Husband has had fever on and off since 9/23/22 (infected, diabetics, arm)
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Good news my husband is going into a step-down unit this evening it turns out he didn't need dialysis after all and he's on the road to recovery and he is no longer in a medically induced coma
So thankful the doctor did that blood work both 3 months ago and now.
So thankful the doctor did that blood work both 3 months ago and now.
Praying, sending good vibes
Sounds like he's getting stronger.
Everything is pretty sketchy with regard to the timeline so I don't want to sound negative or second guess anything or anyone.
My impression is that the working diagnosis was a viral syndrome and the impression given is that a respiratory panel involving 25 pathogens was being screened for When that was done I don't know but it does imply that a respiratory pathogen was being sought. If that was a recent event it would have been nice to have done basic labs then. I say this because with diabetics one is concerned with bacterial pathogens which is why in my initial response was to screen for sepsis via urine culture urinalysis, blood via cultures and respiratory culture in the presence of intermittent fever. The white cells do not function properly in diabetics thus the susceptibility. I felt if there was no evidence of urine infection or lung infection then a subacute infection of the blood would be something to consider.
When a viral infection is suspected normally people will wait a couple of weeks in order to see if it goes away before doing more extensive testing. The working diagnosis in this case was viral until it's not and that part worked against us.
I think diagnostitions need to be more aggressive with diabetics. Basic labe work can detect renal function but it can also detect infections and suggest sepsis with the build up of lactate acid and an increased anion gap with the chemistry panel.
The other fact that can be misleading is that months ago labs were done and things ruled out but things can change on a daily basis and one has to forget about the past and reasses things with a fresh start and a new look.
We don't know all of the details and I doubt that we will know everything. All long as one has a good outcome from this point on then that is all that matters.
If you have diabetes then one should aggressively look for bacterial infections because antibiotic treatment is available to intervene. If one ends up with a viral infection then the wait and see thing is ok but mainly because there aren't any real good antiviral drugs out there for everything. Even if the respiratory panel had turned up a viral pathogen chances are no specific antiviral drug is available for it.
I apologize as I don't want to sound critical in any way here.
It sounds like we had a one week span of time from first feeling of fever & chills to sepsis/hypotension/acute renal failure, with evidence of an obstructing ureteral stone...real common sequence in diabetics....Stone causes UTI & UTI causes stone is a chicken & egg scenario and frequently involved....A Gram negative UTI is often accompanied by septic shock (low BP) which, in turn, causes Acute Tubular Necrosis-- a common scenario for acute RF that improves spontaneously in most cases over a short time span, requiring only close attention to supportive measures along the way.
It's easy to look back and say with confidence that they should have done such & such, but when you're viewing in the present tense and looking only along the forward arrow of time , it's not quite so simple....The drama queens who blow everything out of proportion are difficult to treat, but it's the Stoic tough guys who are the biggest problems. They don't act or look sick, so it's easy to under-estimate the situation.
Everything is pretty sketchy with regard to the timeline so I don't want to sound negative or second guess anything or anyone.
My impression is that the working diagnosis was a viral syndrome and the impression given is that a respiratory panel involving 25 pathogens was being screened for When that was done I don't know but it does imply that a respiratory pathogen was being sought. If that was a recent event it would have been nice to have done basic labs then. I say this because with diabetics one is concerned with bacterial pathogens which is why in my initial response was to screen for sepsis via urine culture urinalysis, blood via cultures and respiratory culture in the presence of intermittent fever. The white cells do not function properly in diabetics thus the susceptibility. I felt if there was no evidence of urine infection or lung infection then a subacute infection of the blood would be something to consider.
When a viral infection is suspected normally people will wait a couple of weeks in order to see if it goes away before doing more extensive testing. The working diagnosis in this case was viral until it's not and that part worked against us.
I think diagnostitions need to be more aggressive with diabetics. Basic labe work can detect renal function but it can also detect infections and suggest sepsis with the build up of lactate acid and an increased anion gap with the chemistry panel.
The other fact that can be misleading is that months ago labs were done and things ruled out but things can change on a daily basis and one has to forget about the past and reasses things with a fresh start and a new look.
We don't know all of the details and I doubt that we will know everything. All long as one has a good outcome from this point on then that is all that matters.
If you have diabetes then one should aggressively look for bacterial infections because antibiotic treatment is available to intervene. If one ends up with a viral infection then the wait and see thing is ok but mainly because there aren't any real good antiviral drugs out there for everything. Even if the respiratory panel had turned up a viral pathogen chances are no specific antiviral drug is available for it.
I apologize as I don't want to sound critical in any way here.
I appreciate your input. They said the kidney stone was infected which caused my husband to be septic.
his WBC Count was 30 on Tuesday now it's 15. His creatine was I believe was 7. BS level was 445 on Tuesday, yesterday it was 130 and today 90. I think he will end up insulin dependent and they will have him stop taking the 3 diabetic meds he was taking in pill form. I hope this is a wake up call for him that he needs to take better care of himself. I can help a little but ultimately it's up to him. He said to me today that he did not realize how bad he was but he said he was scared in the ER.
