Elderly Woman With Fever and Hypotension.

Abstract

An 83-year-old woman with hypertension and dementia presented from an assisted living facility with confusion and diarrhea. She had recently been treated for a small bowel obstruction. On examination, her blood pressure was 75/57 mmHg and her temperature was 38.9 °C (102 °F). She was confused, clinically dehydrated, and had diffuse abdominal tenderness. She had a serum creatinine of 1.6 mg/dL, and her urinalysis demonstrated extensive WBCs with clumps and bacteria. The emergency physician obtained a point-of-care ultrasound to examine the bladder (Figure 1) and then placed an indwelling catheter (Figure 2).Figure 2Catheter bag with purulent material.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Pyelonephritis with purulent obstruction. Infection can cause retention due to urethral edema.1Selius B.A. Subedi R. Urinary retention in adults: diagnosis and initial management.Am Fam Physician. 2008; 77: 643-650PubMed Google Scholar Furthermore, the patient accumulated significant purulent material, which caused obstruction and hydronephrosis. Ultrasonography is highly accurate in determining bladder volumes and potential obstruction.1Selius B.A. Subedi R. Urinary retention in adults: diagnosis and initial management.Am Fam Physician. 2008; 77: 643-650PubMed Google Scholar,2D'Silva K.A. Dahm P. Wong C.L. Does this man with lower urinary tract symptoms have bladder outlet obstruction?: the rational clinical examination: a systematic review.JAMA. 2014; 312: 535-542Crossref PubMed Scopus (38) Google Scholar The patient was administered fluids and broad-spectrum antibiotics and was admitted to the hospital. Her culture grew Escherichia coli. At follow-up a few weeks later, her daughter endorsed that she had returned to her baseline function.