A 100-YEAR-OLD ELDERLY WITH CHRONIC HYPONATREMIA DETERIORATED WITH URINARY TRACT INFECTION


Kuşoğlu H.

Uluslararası Akademik Geriatri kongresi, Antalya, Türkiye, 12 - 16 Nisan 2017, ss.96

  • Basıldığı Şehir: Antalya
  • Basıldığı Ülke: Türkiye
  • Sayfa Sayıları: ss.96

Özet

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