Case study 12.1

Consider which clinical investigations may be requested on Betty’s admission to assist with reaching a definitive diagnosis.

Give a rationale for each investigation.

ARTERIAL BLOOD GAS – To assess hypoxia as SpO2 reduced and to assess lactate, which will indicate severity of her likely septic (distributed) shock.

ELECTROCARDIOGRAPH – As she has an irregular heart rate, it would be useful to investigate which rhythm she in order to treat effectively. Due to her co-morbidities, she is at risk of myocardial ischaemia and infarction.

CAPILLARY BLOOD GLUCOSE – She has co-morbidities which make her at risk of type two diabetes. Infection, which is likely, also increases blood glucose.

BLOODS FOR RENAL FUNCTION – Her assessment and likely sepsis, indicates she is in a hypovolemic state. These tests will indicate if there is any acute kidney injury.

WHITE CELL COUNT AND C-REACTIVE PROTEIN – These inflammatory markers are likely to be raised in an infective diagnosis, urosepsis is likely in this case.

URINALYSIS – Given evidence of infection and foul smelling urine, the urine appears the most likely cause. Positive nitrites and leucocytes on urinalysis will assist in confirming the diagnosis.