The following blood tests are from an otherwise well 53-year-old female, admitted to a general medical ward five days previously for intravenous antibiotic therapy for lower limb cellulitis. Her admission blood tests were all normal. Over the last 24 hours she has become progressively oliguric, but remains otherwise stable with normal vital signs.
The results of her full blood count and urea and electrolytes are as follows:
|
Parameter |
Patient Value |
Normal Adult Range |
|
|
Haemoglobin |
132 g/L |
130 - 175 |
|
|
White Cell Count |
9.8 x 109/L |
4.0 - 11.0 |
|
|
Platelets |
321 x 109/L |
150 - 450 |
|
|
Neutrophils |
10.4 x 109/L* |
1.8 - 7.5 |
|
|
Lymphocytes |
2.06 x 109/L |
1.50 - 4.00 |
|
|
Monocytes |
0.3 x 109/L |
0.2 - 0.8 |
|
|
Eosinophils |
4.3 x 109/L* |
0.0 - 0.4 |
|
|
Haematocrit |
0.35* |
0.40 - 0.52 |
|
|
Mean Cell Volume |
92 fl |
82 - 98 |
|
|
Mean Cell Haemoglobin |
29.9 oa/cell |
27.0 - 34.0 |
|
|
Mean Cell Haemoglobin Concentration |
326 g/L |
310 - 360 |
|
|
Sodium |
140 mmol/L |
135 - 145 |
|
|
Potassium |
3.8 mmol/L |
3.2 - 4.5 |
|
|
Chloride |
106 mmol/L |
100 - 110 |
|
|
Bicarbonate |
22 mmol/L |
22 - 27 |
|
|
Urea |
28.0 mmol/L* |
3.0 - 8.0 |
|
|
Creatinine |
310 µmol/L* |
45 - 90 |
|
|
Total Calcium |
2.17 mmol/L |
2.15 - 2.60 |
|
|
Phosphate |
1.6 mmol/L* |
0.7 - 1.4 |
|
|
Albumin |
31 g/L* |
33 - 47 |
|
|
Total Bilirubin |
20 umol/L |
4 - 20 |
|
|
Conjugated Bilirubin |
4 µmol/L |
1 - 4 |
|
|
y-Glutamvl transferase |
22 U/L |
0 - 50 |
|
|
Alkaline phosphatase |
60 U/L |
40 - 110 |
|
|
Lactate dehydrogenase |
213 U/L |
110 - 250 |
|
|
Aspartate transaminase |
34 U/L |
< 40 |
|
|
Alanine aminotransferase |
25 U/L |
< 40 |
|
Give the likeliest cause of her oliguria. (20% marks)
College answer
Allergic / Acute Interstitial nephritis secondary to antibiotic use.
Discussion
The eosinophils. They are high.
Everything else is normal.
It could be nothing else. The cellulitis, presumably it got flucloxacillin - and then the cillin caused an interstitial nephritis, as they tend to do.
References
Perazella, Mark A., and Glen S. Markowitz. "Drug-induced acute interstitial nephritis." Nature Reviews Nephrology 6.8 (2010): 461-470.