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Dra.DeboraPalma
Dra.DeboraPalma, Médico
Categoría: Urología
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Experiencia:  Soy cirujano general con 8 años de experiencia en tratar problemas urológicos comunes
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Acute Pyelonephritis -(590.1) with torpid evolution We live

Pregunta del cliente:

Acute Pyelonephritis -(590.1) with torpid evolution
We live in Spain.
My girlfriend was admitted to the emergency observation ward with this condition. She was kept there for 36 hours and given paracetamol, saline drip and at least 1 antibiotic "Gentamicine 240mg IV" intravenously which, after 8 hours didn't satisfy the doctors as having had a good enough effect.
She was given an ultrasound which was clear.
By this point she had gone from feeling awful (pain level 8/10 - the worst she had ever experienced with a high fever) to feeling almost fine. They were preparing to send her home and at the last minute a new doctor (quite nasty manner) said she had to be referred to a bigger hospital for specialist treatment as they didn't have the lab facilities in emergency to do the blood and urine cultures necessary to figure out what the infection is and what to treat it with.
They also mentioned she needs to be under constant observation due to the temperature flucutations and her hydration levels.
She was taken by ambulance to a bigger hospital. Instead of admitting her (as promised) they dumped her into an emergency room with approx 100 people all waiting to be seen. Honestly it was like a scene out of the Iraq war. There was an american lady in a far worse condition who had been waiting 6 hours to be seen.
After a couple of hours of being ignored, nobody bringing any water to hydrate my girlfriend, nobody taking her temperature or giving us any idea when we could be admitted, both of us took matters into our own hands and decided to leave. We have had terrible experiences of Spanish hospitals and we have taken the view that if/when her condition worsens it will be quicker to phone an ambulance than to have to wait in that godawful room.
What we'd like to do now is continue treatment at home. We have some unused Amoxiciline Clavulane 875mg/125mg which she is taking every 12 hours. Plus 1000mg paracetamol every 6 hours.
I am making her drink 250ml water every hour and she is only eating morselfs of raw vegetables and fruit.
She is 24 years old, ordinariily healthy and her temperature has now dropped from 28ºC last night to 27.4ºC this morning. She says her right hand kidney pain is now a 2.5/10 and she has a headache. Other than that she is comfortable and much more relaxed.
first question: Are we doing enough for the moment?
second question: is it necessary for us to go to a private lab and ask them to do blood and urine cultures to identify the culprit?
Surely armed with these we can go to the GP and get prescribed the correct antibiotics.
third question: are we making a huge mistake and should we try to re-admit her immediately?
I hope you can tell from the above that we aren't stupid people and havent taken these decisions lightly. We simply feel we can deal with this better ourselves as long as the symptoms do not deteriorate.
We are a young couple and dont have much money so please go easy on us! thanks
Enviada: hace 1 año.
Categoría: Urología
Cliente: escribió hace 1 año.
Como nos han dirigido a la version española, podemos, si hace falta, comunicar en español pero preferemos en inglés gracias. Voy a subir unos archivos que nos dieron en hospital
Experto:  Dra.DeboraPalma escribió hace 1 año.
Thanks for using JA. Before giving you my opinion and recommendations I need some more information.Which antibiotic has she been taken before her admition to the hospital and for how long?Is she taking any antibiotic right now, if so which one? I'll wait for your responses.
Cliente: escribió hace 1 año.
They gave her Gentamicina 240mg IV during 8 hours intravenously. They saw no improvement.I'm now giving her Amoxicilina/Acido clavulanico Aristo 875mg/125mg every 12 hours.Today she is fine, she is at home without fever, temperature around 37ºC. She is eating raw vegetables and drinking lots of water.She still has a headache. Her urine is now clear (not milky)
Cliente: escribió hace 1 año.
May I recommend that you look at the attachments as I gave you all this information earlier
Experto:  Dra.DeboraPalma escribió hace 1 año.
I have seen the attachments. The thing is that the diagnosis Acute Pyelonephritis with torpid evolution implies the patient has been taking an antibiotic for at least 4 to 5 days without any response or with deterioration. That´s why I ask you about medication before the hospital. So, as I understand your girlfriend wasn´t taking any antibiotic before her admittans to the hospital and the urine analysis I see in the attachments was taken before they gave her any antibiotic, Am I right?
Cliente: escribió hace 1 año.
Yes you are right. She was not taking any antibiotic before.We suspect that they did not tell the truth about certain things because they wanted to free up a bed.For example, they claimed to have given her 3 different antibiotics but there was only 1 mentioned in the report. They also claimed to have given her special medication to reduce her fever, but we only ever saw saline and paracetamol.
Experto:  Dra.DeboraPalma escribió hace 1 año.
If that's so. I disagree with the diagnosis. There's no evidence of kidney infection, no nitrites, no bacteria, nor leukocytes(until 10 is consider normal in women)in the urine analysis, just blood. The ultrasound has no evidence of kidney inflammation. This is good because Pyelonephritis can evolve seriously. With all the information my diagnosis is Cystitis. Which explains why she has evolved satisfactorily with just one IV dose. You can continue treatment at home but I strongly suggest another antibiotic like: Trimetoprim/Sulfa 160mg twice a day or Nitrofurantoina 100mg twice a day for 3 days or Monurol 3gm just once. Continue with Paracetamol 500mg every 6 hours if she has fever and drinking abundant water: 3 to 4 lts per day. If you have any other question let me know, if not I'll appreciate you value my assistance positively with the stars above this page. Saludos.
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Cliente: escribió hace 1 año.
Thank you, Doctor.
We have just returned from seeing our GP about your alternative diagnosis. She agrees with you and has followed your recommendations. We are extremely happ with your reponse, thank you!!!