Course in the Ward
Course in the Ward
• Upon admission
– CBC with platelet, urinalysis, serum Na and K were
requested.
– Pre-operative assessment was done.
• On the 2nd hospital day
– Patient underwent bladder autoaugmentation with
associated appendiceal conduit.
• Ceftriaxone 750mg/ SIV infusion was continued for 30 minutes.
• Repeat hemoglobin and hematocrit was done.
• WOF: worsening of hematuria, signs of respiratory distress,
dyspnea, tachypnea.
• Deep breathing exercises were encouraged.
• Vital signs and urine output were monitored hourly and record.
Course in the Ward
• On the 3rd hospital day
– Random urine Na and K was requested.
– IVF-TF: D5 0.3% NaCl to run at 52 cc/hr.
• On the 4rd hospital day
– Repeat Na, K, Ca, and P was requested.
Course in the Ward
• On the 5th hospital day (day 3 post-op)
– Penrose drain was removed.
– Repeat Na and K was normal and urine output
was 1.9 mL/kg/hr.
– 1 L of D5IMB was run at 45 cc/hr and patient was
allowed to take general liquids.
– At this time, patient was afebrile, on day 4-5 of
Ceftriaxone and has a fluid balance of (+)450,
sodium balance of (+) 5.7 and potassium balance
of (-) 11.3.
Course in the Ward
• On the 6th hospital day, day 4 post-op (September 15, 2010)
– IV fluid rate (D5IMB) was decreased to 20 cc/hr after IV
tramadol drip was consumed.
– Na and Potassium monitoring was also discontinued.
– Patient was allowed to have a soft diet.
– 5 mL of Paracetamol 250 mg/5mL was started to be given every
8 hours for a total of 6 doses.
– Antibiotics were shifted to 5 mL of Cefuroxime 250mg/5mL
every 8 hours.
– Paracetamol was adjusted to 5 mL of 200 mg/5ml stock dose
every 8 hours as needed for pain.
– Oral fluid intake was advised to be increased to 1.5 L per day.
Course in the Ward
• On the 7th hospital day, day 5 post-op (September
16, 2010)
– Patient was allowed to have a full diet.
– Urine output was at 2 cc/kg/hour and IVF was
discontinued.
– Vital signs were normal.
• Final diagnosis: neurogenic bladder secondary to
sacral agenesis and anemia secondary to chronic
kidney disease and nutritional deficiency.
Course in the Ward
• Discharge medications:
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–
–
–
–
Cefuroxime 250 mg/5 mL 5 mL TID for 7 days
Paracetamol 250 mg/5 ml 5 mL every 6 hours
Iron syrup(Innemin) 2 mL every 12 hours
Possible human EPO on follow-up.
After 7 days of Cefuroxime,1 capsule of Nitrofurantoin
50 mg/cap was also advised to be taken at bedtime.
• Patient was discharged improved and stable on
8th hospital day, day 6 post-op (September 17,
2010).