Post TURP with non oliguric ATN
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A 52 yr old male patient who is a farmer by occupation
Presented to hospital on 14 June 2021 with Chief Complaints of
Fever since 4 days
Pus in the Urine
History of presenting illness
Patient was apparently asymptomatic 5years back, On routine investigations diagnosed with type 2 diabetes and on treatment Tab GLIMI M1 and goes for regular check up.
1 year back, he gradually developed drippling of urine, Hesitation, reduced flow of urine, Difficulty in void initially not associated with suprapubic pain or burning micturition
But,since 3 months patient had burning micturition not associated with fever or suprapubic pain then he consulted a urologist, where he was told , He had Prostomegaly (60gm) and advised TURP
preoperative patient sugars were high and serum creatinine 2.2mg/dl and serum bilirubin 2.8mg/dl Before preoperative patient had fever associated with chills and rigor and yellowish discolouration of eyes, treated accordingly ( given iv antibiotics)
underwent TURP on 24th March 2021
patient had 1 episode of fever after 2 days of surgery . On 27 th March 2021, his serum creatinine was 7.2mg/dl and on
29th March 2021 it was 6.2 mg/dl and on 6thApril it was 4mg/dl and serum bilirubin was 1.7mg/dl
Few days after his surgery, He presented to the hospital on 14th April 2021 with decreased Appetite and Generalised weakness and he was treated and discharged (1st admission in hospital)
Again he presented to the hospital with drowsiness on 27 April 2021 and excessive sleep that attenders felt difficult to wake him up from sleep and attenders were regularly monitoring his BP , which was found to be fluctuating and patient was brought to the hospital and was found with Hyponatremia, After correction patient improved symptomatically within 2 days
and also his creatinine levels were elevated upto 5.2mg/dl , was given treatment and it was decreased to 3mg/dl when he got discharged (2nd admission )
He presented to the hospital on 17May 2021 with SOB since 4 days which is on exertion , High grade Fever since 2 days associated with chills and rigor , burning micturition since 4 days ( 3rd admission)
And there was raised creatinine levels upto 10mg/dl
There is a history of fleshy mass like and foamy passage in his urine 6 days back (as said by patient's attender)
He presented to the hospital on june 14th 2021 with complaints of High grade fever and pus in the Urine ( 4th Admission )
Past History
He is a known case of Diabetes since 5 years, previously took oral hypoglycemics and now he's taking insulin.
No history of HTN, Asthma, Tuberculosis, Epilepsy, CVDs
H/o Transurethral Resection of Prostrate
Personal history
Diet - mixed diet
Appetite - decreased
Sleep - adequate
Bowel - regular
Bladder - Increased frequency
Addictions - occasional Alcohol consumption
Allergies - No known allergies
Family History
Not significant
General Examination
He is moderately built and moderately nourished
Vitals
Systemic Examination
Abdominal Examination
Respiratory system
Cvs Examination
INVESTIGATIONS
14 April to 27 April 2021
Xray
NCCT KUB
HYDRONEPHROSIS
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