Methods (Investigations and Treatment):
Blood investigations showed a leukocyte count of 8320/mm³ (normal range: 4000-11000/mm³), platelets at 288,000/mm³ (150,000-400,000), RBC at 4.25 million/mm³ (4-5 million/mm³), hemoglobin at 10 mg/dL (12-16 mg/dL for women), mean cell volume at 76.2 fl (80-99 fl), mean cell hemoglobin concentration at 30.9 g/dL (32-36 g/dL), mean cell hemoglobin at 23.6 pg (26-32 pg), packed cell volume at 32.4% (36-54%), erythrocyte sedimentation rate at 66 mm/hr (0-20 mm/hour for <50 years female), and C-reactive protein at 22.9 mg/L (0-5 mg/L). Serum creatinine was 0.66 mg/dL (0.4-1.4 mg/dL), sodium was 140 mmol/L (135-150 mmol/L), and potassium was 4.11 mmol/L (3.5-5.5 mmol/L). Thyroid and liver function tests were normal. Urine examination revealed plenty of pus cells with positive (++) leukocyte esterase, but no growth in urine culture. Abdominal and pelvic ultrasound scans were normal and advised follow up.
Cardiothoracic consultation was done suspecting cardiovascular disorder which advised carotid CT angiogram. The patient was given two rapid boluses of 500 ml Ringer’s Lactate (RL) over an hour. Still the blood pressure could not be recorded from upper limb, however the blood pressure was 130/80 mm of Hg in bilateral lower limb. The blood pressure fluctuation is shown below in table 1. A pint of RL was then infused at 30 ml/hour, maintaining stable vitals.
Table 1: BP fluctuations of the patient.