What do these blood and urine tests in a diabetic person suffering from vomiting indicate?

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Posted on Mon, 25 May 2015 in Infections
Question: My Sister who is 52 years old was having fever with vomiting and loose motion 3 week back. She got relieved with a anit biotic after 3 days. Later after a week Vomiting and loose motion continued and she was totally tired and did not have energy to speak too. She is a diabetic. We did the blood, urine, xray, abdomen scan and following are the results.

Sodium 132
Potassium 5.8
Chloride 101
Bicarbonate 16

Bilateral Prominent Bronchovascular marking is found in the Xray.

Internal Debris was present with Prevoid 86cc, postvoid nil in her scan report.

TSH 6.06, T3 - .44 are the results in the thyroid tests

Rapid Urease test is positive
Blood Urea is 131
Creatine level is 4.1
Bilateral Acute Pyelonephritis

She was admitted on 29th April, 2015 and from the next day her vomiting and loose motion has got stopped. We are yet to get the Culture Test report. Her water intake had been reduced to 1 lt a day since day before and when we measured the out was 750ml against 850ml of intake. She is having Idli and Rice with butter milk with a total 4g Salt as per the dietician menu. Her sugar level is 165 on fast and 200 after food.

Can you help in sharing the risk factors involved and the right approach for treatment.

Regards
XXXXXXX XXXXXXX XXXXXXX
doctor
Answered by Dr. Tushar Kanti Biswas 41 minutes later
Brief Answer:
Diabetes and renal insufficiency

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.
She was initially having metabolic acidosis when she had episodes of vomiting and diarrhea from which she subsequently recovered.Since she is diabetic ,diabetic keto-acidosis also must have been considered.
She is also having mild hypothyroidism may be sub-clinical.
Renal function test reveals moderate renal insufficiency.Let me know what is her creatinine clearance?
Bilateral acute pyelonephritis might have worsened her renal function tests.
Rapid urease test positive means she has Helicobacter pylori infection;The specificity and sensitivity of this test is high-Helicobacter pylori infection is usually treated with a course of standard first-line therapy (a one-week "triple therapy" consisting of proton pump inhibitors such as omeprazole and the antibiotics clarithromycin and amoxicillin).
She is on renal diet . Since she has renal insufficiency ,she should be managed with Inj soluble or regular insulin to have proper glycemic control.
Urine culture report will help in selecting the proper antibiotic/s for management of acute pyelonephritis






Regards

Dr. T.K. Biswas M.D. XXXXXXX

Above answer was peer-reviewed by : Dr. Neel Kudchadkar
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Answered by
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Dr. Tushar Kanti Biswas

Internal Medicine Specialist

Practicing since :1975

Answered : 1909 Questions

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