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Suffering from UTI pus cell. Test showed albumin present (+), erythrocyte 2-3 epithelial cell 1-2 specific gravity 1.005 crystals. Help?

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my mother is suffering from UTI pus cell- plenty, albumin present (+), erythrocyte 2-3 epithelial cell 1-2 specific gravity 1.005 crystals cast absent she is taking levofloxacin from last 15 day the 2nd culture report no growth is seen but still plenty of pus cell are present in urine she has no fever and urine output normal she is currently taking levofloxacin 500 mg OD, phenytoin 50mg BD, levitracetam 250mg TDS asprin 75mg+clopidogrel, ranitidine 15 mg BD, atorvastatin 10mg she was treated for septicemia last year and due to long term antibiotic therapy got an epileptic attack after 8th day due to ofloxacin she is bed ridden now and paralyzed and catheterized from last 1 year i am genuinely need in of help plz call me if you need any information
Posted Wed, 6 Nov 2013 in Urinary and Bladder Problems
 
 
Answered by Dr. Amit Jain 57 minutes later
Brief Answer:
Please see the details

Detailed Answer:
Hello! Thanks for putting your query in XXXXXXX

I appreciate your concern regarding your mother. I have gone through the reports

Presence of catheter is the cause for recurrent UTI). I hope she is getting her catheter changed in every 7 to 10 days

Levofloxacin also belongs to quinolone group so when she is allergic to quinolones it should be stopped. Also as all quinolone including levoflox lower the threshold for seizure so it is not advisable in patient who have history of seizure

As per culture report I will advise that at least two antibiotics should be given like cefixime and amikacin

I hope I have answered your query and this will help you. If you have any further query I will be happy to answer that too. Remain in touch and get-well soon.



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Follow-up: Suffering from UTI pus cell. Test showed albumin present (+), erythrocyte 2-3 epithelial cell 1-2 specific gravity 1.005 crystals. Help? 17 hours later
Dear Sir,

kindly go through todays urine analysis report and suggest the course of treatment i am still not satisfied with answer
 
 
Answered by Dr. Amit Jain 38 minutes later
Brief Answer:
Levoflox can be stopped

Detailed Answer:
Hello! In the present urine report wbc is only 4-5 which suggest she has responded to levoflox and it can be stopped. If you have any further query then let me know
Above answer was peer-reviewed by
 
Follow-up: Suffering from UTI pus cell. Test showed albumin present (+), erythrocyte 2-3 epithelial cell 1-2 specific gravity 1.005 crystals. Help? 23 hours later
Dear Sir,
Thanks a lot for your prompt response!

No growth was seen in the 2nd culture they only told me about growth of fungus
I am also worried about is there any yeast infection developing?
should we start treating with fluconazole? currently white pus cells are
visible in urine and also a white urethral discharge. but she is asymptomatic
will it be safe to start fluconazole. Is there any drug interactions
with currently taking medicine Her creatinine was 1.64 kindly suggest
 
 
Answered by Dr. Amit Jain 2 hours later
Brief Answer:
No need of treating with fluconazole

Detailed Answer:
Hello! Presence of yeast in urine suggest that urine sample was contaminated so there is need of fluconazole. Also since she is asymptomatic there is no need of at least fluconazole. Mild increase in serum creatinine may be due to sepsis which she was having, just keep her hydration level well, and get repeat serum creatinine after 3 days. I hope it will also improve.
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Follow-up: Suffering from UTI pus cell. Test showed albumin present (+), erythrocyte 2-3 epithelial cell 1-2 specific gravity 1.005 crystals. Help? 14 days later
Dear Sir,
plz. go through todays report of my mother
pus cells are still there in urine and she has taken fluconazole 150mg once in a week two times still yeast cells are present in urine
she is dehydrating day by day and we are making every effort to keep her hydrated and she also becomes sleepy after taking fluconazole tab the urine remains clear for 3 days after taking fluconazole but gradually becomes turbid after that. the urine output and input are approximately same (around 2000 ml/day) kindly help
also comment on my father's report if you can
Dear Sir, i'll be very thankful to you if you help me getting out of this situation kindly help.
 
