A 62 year old lady presented to the casualty with sudden onset of shortness of breath since 1 week.
Her spo2 was maintaining at room air.

This lady had attained her menarche at 13 years of age. She had obstetric history of P2D2. The 2 deaths were of male babies who had survived for the age of 1year and 2 years respectively with the difference of 3 years between both the deaths. After that she didn't concieve. No history of infertility treatment or OCP usage.

The old lady was apparently symptomatic 3 months back when she developed complaints of increased urinary frequency and burning micturition with white discharge which was mucoid and non foul smelling for 15 days. Also had history of fever which was intermittent in nature for those 15 days.  Had given history of pedal edema and facial puffiness intermittently for 1 month. She had thin stream of urine and was diagnosed to be having a structured urethra (opd prescription available mentioning the above)
She had been catheterised.
Her USG was suggestive of Thickened bladder wall with trabeculations. Bilateral moderate hydroureteronephrosis with bilateral dilatation of ureter noted up to VUJ. features suggestive of ? Bladder outlet obstruction.

Urine culture and sensitivity-
2-3 pus cells
>100000 CFU/ml.
E.coli isolated which was only sensitive to Nitrofurantoin.

1MONTH LATER URINE C/S REVEALED

 >10 pus cells seen. Escherichia coli >100000 CFU/ml
Sensitive to- Piperacillin
                        Gentamicin
                        Cefuroxime
                         Ceftazidime
                         Amikacin

Since the past 1 week she had developed fever which was high grade associated with chills. Also gives history of shortness of breath which was insidious in onset and on exertion which gradually progressed to even at rest. Had even complained of decreased urine output since the past one week.

GENERAL EXAMINATION
Patient is conscious oriented
Pallor +
No signs of icterus
cyanosis
Clubbing
Generalised lymphadenopathy
Pedal edema.

VITALS
BP- 110/70 mmhg in supine position in right arm
PR-90 bpm in right radial artery
CVS- S1S2 heard no added sounds
R/s- BAE present.

ABG
PH-7.17
PCO2-8.2
Po2-148
Hco3-2.9

RFT
Urea -184
Creatinine -5.5
Sodium -140
Potassium -7.5

CBP
Hb-8.3
TLC-18500
PLTLTS- 2.51 Lakhs



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