML) (BD).
• INJ.H.ACTRAPID ACC TO S/C.
CLINICAL NOTES:
PATIENT IS CONSCIOUS AND COHERENT.
CVS-S1 AND S2+.
 DAY:1
LABORATORY DATA:
(17/4/19)
• HB - 10.1 GM/DL • URINE ANALYSIS

• WBC - 8,100 CELLS/CUMM • SPECIFIC GRAVITY – 1.016

• NEUTROPHILS – 14% • ALBUMIN - ++

• LEUKOCYTES – 10% • SUGAR - ++++

• EOSIONPHILS – 1% • EPITHELIAL CELLS – 1-2HPF

• MONOCYTES – 5% • PUS CELLS – 184-195HPF

• RBC – 3.4 MILLION CELLS/CUMM • RBC - 9-10HPF

• PLATELETS – 2,30,000 CELLS/CUMM

 DAY:2
(18/4/19)
• TEMP:AFEBRILE.
ADDED MEDICATIONS:
• PR:98BPM.
 NEB. DUOLIN (500MCG+1.25MG) TID
• RR:25CPM.
 K BINDING SACHETS PO TID
• BP:120/70MMHG.
 TAB. ULTRACET (37.5MG+325MG) BID
CLINICAL NOTES:
 SYP. DUPHALAC 15ML PO OD
RIGHT HYPOCHONDRIUM PAIN
 INJ. PIPTAZ 2.25GM IV TID
DECREASED URINE OUTPUT
 INJ. LEVOFLOX D1 750MG IV OD
HAS INCONTINENCY
 INJ. LEVOFLOX D2 500MG IV OD
HAS BURNING MICTURITION
 INJ. ACTRAPID SC TID
LABORATORY DATA: DAY:2
(18/4/19)
• SR. UREA – 110 MG/DL
• SR. CREATININE – 3.8 MG/DL
• SR. POTASSIUM – 5.3 MG/DL
• GFR – 16.97ML/MIN/1.7MM2

• USG ABDOMEN:
• FATTY CHANGES IN LIVER
• RIGHT HYDRONEPHROSIS, CYSTITIS
 DAY:3
• TEMP:AFEBRILE. (19/4/19)
• PR:94BPM.
STOPPED MEDICATIONS:
• RR:25CPM.
 IVF NS @50ML/HR
• BP:100/70MMHG.
 INJ.MAGNEX FORTE (1.5GM) (IV) (BD).
CLINICAL NOTES:
 NEB. DUOLIN (500MCG+1.25MG) TID
NO FEVER SPIKE
 K BINDING SACHETS PO TID
PAIN IN RIGHT LUMBAR AND GROIN REGION
 TAB. ULTRACET (37.5MG+325MG) BID
HAS BURNING MICTURITION
INCREASED URONE OUTPUT
HAS URINARY INCONTINENCY
 DAY:4
(20/4/19)
• TEMP:AFEBRILE. ADDED MEDICATIONS

• PR:102BPM.  NEB. ASTHALIN 0.5% TID

• RR:25CPM.  INJ. TRAMADOL 1 AMP @1000ML

• BP:90/60MMHG.  INJ. IMIPENEM AND CILASTATIN

(500MG/500MG) IV BD
CLINICAL NOTES:
 IVF NS 1
NO FEVER SPIKE 100ml/h
 IVF RL 2 r
RIGHT ABDOMINAL PAIN
 STOPPED MEDICATIONS
HAS BURNING MISCTURITION
 INJ. PIPTAZ 2.25GM IV TID
URINARY URGENCY
 INJ. LEVOFLOX D1 750MG IV OD
HAS NOT PASSED STOOLS
 INJ. LEVOFLOX D2 500MG IV OD
 DAY:5
(21/4/19)
• TEMP:AFEBRILE.
STOPPED MEDICATIONS:
• PR:98BPM.
• TAB.DOLO (650MG) (SOS)
• RR:25CPM.
• INJ. TRAMADOL 1 AMP @1000ML
• BP:120/80MMHG.
CLINICAL NOTES:
NO FEVER SPIKE
PAIN IN RIGHT HYPOCHONDRIUM
HAS BURNING MICTURITION
TENDERNESS IN RIGHT LUMBAR AND GROIN
REGION
 DAY:5
LABORATORY DATA: (21/4/19)
• SR. UREA – 64 MG/DL
• SR. CREATININE – 2.7 MG/DL
• SR. POTASSIUM – 4.2 MG/DL
 DAY:6
(22/4/19)
• TEMP:AFEBRILE. STOPPED MEDICTAIONS:
• PR:80BPM.
• RR:25CPM.
• BP:120/80MMHG.
CLINICAL NOTES:
PAIN IN RIGHT ABDOMEN DECREASING
HAS BURNING MICTURITION
MILD TENDERNESS IN RIGHT FLANK
 DAY:7
(23/4/19)
• TEMP:AFEBRILE.
• PR:90BPM. DRUGS PRESCRIBED:

