1. CASE PRESENTATION ON K/C/O T2DM, HYPERTENSION
WITH UROSEPSIS
Presented by:
S.SHAIK IMRAN
HUSSAIN

2. DEMOGRAPHIC DETAILS:
• Patient Name:XXXX
• Age:56yrs
• Sex:Female
• Ward:Female ward-01
• IP No:9267
• DOA:20/2/2021
• DOD:01/3/2021
• Physician:Dr.Maheshwara, M. D

3. History of present illness:
• Fever
• Burning micturation
• Weakness of lower limbs
• Past Medical History:
Patient was found to be diagnosed case of
1. Hypertension
2. Type 2 diabetes milletus

4. • Family history:
• Nil significant.
• Past medication history:
• Did not bring medication to hospital
• Personal history:
• Occupation:coolie Appetite:Normal
• Income:400/- Bladder:Partially filled
• Education:illiterate sleep:normal
• Smoker/Alcoholic:negative

5. Physical examination:
patient was conscious and cohorent.
• General examination: Systemic examination:
• BP:140/90mm of Hg CVS:S1S2+
• PULSE RATE:102beats/min RS:BAE+
• FBS:301 mg/dl CNS:Nfnd.

6. CHIEF COMPLAINTS:
• A 56 yrs old female came to the hospital with the chief complaints of:
1. Fever since 10days
2. Burning micturation since 10 days
3. Weakness of lower limbs since yesterday.
4. Pain in the gluteal region

7. Laboratory investigation:
• COMPLETE BLOOD PICTURE (21, 22,24&27-02-2021)
• URINE ANALYSIS (21-02-2021)
• PATHOLOGY TEST (21-02-2021)
• USG GLUTEAL REGION (24-02-21)
• USG ABDOMEN (24-02-2021)

8. Complete blood pictures:
PARAMETER VALUES NORMAL RANGE
HAEMOGLOBIN 7.2mg/dl 11-13g/dl
W. B. C 23,800 4000-11000cells/mm³
BLOOD PRESSURE (B.P) 140/90 mm of Hg 120/80mm of Hg
FASTING BLOOD SUGAR (FBS) 301mg/dl 70-100mg/dl
BLOOD UREA 46mg/dl 7-20mg/dl

9. Urine Analysis:
• Heamaturia
• Albuminuria(+++)
• Increased epithelial cells-15. 2H.P.F(1-5H.P.F)
• Her pathological test was positive for KLEBSIELLA SPECIES (more than
10,00,000cfu/ml.
• Her UDG of gluteal region showed SUBCUTANEOUS EDEMA.
• Her USG abdomen showed mild hepatomegaly

10. Subjective Evidence
1. Fever
2. Burning micturation
3. Weakness of lower limb
4. Pain in gluteal region
Objective Evidence
• Leucocytosis(23, 800cells/mm³)
• Blood urea(46 mg/dl)
• Albuminuria
• Hematuria
• Klebsiella species
• Subcutaneous edema in gluteal
region

11. Assessment or Diagnosis
K/C/O TYPE 2 DIABETES MELLITUS,
HYPERTENSION WITH UROSEPSIS

12. Discussion
• UROSEPSIS Is a term used to describe a type of sepsis that is caused by
the urinary tract infections.
• It is often a complication caused by the untreated urinary tract
infection.
• It requires immediate medical care to avoid life threatening
conditions.
• Aetiology:
• Urethral catheres/urine tubes
• Bacterial infections
• Respiratory tract infections(pneumonia)
• GI infections, surgery, perforation.

14. Signs and symptoms
• Fever and chills
• Frequent urination
• Burning micturation
• Severe abdominal pain, pelvic and back pain.
• Shortness of breath
• Fall in pulse rate etc

15. Risk Factors include:

16. Pathophysiology • The bacteria spread from urethra into
bladder Where they multiply causing
the infection.
• If the urinary tract infection is
untreated then ot leads to the
complications such as urosepsis.
• Sometimes urosepsis also occur
because the bacteria present in the
bladder had multiply to an unhealthy
level.
• When the increase levels of bacteria
reaches to blood circulation it causes
blood poisoning (sepsis)
• The sepsis caused from urinary tract
infections is urosepsis.

