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Case Study: Fever of Unknown Origin (FUO) A 59-year-old woman with a history of Type II...

Case Study: Fever of Unknown Origin (FUO)

A 59-year-old woman with a history of Type II diabetes mellitus was found unconscious at home by her family members. In the emergency center, she was noted to have a temperature of 38.6°C, pulse rate of 112 beats/min, blood pressure of 96/50 mm Hg, and respiratory rate of 26 breaths/min. After 2L of normal saline, the patient became more alert and began to answer questions appropriately. Laboratory values reveal WBC 26,000 cells/mcL, hemoglobin 12 g/dL, normal platelet count, and a serum glucose level of 280 g/dL. An indwelling urinary catheter was placed and showed return of concentrated and cloudy urine. The urinalysis revealed 50 WBC per high power field. A CT scan of the abdomen without contrast revealed no free fluid in the abdomen and an inflamed right kidney with perinephric fat stranding. Shortly after the patient was transferred to the ICU, her nurse notifies you that her blood pressure is 78/50 mm Hg and heart rate is 120 beats/min.

  1.   What is the most likely diagnosis?
  2.   What are the priorities in this patient’s management?
  3.   How would you monitor and support this patient’s status?

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Solutions

Expert Solution

The diagnosis will be a septic shock.

The most important intervention for this patient is to increase her blood pressure to a normal level. Her BP fell to 78/50 and can lead to shock. Lowered blood pressure can lead to poor perfusion. Therefore fluid resuscitation is the initial management. Vasopressors can be used to increase BP. Then next thing is to control the infection process. Broad-spectrum antibiotics can be initiated once the septic shock has been diagnosed. Then fever needs to be controlled.

The patient is need to be closely monitored. Vital signs especially BP should be monitored every 15 minutes until it stable.Patient should be connected to the cardiac monitors.. BP can bring back to normal by administering crystalloids like normal saline and ringer lactate. In addition to it, vasopressors like dopamine, dobutamine and epinephrine can be adminisrederd to increase the BP

Anibiotic therapy should be started immediately to manage sepsis. Fever management can be initiated.


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