It sounds like we had a one week span of time from first feeling of fever & chills to sepsis/hypotension/acute renal failure, with evidence of an obstructing ureteral stone...real common sequence in diabetics....Stone causes UTI & UTI causes stone is a chicken & egg scenario and frequently involved....A Gram negative UTI is often accompanied by septic shock (low BP) which, in turn, causes Acute Tubular Necrosis-- a common scenario for acute RF that improves spontaneously in most cases over a short time span, requiring only close attention to supportive measures along the way.
It's easy to look back and say with confidence that they should have done such & such, but when you're viewing in the present tense and looking only along the forward arrow of time , it's not quite so simple....The drama queens who blow everything out of proportion are difficult to treat, but it's the Stoic tough guys who are the biggest problems. They don't act or look sick, so it's easy to under-estimate the situation.
Glad he's feeling better.
Thanks. You are spot on with his diagnosis. Very low BP Tuesday morning it was 69/50, he had a gram negative and was in septic shock. Infection still there but no longer septic. I am so glad I took him back to the doctor Monday evening and got the blood work because he could have died. He was so out of it Tuesday morning when I told him he had to be rushed to the hospital and that he was going into kidney failure. His response was ok get my pants and sneakers. I had him go by ambulance and as soon as he arrived they started treating him. I will be returning to work on Monday. No Idea when he is coming home yet. He will also receive physical therapy to gain his strength back.
I appreciate your input. They said the kidney stone was infected which caused my husband to be septic.
his WBC Count was 30 on Tuesday now it's 15. His creatine was I believe was 7. BS level was 445 on Tuesday, yesterday it was 130 and today 90. I think he will end up insulin dependent and they will have him stop taking the 3 diabetic meds he was taking in pill form. I hope this is a wake up call for him that he needs to take better care of himself. I can help a little but ultimately it's up to him. He said to me today that he did not realize how bad he was but he said he was scared in the ER.
I am glad that he is doing well.
The sequence is fairly common and typical. A UTI with or without stones can cause the infection to go become an upper UTI kidney infection and then from there the blood stream. The kidney is a sterile body site and any bacteria that ends up there would come from down lower in the urinary tract. The bacteria can adhere to the stone and cause biofilms which protect the bacteria from host immune systems. If the stone is being passed then it generates red blood cells in the urine and any infection in the urinary system will generate white blood cells and bacteria to be present. It would be nice to have urinalysis whenever one has any type of discomfort. Even if they don't have discomfort a urinalysis is often performed to make sure everything is ok.
There are three stages of sepsis with early, severe sepsis and then septic shock. The early signs are fast respirations, fast pulse, temperature, and confirmed infection. Obviosuly when one speaks of shock one is talking about low blood pressure. Gram negative bacteria and sepsis is almost synomyous with septic shock because of the way the bacteria is structured. It can release toxins when it is destroyed. One major mode of entry for gram negative bacteria is through the urinary tract. That's why a urinalysis is included in all septic workups. We try and catch sepsis in patients very early on and it is a high priority hospital code.
With regard to stones. Diabetics are more susceptible to calcium oxalate stones because of the increased acidity in urine and that's one thing I learned from guido. There's no role for stone formation by bacteria unless we are talking about proteus bacteria which is a gram negative rod also but it changes the pH to a very high alkaine level and it causes what we call triple phosphate stones which are completely different from what diabetics usually get.
So we know he has a weakened urinary system which one needs to look out for. A urinalysis when he doesn't feel good next time might be a good thing to start with.
Didn't want to say this until he was on the road back, but it was starting to sound like my grandfather. He never told anyone he hadn't urinated in 3 days, until he collapsed. He probably would have regretted not saying anything, if he had lived long enough to regret it. Presumed kidney stone involvement but we don't really know. Those old Germans didn't talk about stuff. They just toughed it out.
Thanks. You are spot on with his diagnosis. Very low BP Tuesday morning it was 69/50, he had a gram negative and was in septic shock. Infection still there but no longer septic. I am so glad I took him back to the doctor Monday evening and got the blood work because he could have died. He was so out of it Tuesday morning when I told him he had to be rushed to the hospital and that he was going into kidney failure. His response was ok get my pants and sneakers. I had him go by ambulance and as soon as he arrived they started treating him. I will be returning to work on Monday. No Idea when he is coming home yet. He will also receive physical therapy to gain his strength back.
Your hub is very lucky that you had the sense to take him to urgent care, then his GP twice because you felt something was not right. You probably saved his life. Had you not asked the doctor to do blood work, it would have taken longer to figure out what was the cause if he would have eventually passed out at home, then gone to the ER, then figure out what's up. It would have been tick tock goes the clock, most ER's are backed up. Knowing how serious he was when the ambulance brought him helped for his recovery.
I'm glad to hear he's on his way to recovering. He's a young guy, hopefully he takes care of himself. Now you know to keep an eye out for UTI's since he's diabetic.
