BMJ Elective Case Log

Pregnancy that changed her life    A 28 Y old female resident of durgapur came to hospital on 22 nd may 2017 with the chief complaint of altered sensorium, slurring of speech, drowsiness and since 1day. Patient was apparently alright 1 year back around April 2016, it all started after caesarean section of pregnancy where she had developed bleeding, after 1 hour she developed flushes and anasarca. At that time she passed only 650 ml of urine. After transferring to a higher centre where she was diagnosed as AKI (Acute Kidney Injury). She was given haemodialysis for 1.5 months. During this she developed sepsis for which she was given meropenem injection. In the month of June she was given 1 unit of blood as her RBC were decreased.During July and august she developed DVT in the femoral vein that had a hemodialysis catheter inserted in it. After that she developed restlessness, slurring of speech for which she was admitted to hospital where she has undergone 3 cardiac arr

A 58-year-old lady presented with complaints of vomiting with fever for 4 days and pain abdomen for 2 days prior to admission. Diabetic Ketoacidosis. Her past medical history was significant for hypothyroidism for 8 years, hypertension for 10 years, type diabetes mellitus for 17 years (she says her diabetes started after an abdominal tumor removal- details of which is not available) .  On general examination, she was conscious, alert and oriented. Her blood pressure was 120/80 mmHg, Pulse was 120/min, temperature was 99.5 degree F. Respiratory system examination showed normal vasicular breath sounds. On cardiac examination, S1 and S2 was audible with no murmur. Abdomen was soft and nontender. CNS examination found no neurological deficits. Her Urine report was positive for ketone body (++). Patient was diagnosed to have diabeteic ketoacidosis. {Her discharge summary and advice on discharge documents are attached below]: Despite adequate fluid management her glucose level

A 57 year old woman with diabetes and uncontrolled blood sugars had an MDR urinary tract infection and was sensitive only to colistin and tigecycline (figure 1-3). Her weight is around 60 KG. Her eGFR was 42 mL/min/1.73 m2.   1 2 3 Based on the Urine C/S report, one shot of colistin 9 million units was given and as the patient couldn't afford any further therapy and just after one shot of colistin subjectively she was much better, so collistin was stopped.  In this case the patient had a short window of opportunity to benefit from just a single shot of colistin which was serendipity as at that point of time we didn't know that she wouldn't be able to afford the subsequent doses. Once she said that her symptoms had reduced dramatically with that one shot of colistin we felt that this was our window of opportunity as we needed to check out what was happening to the MDR klebsiella inside her and repeat urine culture sensitivity now showing that a