• RR:25CPM. • INJ. ACTRAPID SC TID

• BP:120/70MMHG. • SYP.CITRALKA (5ML) (BD)

CLINICAL NOTES: • SYP. DUPHALAC 15ML PO OD

NO FEVER SPIKE • INJ. IMIPENEM AND CILASTATIN

(500MG/500MG) IV BD
PAIN IN RIGHT ABDOMEN DECREASED
• ADDED MEDICATIONS:
BURNING MICTURITION DECREASED
• IVF NS 1
URINE OUTPUT INCREASED
• IVF RL 1 75ML/H
NO TENDERNESS OR FLANK PAIN R
 DAY:7
LABORATORY DATA:
(23/4/19)

• SR. CREATININE – 2.7 MG/DL

• SR. POTASSIUM – 4.2 MG/DL
DISCHARGE MEDICATIONS

 INJ. ACTRAPID SC TID

• SYP.CITRALKA (5ML) (BD)
• SYP. DUPHALAC 15ML PO OD
• INJ. IMIPENEM AND CILASTATIN
(500MG/500MG) IV BD
 SOAP ANALYSIS

• SUBJECTIVE : • OBJECTIVE :
• FEVER
• ABDOMINAL PAIN
• DECREASED APPETITE
• BURNING MICTURITION
• 2-3 EPISODES OF VOMITINGS SINCE 6DAYS
TREATMENT REGIMEN
TREATMENT ALGORITHM
S.No. BRAND NAME GENERIC NAME DOSAGE START DATE STOP DATE
REGIMEN
1) INJ. MAGNEX SULBACTAM IV 1-0-1 17/4/19 19/4/19
FORTE 500MG +
CEFPERAZONE
1000MG
2) TAB. DOLO PARACETAMOL PO 650MG SOS 17/4/19 21/4/19

3) SYP. CITRALAK SODIUM PO 5ML 1-0-1 17/4/19 DM

CITRATE-
CITRIC ACID
4) INJ. ACTRAPID HUMAN INSULIN SC 100-100-100 17/14/19 17/4/19

5) INJ. ACTRAPID HUMAN INSULIN SC 100-140-140 18/4/19 20/4/19

6) INJ. ACTRAPID HUMAN INSULIN SC 200-200-200 21/4/19 21/4/19

7) INJ. ACTRAPID HUMAN INSULIN SC 200-240-240 22/4/19 22/4/19

8) INJ. ACTRAPID HUMAN INSULIN SC 200-240-240 23/4/19 DM

S. NO. BRAND NAME GENERIC NAME DOSAGE REGIMEN START DATE STOP DATE

9) NEB. DUOLIN SALBUTAMOL + TID 18/4/19 19/4/19

IPRATROPIUM
10) K BINDING POTASSIUM PO TID 18/4/19 19/4/19
SACHETS
11) TAB. ULTRACET TRAMADOL 37.5MG + 325MG PO 18/4/19 19/4/19
HYDROCHLORIDE + 1-0-1
ACETOMINOPHEN
12) SYP. DUPHALAC LACTULOSE PO 15ML PO 18/4/19 DM
0-0-1
13) INJ. PIPTAZ PIPERACILLIN 4GM/0.5GM IV TID 18/4/19 20/4/19
TAZOBACATM
14) INJ. LEVOFLOX D1 LEVOFLOXACIN 750MG IV 0-1-0 18/4/19 20/4/19

15) INJ. LEVOFLOX D2 LEVOFLOXACIN 500MG IV 0-1-0 18/4/19 20/4/19

16) NEB. ASTHALIN SALBUTAMOL 0.5% TID 20/4/19 23/4/19

17) INJ. TRAMADOL TRAMADOL 1 AMPULE @ 20/4/19 21/4/19

HYDROCHLORIDE 1000ML IV
18) INJ. IMPENEUM IMPENEUM AND 500MG/500MG IV 20/4/19 DM
AND CILASTATIN CILASTATIN BD