a 39 year old male with a history of insulin dependent mellitus was treated for

Question

a 39 year old male with a history of insulin dependent mellitus was treated for a urinary tract infection . after several days, he ban feeling better and completed his antibiotic regime as instructed he presents to your office today, eight days after completing his antibiotic regime, complaining of persistent, moderate, right flank pain. Physical exam reveals an ill- appearing male, dehydrated, and without fever. His heart rate is 110, respiratory is 20, and his BP is 180/100 mmHg. Non radiating right costovertebral angle and right lower quadrant tenderness are elicited on the papation. the patient is sent for baseline blood and urinalysis work up which reveals: Chemistry7

sodium:128 mEq/L

potassium= 5 mEq/L

chloride= 93 mEq/L

bicarbonate= 17 mmol/L

glucose= 665 mg/dL

BUN= 32

Creatinine= 1.6

blood and urine cultures are negative.

Urinalysis appearance: pink/cloudy

glucose= 2+

ketones= 1+

protein= 3+

sediment = many rbcs

bacteria= 30/hpf

what is the most likely diagnosis?

does the urinalysis support the diagnosis? if so, how?

what is the significance of the decreased bicarbonate value?

what can you conclude regarding the patient's BUN and creatinine values?

Explanation / Answer

After closely analysis of laboratory results it is to mark that Glucose level is very high and bicarbonate is decrease but not so signifcantly. BUN and creatinine value is under normal range. Urine results help in diagnosis and it makes clear glucose is more in urine that may be due to high serum glucose level and excreation of sugar in urine beyond thershold of kidney units. High protien and presence of bacteria in urine also helps in diagnosis. This indicates bacteria due to high glucose in blood.

This might be due to patient has skipped or forget insulin or oral glucose-lowering medicine dutring antibiotic therapy. Hyperglycemia causes glucose more than 240mg/dl and person feel thirsty and dehydrated. The abnormal urine report also indicates that due to high glucose there might be infection still exites that cause inflamation of nephron. Right lower quadrant tenderness would be causing due to infection that caued or not treated the previous one.

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