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Diabetic ketoacidosis complicated by emphysematous pyelonephritis: a case report and literature review

BACKGROUND: The management of emphysematous pyelonephritis (EPN) includes conservative medical treatment, percutaneous drainage, and surgical resection of the involved kidney. EPN with diabetic ketoacidosis(DKA) is very rare, in which the clinical management of refusing surgical drainage is inexperi...

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Autores principales: Song, Yuanhao, Shen, Xingping
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6990560/
https://www.ncbi.nlm.nih.gov/pubmed/31996190
http://dx.doi.org/10.1186/s12894-020-0575-0
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author Song, Yuanhao
Shen, Xingping
author_facet Song, Yuanhao
Shen, Xingping
author_sort Song, Yuanhao
collection PubMed
description BACKGROUND: The management of emphysematous pyelonephritis (EPN) includes conservative medical treatment, percutaneous drainage, and surgical resection of the involved kidney. EPN with diabetic ketoacidosis(DKA) is very rare, in which the clinical management of refusing surgical drainage is inexperienced. CASE PRESENTATION: A 34-year-old woman presented with abdominal pain, chills, fever, nausea, vomiting, chest tightness, and shortness of breath. Blood test results were consistent with diabetic ketoacidosis. Urinary computed tomography scan showed multiple stones in the right kidney and lower ureter, with right hydronephrosis. Blood culture demonstrated Escherichia coli bacteremia, and EPN was diagnosed. Considering the need for a second percutaneous nephrolithotomy, the patient refused percutaneous drainage. After continuous intravenous infusion of small doses of insulin and antibiotic treatment, the ketoacidosis resolved. The patient’s temperature returned to normal and abdominal pain was alleviated, and liver and kidney functions were also back to normal. After hospital discharge, the patient underwent two percutaneous nephrolithotomy in the department of urology. CONCLUSIONS: EPN with diabetic ketoacidosis should be diagnosed as soon as possible. For patients with Class 1 and Class 2 EPN with diabetic ketoacidosis and urinary tract obstruction, if surgical drainage is refused, it is particularly important to rapidly correct diabetic ketoacidosis and intravenous use of sensitive antibiotics, so as to create conditions for follow-up percutaneous nephrolithotomy.
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spelling pubmed-69905602020-02-04 Diabetic ketoacidosis complicated by emphysematous pyelonephritis: a case report and literature review Song, Yuanhao Shen, Xingping BMC Urol Case Report BACKGROUND: The management of emphysematous pyelonephritis (EPN) includes conservative medical treatment, percutaneous drainage, and surgical resection of the involved kidney. EPN with diabetic ketoacidosis(DKA) is very rare, in which the clinical management of refusing surgical drainage is inexperienced. CASE PRESENTATION: A 34-year-old woman presented with abdominal pain, chills, fever, nausea, vomiting, chest tightness, and shortness of breath. Blood test results were consistent with diabetic ketoacidosis. Urinary computed tomography scan showed multiple stones in the right kidney and lower ureter, with right hydronephrosis. Blood culture demonstrated Escherichia coli bacteremia, and EPN was diagnosed. Considering the need for a second percutaneous nephrolithotomy, the patient refused percutaneous drainage. After continuous intravenous infusion of small doses of insulin and antibiotic treatment, the ketoacidosis resolved. The patient’s temperature returned to normal and abdominal pain was alleviated, and liver and kidney functions were also back to normal. After hospital discharge, the patient underwent two percutaneous nephrolithotomy in the department of urology. CONCLUSIONS: EPN with diabetic ketoacidosis should be diagnosed as soon as possible. For patients with Class 1 and Class 2 EPN with diabetic ketoacidosis and urinary tract obstruction, if surgical drainage is refused, it is particularly important to rapidly correct diabetic ketoacidosis and intravenous use of sensitive antibiotics, so as to create conditions for follow-up percutaneous nephrolithotomy. BioMed Central 2020-01-29 /pmc/articles/PMC6990560/ /pubmed/31996190 http://dx.doi.org/10.1186/s12894-020-0575-0 Text en © The Author(s). 2020 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Song, Yuanhao
Shen, Xingping
Diabetic ketoacidosis complicated by emphysematous pyelonephritis: a case report and literature review
title Diabetic ketoacidosis complicated by emphysematous pyelonephritis: a case report and literature review
title_full Diabetic ketoacidosis complicated by emphysematous pyelonephritis: a case report and literature review
title_fullStr Diabetic ketoacidosis complicated by emphysematous pyelonephritis: a case report and literature review
title_full_unstemmed Diabetic ketoacidosis complicated by emphysematous pyelonephritis: a case report and literature review
title_short Diabetic ketoacidosis complicated by emphysematous pyelonephritis: a case report and literature review
title_sort diabetic ketoacidosis complicated by emphysematous pyelonephritis: a case report and literature review
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6990560/
https://www.ncbi.nlm.nih.gov/pubmed/31996190
http://dx.doi.org/10.1186/s12894-020-0575-0
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