UROSEPSIS ENCEPHALOPATHY

1. By
Kiran kumar reddy
CASE PRESENTATION ON
UROSEPSIS ,
REFRACTORY SHOCK
ENCEPHALOPATHY

2. SOAP ANALYSIS
Subjective Evidence :
 H/O fever with chills since 3 days
 Generalized weakness, SOB , abdominal
discomfort with distention.
 Decreased urine output
 Headache , nausea & 1 episode of vomiting

3. Objective evidence :
 Increase in blood sugar levels
 Increase in pulse rate(tachycardia)
 Increase in serum urea & creatinine levels
 Increase in WBC & neutrophil count
Assessment :
 Increase in serum urea and creatinine levels indicates that the
patient was suffering from urosepsis
 Abnormal increase inESR , WBC , neutrophils indicates
septicemia.
 2D Echo revealed LV diastolic dysfunction
 Decrease in urine output , cardiac output, and circulatory failure
unresponsiveness to medical therapies can be seen in refractory
cardiogenic shock

4. Goals Of Treatment :
• Increase RBS levels
• Increase in S.Na levels
• Increase in hb levels
• Decrease in s.urea & creatinine levels
• Control HTN & DM 2

5. Treatment Options :
 Statins and antiplatelet as DM HTN are risk
factors foe developing hyperlipidemia and
atherosclerosis .
 Probiotics for CKD
 Monitoring serum electrolytes.
 PPIs & antiemetics as antibiotics can cause GI
disturbances

6. S.No Drug ROA Dose Fre Indication
1 Clindamycin i.v 600mg TID aminoglycoside
2 Tramadol i.v 50mg BD analgesic
3 levosulpride i.v 25mg TID Dyspepsia,
axiolytic
4 KCL i.v 1amp BD hypokalemia
5 clarithromycin i.v 500mg BD Macrolide
6 Hydrocortisone i.v 50mg 6th
hrly
Adrenal
insufficiency
7 Acebrophylline p/o 200mg OD Anti inflammatory

7. S.N
o
DRUG ROA Dose Fre Indication
7 Acetylcystine p/o 600mg BD Mucolytic
8 levosalbutamol
+ipratropium
p/n 1resp 6th
hrly
bronchodilator
9 Atorvastatin p/o 10mg OD hyperlipidemia
10 Bisacodyl
suppository
1 OD constipation

8. Monitoring Parameters :
 B.P
 RBS
 Serum urea , creatinine and electrolyte levels
 Hemoglobin , Fe , RBCcount
 TSH levels
 HDL,LDL levels
 GFR
 ESR
 Hemogram

9. Understand the causes.
Practice good personal hygiene.
Drink plenty of fluids (at least three to four glasses of
water each day) to help flush bacteria out of the urinary
tract.
Empty your bladder completely as soon as you feel the
urge, or at least every three hours.
Get plenty of vitamin C. It makes urine acidic and helps
keep bacteria down. Vitamin C is found in orange juice,
citrus fruits, and broccoli.
Wear cotton underwear. Bacteria grows better in moist
places. Cotton does not trap moisture.
If you contract an infection, see your doctor and follow
the prescribed treatment.

10. Taking any medications you are given
(such as lactulose) as directed.
 Asking your doctor if any of your other
medications might be causing trouble
with your liver .
Checking with your doctor or nurse
before starting any new medicines.
 Never using alcohol or street drugs.
 Telling your medical team if you feel
sleepy or drowsy a lot or if you are very
forgetful or have trouble thinking clearly.