Quote:
Originally Posted by guidoLaMoto
It sounds like we had a one week span of time from first feeling of fever & chills to sepsis/hypotension/acute renal failure, with evidence of an obstructing ureteral stone...real common sequence in diabetics....Stone causes UTI & UTI causes stone is a chicken & egg scenario and frequently involved....A Gram negative UTI is often accompanied by septic shock (low BP) which, in turn, causes Acute Tubular Necrosis-- a common scenario for acute RF that improves spontaneously in most cases over a short time span, requiring only close attention to supportive measures along the way.
It's easy to look back and say with confidence that they should have done such & such, but when you're viewing in the present tense and looking only along the forward arrow of time , it's not quite so simple....The drama queens who blow everything out of proportion are difficult to treat, but it's the Stoic tough guys who are the biggest problems. They don't act or look sick, so it's easy to under-estimate the situation.
Glad he's feeling better.
Weird that she said he was peeing fine. Painful urination was not something she put down. He had a fever, headache and ear issue plus some back pain that didn't sound alarming because he has back pain every now and then. I know when I get sick, everything goes right to my back. I guess the back pain this time was from the kidneys.
Quote:
Originally Posted by Medical Lab Guy
I am glad that he is doing well.
The sequence is fairly common and typical. A UTI with or without stones can cause the infection to go become an upper UTI kidney infection and then from there the blood stream. The kidney is a sterile body site and any bacteria that ends up there would come from down lower in the urinary tract. The bacteria can adhere to the stone and cause biofilms which protect the bacteria from host immune systems. If the stone is being passed then it generates red blood cells in the urine and any infection in the urinary system will generate white blood cells and bacteria to be present. It would be nice to have urinalysis whenever one has any type of discomfort. Even if they don't have discomfort a urinalysis is often performed to make sure everything is ok.
There are three stages of sepsis with early, severe sepsis and then septic shock. The early signs are fast respirations, fast pulse, temperature, and confirmed infection. Obviosuly when one speaks of shock one is talking about low blood pressure. Gram negative bacteria and sepsis is almost synomyous with septic shock because of the way the bacteria is structured. It can release toxins when it is destroyed. One major mode of entry for gram negative bacteria is through the urinary tract. That's why a urinalysis is included in all septic workups. We try and catch sepsis in patients very early on and it is a high priority hospital code.
With regard to stones. Diabetics are more susceptible to calcium oxalate stones because of the increased acidity in urine and that's one thing I learned from guido. There's no role for stone formation by bacteria unless we are talking about proteus bacteria which is a gram negative rod also but it changes the pH to a very high alkaine level and it causes what we call triple phosphate stones which are completely different from what diabetics usually get.
So we know he has a weakened urinary system which one needs to look out for. A urinalysis when he doesn't feel good next time might be a good thing to start with.
I agree, having his urine done when he's not feeling well should be routine since he's diabetic. OP's hub is very lucky she was on top of this. She knew something wasn't right
Thankful for informative posts from you and Guido.
Quote:
Originally Posted by Deserterer
Didn't want to say this until he was on the road back, but it was starting to sound like my grandfather. He never told anyone he hadn't urinated in 3 days, until he collapsed. He probably would have regretted not saying anything, if he had lived long enough to regret it. Presumed kidney stone involvement but we don't really know. Those old Germans didn't talk about stuff. They just toughed it out.
I rescanned the thread, she said he was urinating fine. Apparently he didn't have painful urination, sounds like the pain was just in his back. I've never had a stone, I've heard they're really painful, especially when you urinate so I'm clueless why he didn't have that issue.
...BS level was 445 on Tuesday, yesterday it was 130 and today 90. I think he will end up insulin dependent ....
The stress of the acute, severe illness causes increased secretion of adrenalin, cortisol, GH-- all of which raise BS, and if his urine output was low, then the sugar builds up in the blood too....There's a reason chronically uncontrolled diabetics often stabilize with a BS ~220--- that's the usual "urinary threshold" of a diabetic kidney...any BS higher than that spills into the urine....He won't necessarily need long term insulin.
Quote:
Originally Posted by Roselvr
Weird that she said he was peeing fine. Painful urination was not something she put down. He had a fever, headache and ear issue plus some back pain that didn't sound alarming because he has back pain every now and then. I know when I get sick, everything goes right to my back. I guess the back pain this time was from the kidneys....
I rescanned the thread, she said he was urinating fine. Apparently he didn't have painful urination, sounds like the pain was just in his back. I've never had a stone, I've heard they're really painful, especially when you urinate so I'm clueless why he didn't have that issue.
Stone s only hurt when they cause high grade obstruction. Diabetics often have some degree of neuropathy (maybe silent) and burning on urination may not be apparent with a UTI..."Silent MI" is real common (probably about 50% of cases) in diabetics....In fact, the smartest docs would have been suspicious and checked for it in this case of a diabetic complaining only of "I just don't feel right"
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