Single Dose of Collistin and Dramatic Improvement in Klebsiella Sensitivity Pattern

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.

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 klebsiella dramatically changed its sensitivity pattern after one single dose (figure 4).

Comments

Consent Forms

Hindi BMJ Consent form Bengali BMJ Consent form English BMJ Consent form Telegu BMJ Consent Form Telegu BMJ Consent Form UDHC Consent Form

55 years Old male with Bipolar affected disorder moving from depression to Manic to depression phase

Disclaimer:- This is a HIPAA de-identified open-online-patient-record with initial information in patient's voice, posted here December 2017 after collecting informed patient consent (form downloadable Click Here) This is a case of a 55 years old, diabetic, hypertensive patient who was diagnosed with Bipolar affected disorder since 1995. In 1995 due to financial loss he was attacked by this condition. He was seen by Dr. D. K Agarwala and diagnosed as BPAD-Depression phase and treated with lithium, sodium valporate, propranolol, Zeptol cr, Nitrosum - S. With the treatment he was reasonably well but every 6 months of interval he appeared to have some disturbance like didn't want to talk to anybody, forgot to smile etc. They went to the doctor and treated accordingly and was continuing the treatment. In the year of 2013, August he was diagnosed with BPAD-severe depression phase but, he was not responding well to the medications and then they went to NIMHANS for

60 year old woman with hypothyroidism and SIADH

This patient is a 60 year old woman with recent vomiting, coma (sodium 107) and clinical features of dull apathy, skin coarsening, bradycardia, areflexia strongly suggesting hypothyroidism. Serum osmolality and urine sodium are suggesting SIADH. Thyroid profile: Our patient's current dose of sodium is 10ml per hour and she is having mild hypotension at times and in her blood sugar recordings hypoglycemia (attached below) was noted. In brain imaging, empty Sella is noted (attached below). Most of the data we have till now is suggesting hypopituitarism Online Discussion:

BMJ Elective Case Log

Search This Blog