17. Symptoms:
• Antibiotics
• Antipyretic &analgesic
• Furosemide
• vasopressors
Fever
Shortness of breathe
Burning micturation
Pain in abdomen, back
region
Fall in pulse rate

18. Prognosis:Day-01
Physical examination:
• PR:96bpm
• RR:18bpm
• CNS:NFND
• CVS:S1S2+
• B.P:120/80mm of Hg
• SPo2:97%
• GRBS:218 mg/dl
Treatment
• Inj. Piptaz-4. 5g-IV-BD
• Inj.Pantop-40mg-IV-OD
• Inj.Human Actrapid-6U-TID
• T.PCT-650mg-TID
• T.Bc-OD-PO.

19. Day-2 to Day-3
Physical examination
• PR:102bpm
• Pt:c/c
• Spo2-98%
• P/A-Soft
• CNS:Nfnd
• B.P:140/90mm of Hg
Treatment
• Inj. Safezone-1. 5g-IV-BD
• Inj.Metrogyl-100ml-iv-Bd
• Inj.PCT-2amp-iv-Bd
• Inj.Artesunate-120mg-IV-OD
• Inj.Lasix-20mg-iv-Bd
• Inj.Human Actrapid-8U-iv-tid
• Inj.Pantop-40mg-iv-od
• T.Amlo-5mg-po-OD

20. Day 04 and day 5
Physical examination
• Pt:c/c
• PR:96bpm
• BP-110/80mm of Hg
• CVS-S1S2+
• P/A-soft
• CNS-Nfnd
Treatment
• Continue Same treatment
• Inj.insultard-8U-iv-od(h/A)
• Ink.MVI-1amp.

21. Day-06 and day-10
Physical examination
• Pt:c/c
• B.P-150/100 mm of Hg
• PR:92bpm
• Spo2:99%
• CVS:S1S2+
• RS:BAE+
• P/A:soft
Treatment
• Continue same treatment
• T.Gabapin-100mg-PO-Tid

22. Discharge Medication:
• Inj. Human Actrapid-12U-Tid
• T.Udiliv-100mg-po-Bd
• Inj.Human insultatd-8U-IV-OD
• T.Pantop-40mg-po-od
• T.Diclo-25mg-po-SOS
• T.PCT-500MG-PO-SOS
• T.BC-PO-OD
• T.Ca+T.Vit-D-PO-OD.
• Patient is sensitive to ampicillin, salbactum, ceftriaxone, levifloxacin
• So prescribed with NITROFUTANTOIN.

23. Drug chart:
S. NO DRUG DOSE Route Of
Administration
FREQUENCY INDICATION DURATION
01 Inj. Metrogyl 100ml IV BD Antibacterial
&antiprotozoal
9days
02 Inj. Safezone 1.5g Iv BD Antibiotic 9days
03 Inj. PCT 2amp Iv TID Analgesic&Anti
pyretic
3days
04 Inj. Artesunate 120mg Iv OD Antimalarial 8days
05 Inj. Lasix 20mg Iv BD Diuretic 9days
06 Inj. pantop 40mg Iv OD Proton pump
inhibitors
10days
07 T. Amlo 5mg Po OD Anti
hypertensive
9days
08 Inj. Human
Actrapid
8U Iv TID Short acting
insulin
10days

24. S. NO DRUG DOSE ROUTE OF
Adm
FREQUENCY INDICATION DURATION
09 Inj. Insultatd 8U IV OD Isophane
insulin
6days
10 Inj. MVI 1A Iv OD Multivitamin
supplement
6days
11 T. Gabapin 100mg Po TID Anticonvulsant
(good for
treating nerve
pain)
4days
12
13
14
15

25. Drug interactions:
1. Furosemide+insultard
• Furosemide when given along with any anti diabetes drug causes
diminish in the activity of insultard.
• This causes increase in hyperglycemic levels and onset of glucose
intolerance, preexisting diabetes conditions worsen.
2.Pantaprazole+Furosemide
Chronic use of pantaprazole(proton pump inhibitors) induce
hypomagnesemia., riskay be increase during use of concomitant
diuretics.
ADRs include-tetany, seizures, atrial fibrillation, Qtabnormal intervals.

