Concluded Case

BACK PAIN

History A 27-year-old woman is admitted to the emergency department complaining of pain across her back. She became unwell 2 days previously when she started to develop a fever and an ache in her back. The pain has become progressively more severe. She has vomited twice in the past 6 h. She has had no previous significant medical history, apart from an uncomplicated episode of cystitis 3 months ago. Examination She looks unwell and is flushed. Her temperature is 39.5°C. Her pulse is 120 beats/min and blood pressure 104/68 mmHg. Examination of the cardiovascular and respiratory systems is unremarkable. Her abdomen is generally tender, but most markedly in both loins. Bowel sounds are normal. INVESTIGATIONS Haemoglobin White cell count Platelets Sodium Potassium Urea Creatinine Albumin C-reactive protein (CRP) 15.3 g/dL 25.2* 10/L 406* 10/L 134 mmol/L 4.1 mmol/L 14.2 mmol/L 106 micromol/L 44 g/L 316 mg/L Normal 11.7–15.7 g/dL 3.5–11.0 10/L 150–440 10/L 135–145 mmol/L 3.5–5.0 mmol/L 2.5–6.7 mmol/L 70–120 *mol/L 35–50 g/L 5 mg/L Urinalysis++: protein,++blood,++nitrites Urine microscopy: less than50 red cells;less than50 white cells Abdominal X-ray: normal Questions • What is the likely diagnosis? • How would you investigate and manage this patient?

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Tab Baclofen 20mg BD for 3days Tab Medicam DT BD for 3days

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