Renal colic and alterations in red series | Figure 1

Renal colic and alterations in red series

A 22-year-old male, mayor by trade, who has presented recurrent colic-type pain and pain when urinating, has a history of renal colic secondary to kidney stones, resolved in a hospital entitled 2 months ago. He denies personal pathological and hereditary family history. He denies drug addiction. The patient lives at sea level and denies having traveled to areas of higher altitude in recent months. After the last treatment, he has continued with burning pain when urinating, which makes him return to his family medicine unit. Blood and urine studies are performed, finding the following: Hematic biometry: leukocytes 11.25, Erythrocytes: 5.96 M/μL, Hemoglobin: 16.62 g/dL, hematocrit: 52.51%, Mean corpuscular hemoglobin: 27.88 pg, Mean corpuscular hemoglobin concentration: 31.66 g/dL, erythrocyte distribution width: 11.10%, Neutrophils: 31.19%, Monocytes: 8.49%, Eosinophils: 23.75%, Lymphocytes: 3.93 K/μL, Monocytes: 0.96 K/μL, Eosinophils: 2.67 K/μL, Basophils : 0.18 K/μL, Mean platelet volume: 12.66 fL. General urine test: amorphous urate " +", rest normal. Negative bacteria and negative urine culture. Imaging studies (kidney and urinary tract ultrasound) are pending. Probable causes of alteration of the red series?

Cólico renal y alteraciones en serie roja

Masculino de 22 años de edad, intendente de oficio, el cual ha presentado dolor tipo cólico recurrente y dolor al orinar, presenta antecedente de cólico renal secundario a litiasis renal, resuelto en hospital de derechohabiencia hace 2 meses. Niega antecedentes personales patológicos y heredofamiliares. Niega toxicomanías. El paciente vive a nivel del mar y niega haber viajado a zonas de mayor altitud en los últimos meses.

Posterior a ultimo tratamiento ha continuado con dolor tipo ardor al orinar, lo cual le hace volver a su unidad de medicina familiar. Se le realizan estudios de sangre y orina encontrando lo siguiente:

Biometría hemática: leucocitos 11.25, Eritrocitos: 5.96 M/μL, Hemoglobina: 16.62 g/dL, hematocrito: 52.51%, Hemoglobina corpuscular media: 27.88 pg, Concentración de hemoglobina corpuscular media: 31.66 g/dL, ancho de distribución eritrocitaria: 11.10%, Neutrófilos: 31.19%, Monocitos: 8.49%, Eosinófilos: 23.75%, Linfocitos: 3.93 K/μL, Monocitos: 0.96 K/μL, Eosinófilos: 2.67 K/μL, Basófilos: 0.18 K/μL, Volumen plaquetar medio: 12.66 fL.

Examen general de orina: urato amorfo " +", resto normales. Bacterias negativas y cultivo de orina negativo. Esta pendiente de realizarse estudios de imagen (ultrasonido de riñón y vía urinaria).

¿Probables causas de alteración de la serie roja?

Del siguiente caso decir diagnósticos de impresión y el tratamiento a seguir con dicha paciente.

Se trata de paciente femenina de 67 años de edad con app de esquizofrenia, DM controlada, HTA controlada, ACV hemorragico en dos ocasiones & tromboembolismo pulmonar hacían 20 años. Acude a centro de salud de su comunidad acompañada de familiar quien refiere que dicha pcte había espectorado sangre negra en forma de pozos de café, heces de color negruzca y maloliente (melena)

A su llegada al centro paciente no orientada en tiempo pero si en persona y espacio, al examen físico presentaba dolor abdominal a la palpación superficial y profunda, dolor torácico de intensidad 5/10, ruidos respiratorios sin agregados, no soplos audibles, no masas, no visceromegalias valorables.

Signos vitales

TA: 120-90 mmhg
FC:101 lxm
FR 33 rxm
spo2 : 85 % por lo cual se procede a colocar oxigenoterapia con mascarilla simple

Al transcurrir aproximadamente 2 horas en sala de emergencias paciente presenta descenso de Signos vitales con TA 50/30 mmhg y alteración de la consciencia. se le colocó sonda vesical la cual es presentada en el caso

EMS dispatched to residence "Heart problems/chest pains". Pt is a 41 y/o M w/ a hx of horseshoe kidney, pyelonephritis, and renal calculi. Pt denies taking any meds and denies any major surgeries, except ureteral stent placed 3 months prior. Upon arrival pt denies any chest pain, but states while he was relaxing on the couch eating ice cream he suddenly was unable to taste anything and states he became numb from the mid humerus up to behind his ears and partially on his zygoma bilaterally. Pt states last 3 days he has been experiencing urinary retention but denies any burning w/ urination. Pt works a desk job and states he travels constantly via car and airplane but denies any pain in his legs or hx of DVT. Upon examination: pt has warm dry skin. Strong radial pulse @ 90 BPM. BP 133/90. BGL 107 mg/dl. spO2 97%. Lungs are clear bilaterally. EKG is normal sinus rhythm w/ mild artifact (pt couldn't stop shivering. Denies being cold, but states he shivers every time he is examined due to nervousness). Aniscoria. 98.6 F temp. Pt passed stroke test, equal strength bilaterally. After examination pt states the symptoms resolved and the aniscoria resolved as well. Pt was transported to ED. Upon arrival at ED symptoms came back and vitals were taken again and were the same as before. NIH score 0 per ED physician. Any ideas on what may be causing these symptoms? What would be your plan?

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.