Triage: c/o sharp shooting pains in her bilateral legs. Pain starts in the calves and radiates to the hips. Also has generalized weakness. No back or abdominal pain.
History of Present Illness: 39-year-old female with bilateral leg pain, shortness of breath and generalized weakness. No fever, chills, nausea, vomiting, or change in her chronic back pain. No bowel or bladder symptoms or injections. No other complaints.
Vital Signs: 36.9, 147, 131/82, 26, 100%
Physical Exam: lungs clear, rapid pulse, possible mild left CVAT, no leg edema, normal neuro function
Initial Diagnostic Testing:
- CBC+: CBC shows a white count of 12, lactic acid 3.4, CRP 1.3.
- EKG and D-dimer: normal
- Chemistries: anion gap of 19 potassium 3.2.
- Imaging: CXR NAD
- Urinalysis: 5-9 white cells with moderate bacteria.
What is the most likely cause of the arthrocentesis findings?
- A) Sciatica
- B) DVT
- C) Pyelo
- D) None of the above
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ANSWERS: What is the most likely cause of the pain?
1-Minute Consult on this topic:
CASE CONCLUSION: Patient was given IV fluids cultures started on antibiotics. I do have some concern of pyelonephritis although I realize urinalysis is equivocal. Heart rate and lactic acid have been improving but still abnormal at 2.5 and now flat lactic acid. Recommendation was for admission but did discuss risks and benefits of treatment at home with return precautions. Definitely recommend admission. Case discussed with hospitalist and plan is for admission. Think she has pyelonephritis. Urine culture showed >100,000 E. coli
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