Research Information System
Uluslararası Akademik Geriatri kongresi, Antalya, Turkey, 12 - 16 April 2017, pp.96
Hülya Kuşoğlu1, Seda Aydın Dal2
1
Acıbadem University School of Medicine,ınfectious Diseases And Clinical Microbiology
2
Acıbadem Fulya Hospital,clinical Education Nurse
Introduction: Patients with comorbid chronic diseases are more
prone to have electrolyte imbalances but the vulnerable population
like the geriatric age group have more frequent hospital admissions
due to clinical deterioration with various causes. Here we present an
old patient who has hyponatremia for several years but was admitted
to the hospital with hyponatremia together with bacteremia secondary to catheter-associated urinary tract infection which started with
vomiting.
Case presentation: A 100-year- old woman was admitted to the
hospital with fever, severe vomiting and impaired cognitive function
present for the last 2 days. Her caregiver admitted that the patient did
not have diarrhea. Her past medical history included hypertension,
chronic renal failure, hypothyroidism, Alzheimer’s disease and Sleep
apnea syndrome. She was diagnosed with a subdural hematoma 7
years ago and was bedridden since then. Her enteral feeding was established via a percutaneous endoscopic gastrostomy (PEG) tube for
the last 6 years, and a urinary catheter was used because of her immobilization. She had frequent hospital stays during the last year for
various reasons. Her medications included L-thyroxin, metoprolol,
amlodipine-valsartan and pantoprazole. Her physical examination
revealed fever as 38.1°C, blood pressure to be 136/70 mmHg. She
was uncooperative and murmured meaningless words to tactile stimuli. There was mild seropurulent discharge around the PEG tube. The
urine appeared cloudy inside the urinary catheter. Laboratory findings showed leukocytosis of 16.000/mL, CRP 4.2 mg/dl, creatinine
2.09 mg/dL, albumin 3.4 g/dL, serum sodium 126 mmol/L, urine
sodium 24 mmol/L. Blood culture was reported as ESBL-producing
E.coli; urine culture as ESBL-producing E.coli and Pseudomonas
aeruginosa; swab culture taken around the PEG tube revealed Enterobacter cloacae and Enterobacter aerogenes growth. Three weeks
ago her serum sodium level was 136 mmol/L which was within the
normal range. The patient was diagnosed as bacteremia secondary
to urinary tract infection, peristomal wound infection around the PEG
tube, acute on chronic renal failure and hyponatremia. Her infection
was treated with meropenem according to the culture antibiogram
report; hyponatremia was corrected with sodium replacement and
the PEG tube was changed. The patient became afebrile and serum
sodium levels became normal on the 4th day of replacement therapy.
After 5 weeks she became cooperative although her responses were
with few words, and received daily salt tablets for her chronic hyponatremia.
Discussion: Urinary tract infection can present with vomiting
which may further lower sodium level in patients who are prone to
have electrolyte imbalance. Elderly patients who have hyponatremia
due to chronic diseases like chronic renal failure, hypothyroidism or
syndrome of inappropriate ADH secretion who suffer an infection
should be controlled for electrolyte disturbances
Keywords: Hyponatremia, Urinary tract infection, Elderly