A woman with syncope and acidosis

• DOI: 10.1002/emp2.12853
• Publication Date: 2022-11-22T13:36:02Z
• Authors: Adnan Ather Malik; Aran Nanthakumar; Dana Mahdi; Sai Venkatesh Alluri; Salonee Dhungana; Laura Bleehen; Charlsea Maynard; Umar Butt; Jerry Chacko; M. Adam Ali
• Keywords: Leukocytosis; Lactic acidosis

A 77-year-old-woman with poorly controlled type 2 diabetes mellitus presented a 1-week history of anorexia and nausea. Blood tests revealed leukocytosis associated left shift (white cells 21,140 neutrophil count 17,380 per cubic millimeter) elevation the levels C-reactive protein (21.0 mg/dL). In emergency department, she collapsed. Arterial blood gas analysis metabolic lactic acidosis pH 7.23 lactate 13.5 mmol liter. Abdomino-pelvic computed tomography demonstrated intramural bladder in cobblestone pattern (arrows, Figures 1, 2). diagnosis emphysematous cystitis was made, which i rare complication ascending urinary tract infection gas-forming organisms. The patient treated catheterization, intravenous fluid resuscitation, antibiotics, but not fit for surgical intervention. Subsequent urine culture positive Escherichia coli. Although there radiological evidence resorption, died several days later due to multiorgan failure.