26. Critical Evaluation
• The given prescription was inappropriate to treat the patient
symptoms because drug interactions were seen.
• Hence the given prescription was irrational.

27. Patient counselling:
• REGARDING DISEASES:
• Urosepsis is a term used to describe a condition that occurs because
of urinary tract infections.
• It is often a complication caused by untreated urinary tract infections.
• When the bacteria in urinary tract multiplies to a unhealthy level and
reaches into systemic circulation then it causes urosepsis.
• HYPERTENSION:
• It is defined as the elevated blood pressure more than 120/80 mm of
Hg

28. REGARDING MEDICATIONS:
• T. PCT-500mg.
• Mechanism of Action:

29. • Adverse effects of pct:
1. Minore effects:rashes
2. Hives
3. Itching
4. Tiredness
5. Nausea.
6. Serious effects:heamaturia
7. Decreased urine output
8. Jaundice and sore throat
USES:
Used to treat aches and pains
Used to lower body temperature.

30. 2) inj. Safezone
• MOA:It acts by inhibiting enzymes transpeptidase which is essential
for the synthesis of cell wall of bacteria.
• ADR:Shortness of breathe
• Pain, tenderness, hardness where injection was injected.
• 3) Metronidazole:
• MOA:It is a antibacterial and antiprotozoalprotozoal antibiotic that
acts by inhibiting nucleic acid synthesis there by causes destruction of
DNA of microbial cells.
• ADR:Thromboplebotis, mettalic taste, nausea &vomiting.
• Use:it’s used to treat protozoal and bacterial infections.
•

31. • Artesunate:
• MOA:It is a prodrug which after ingestion get converted to it’s active form
dehydroartemisinin . It act by inhibiting the enzyme glutathione –S-transferase
enzyme(membrane protein) as a result decrease in glutathione cause death of
protazoa.
• ADR:RBC destruction and allergic reaction.
• Use:used to treat malarial infections

33. • Uses:furosemide is used to treat edematous conditions.
• It is also to treat to lower high blood pressure.

34. • Piptaz. Inj
• MOA:It acts by inhibiting bacterial cell wall synthesis by binding to one or more
penicillin binding proteins.
• ADR:phlebitis, erythema, anemia and hepatitis.
• Use:it is used to treat infections cause by resistant organisms.
• GABAPIN.T
• MOAUse:IT is class of drugs belonging to anticonvulsant but in conditions of pain
it acts by changing the way that nerve send messages to brain.
• Bu changing the way messages are send it reduce pains.
• ADR:Allergic reaction, kidney disease, suicide thought and respiratory
depression
• Use:it is used to treat posttherapeutic neuralgia
• Pain caused by damaged nerves

35. • Human Actrapid. Inj
• MOA:Insulin acts by binding to insulin receptors on liver, muscle &fat tissue
and increase uptake of glucose from the bloodstream there by decreasing
insulin levels in blood.
• Adr:Anxiety, nervousness, hypoglycemia and tiredness.
• Use: it is used to treat type 2 Diabetes Mellitus.
• GOALS ACHIEVED:

36. LIFE STYLE MODIFICATIONS:
1. Keep your genital area clen
2. Drink more fluids(2to4 quarter each day) to flush out bacteria.
3. Dont drink fluid that irritate bladder such as alcohol, citrus juices
and caffeine.
4. Place warm pad on your abdomen to minimize bladder pressure