Dr. Ashaq Hussain Parrey
Rheumatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
My mother, 66-year-old, has been having some discomfort in the upper abdomen for five days. She has been experiencing some gas and tightness in the upper abdomen. Her stools are a little constipated, but she is going every day. She has had a fever between 99 to 100 degrees F for five days in the evening. She feels uncomfortable, especially after eating. Please advise. She is diabetic and hypertensive. We showed her to a doctor who has advised her to take Medomol 500 mg and Rabez DSR twice a day for five days. But, there is a lot of gas and tightness in the abdomen. She is also feeling fragile. As the discomfort was still there and her evening fever below 100, the doctor did a blood test and urine test, and her WBCs were relatively high. He has started her on Oflox OZ twice a day for five days, along with Rabez DSR and Zantac. Please advise if the high WBCs are because of some stomach infection as she does not have any loose motions and if the antibiotics will help. I hope there is nothing to worry about. Also, the fever ranging from 99 to 99.6 F comes only in the evening. We got her ultrasound done, and here are the findings. Please advise why there is so much urinary retention? She is currently taking Glycomet-GP 3/850, Voglibose 0.3 mg, Telmisat AM 5 mg, Alzolam 0.5 mg, Nexito 10 mg, and Fibator 5 mg.
Hi,
Welcome to icliniq.com.
Went through your post and the investigations you have posted (attachment removed to preserve the patient's identity). Your mother has an infection evident by high white blood count (WBC), with predominant cells being neutrophils. Patients with diabetes do not have fever proportionate to their infection because they have low immune strength. The most likely is a gastrointestinal system illness, as is suggested by her symptoms. Whether Ofloxacin and Ornidazole is good enough antibiotic for her infection will need to be observed for 72 hours after starting this antibiotic. If her symptoms improve and her fever subsides, the antibiotic is good and should be continued for a week. However, if she does not improve and her WBC count does not come down, that means it is not working, and a better antibiotic like injectable Ceftriaxone or a combination of Ofloxacin with Cefixime or Azithromycin may be used. Consult your specialist doctor to discuss with them and take medicines with their consent.
Regards.
Patient's Query
Hello doctor,
The symptoms have improved. The fever has come down and ranges from 98.5 to 98.8 F, and also there is relief in the stomach. In her ultrasound report, there is significant residual urine. What is the remedy for that?
Hi,
Welcome back to icliniq.com.
She will need uroflowmetry once her symptoms settle down to see whether she has bladder outflow obstruction or weak contraction of bladder muscle resulting in urinary retention.
Regards.
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Rheumatology
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