 
Answered by Dr. Amit Jain 26 minutes later
Brief Answer:
Please see the details

Detailed Answer:
Hello! I appreciate your concern regarding your parents.

About your mother:
1. Are you getting the catheter change as I advised earlier
2. Is She is having fever
3. What is total and differential leucocyte count (TLC and DLC)

If she is not having fever and her TLC and DLC are normal it suggest that she is having asymptomatic bacteriuria which is very common in cathetrized, aged and diabetic patients. So if she is asymptomatic please don't treat her. Keep her blood sugar levels controlled, if feasible remove the catheter and if not then please change it within 2 weeks. For hydration you have to increase her fluid intake either be enteral or parentral route. However if she is symptomatic that is having fever and her TLC is increased then get urine culture and sensitivity and treat accordingly

About your father:
If he is symptomatic (fever) and his TLC and DLC are elevated then get urine culture and sensitivity

Wish them a good health


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Follow-up: Suffering from UTI pus cell. Test showed albumin present (+), erythrocyte 2-3 epithelial cell 1-2 specific gravity 1.005 crystals. Help? 2 days later
Dear Sir,
thanks for the help. we are regularly changing the catheter (all silicone) and today during the change, white discharge came out of the urethral opening. is it pus?
the current complaints of my mother are as follows
1. irregular motions (constipation) once in 3 days and that to after giving Lactulose.
2. difficulty in swallowing and drinking water.
3. dizziness, she remains sleepy
4. dehydration
5. inability to maintain posture while sitting.
TLC (count 0000)and DLC are normal and no fever, sugar levels are also normal (F-110 PM-140) kindly suggest is there anything wrong with current medicines?

 
 
Answered by Dr. Amit Jain 12 hours later
Brief Answer:
Please see the details

Detailed Answer:
Hello! White discharge may be pus

For constipation you can increase the dose of lactulose or may use laxative like syrup cremaffin plus which is a mixture of three different laxative like sodium picosulphate, milk of magnesia and liquid paraffin. I found it very effective in my patients

Since TLC, DLC are normal and there is no fever it's good so she is asymptomatic bacteriuria only. No need of treatment

Both levipil and phenytoin causes sedation and drowsiness. But there is no antiepileptic which has not got these side effects. However discuss with your doctor if feasible they can be stopped.

Wish her a good health
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Follow-up: Suffering from UTI pus cell. Test showed albumin present (+), erythrocyte 2-3 epithelial cell 1-2 specific gravity 1.005 crystals. Help? 28 hours later
Dear Sir
from last two days urine out put is increased 2700 ml and input is 2500 ml the yesterdays (5pm) blood report is as follows
haemoglobin-10.5
TLC-0000 cu/mm
RBC- 3.32 Mil/ccmm

DLC- N-63% L-34% E-2% M-1% mpv-9.7fl pcv-30.7%
platelet count-2.65 lack/cumm mcv, mch,mchc,rdw are within normal range.

KIDNEY FUNCTION TEST- UREA-42.2 mg/dl Creatinine-1.3 mg/dl
Sr. Na-126.0 mEq/l Sr. K-4.1 mEq/l
as sodium level is decreased and there is continuous loss of water from the body is it the sign of renal failure? kindly suggest the treatment she is drowsy and facing difficulty in drinking water kindly tell how to correct Sr. Na

 
 
Answered by Dr. Amit Jain 29 hours later
Brief Answer:
Please see the details

Detailed Answer:
Hello! Thanks for feedback

Her urine output has increased suggest that her renal failure is improving. Also it is clear from her report of serum creatinine which was 1.6 earlier and now it is improved to 1.3. Now important thing is to keep hydration level well and correction of serum sodium both of which can be done by intravenous fluid which I will suggest to be done under monitoring for which she should be hospitalised. Wish her a good health. If there is no further you may close the discussion
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