Case Study III - The Kahootas

Case Study

Clinical features

Symptoms

1. Generalised fatigue

2. Acute pain upon urination

3. Depression

Signs

1. Flushed to touch > elevated temperature

2. Elevated blood pressure (150/95 mm Hg)

3. Higher range of normal HR (85bpm)

Complications

1. Overweight (92kg at 166cm tall)

2. Uses recreational drugs (route of administration?)

3. Cigarette smoker

4. Reduced fluid/food intake (detox)

General Points

1. Female

2. 29 y/o

3. 92 kilos - 166 cm tall

Diagnosis

Differential diagnosis

1. Lower urinary tract disease (due to stone formation/urolithiasis); may present with acute pain upon urination, possibly due to metabolic disturbances and/or reduced fluid intake. May lead to renal colic if untreated

2. Lower urinary tract disease (Infection); possibly due to her drug use, her gender predisposition to acquiring, may be aetiology of elevated temperature. If untreated may lead to renal pelvis/calyx infection)

3. Transitional Cell Carcinoma (of the Bladder); possibly due to smoking, possible genetic predisposition

4. Diabetes Mellitus (T2); may be responsible for her generalised fatigue & more likely due to her weight. If left untreated may result in myocardial infarct, renal failure, cerebrovascular accident or cancers

5. Kidney disorder; may be aetiological factor for her hypertension, which may be contributed to by reduced fluid intake

Presumptive Diagnosis

Lower urinary tract disease; Urolithiasis in conjuct with early onset of type II diabetes

Lab Tests

1. Urinanalysis (detection of hypercalciuria/hyperoxaluria)

2. Glucose tolerance/Fasting blood glucose tests

3. M, C & S (possible infection)

4. Ultrasound, CT scan, Intravenous pyelogram, Micturating cystogram

Definitive Diagnosis

Urolithiasis with borderline type II diabetes mellitus

Advice

1. Modification of lifestyle factors (E.g. diet (reduce oxalate content), exercise etc.)

2. Increase fluid intake & maintain hydration ("Flush-out" urinary system)

3. Educate on possible drug therapies such as analgesics that may alleviate pain while stone passes

Treatment

"Things not to ignore"

Things Not To Miss

- Cigarette smoker; may predispose to malignancy

- Depression; difficulty comprehending lifestyle change, overweight, recreational drug use