Marjorie Williams
78, Female

8 hours later Mrs Williams’ urine output has picked up to 40-50 ml/hour. She remains confused but her temperature has come down to 37.4°C. Her renal function and arterial blood gases are repeated:

• sodium 142 mmol/L
• potassium 4.9 mmol/L
• urea 20 mmol/L
• creatinine 220 µmol/L

ABGs on room air:

• PO₂ 10.5 kPa
• pCO₂ 4.0 kPa
• pH 7.33
• HCO₃ 18 mEq/L
• Base excess -4

Over the next 4 days Mrs Williams continues to get better.  Her kidney function improves to a creatinine of 105 giving her an eGFR of 47 ml/min.  The urine and blood cultures both grow E. coli sensitive to tazosin and amoxicillin and on day 4 she is converted to oral antibiotics which she continues for another 6 days on microbiology advice.

Although her acute confusion improves, she does not return to her normal baseline and she is referred to the dementia team for further assessment and on-going management.

She is eventually discharged home with a new diagnosis of vascular dementia