Septic coma shock is actually related to long-term poor blood sugar control! Renji Urology Team Shanghai Xu 500 Li Urgent Joint Force Essence | Right Kidney | Team
Grandma Zhu, who is 67 years old, suddenly fell into a coma and went into shock. She traveled 500 miles from Shanghai to Xuzhou for emergency treatment. Experts have discovered, after dissecting the cocoon, that the rare case of pneumococcal infection in the renal parenchyma leading to septic shock is actually related to poor long-term blood sugar control. Accurate diagnosis has brought vitality to Grandma Zhu, whose life is in danger. The Urology Department, Intensive Care Medicine Department, Endocrinology Department, and other departments of Renji Hospital affiliated with Shanghai Jiao Tong University School of Medicine collaborated to save Grandma Zhu from danger.
It is reported that based on the Yangtze River Delta Urology Alliance, a urological emergency diagnosis and treatment referral and treatment network covering the entire city of Shanghai and benefiting the whole country has been formed, forming a treatment system for difficult and urgent urological diseases such as urinary tract obstruction, urinary tract infection, and severe hematuria.
Identify the source of crisis from various symptoms
Identify the source of crisis from various symptoms
67 year old Grandma Zhu visited a local tertiary hospital in Xuzhou due to intermittent high fever and coma for 2 days. After examination, she was finally diagnosed with septic shock caused by pneumococcal infection in the right renal parenchyma, accompanied by cerebral hemorrhage.
In the local ICU, doctors use various rescue measures, including tracheal intubation to assist breathing, vasopressor drugs to maintain vital signs, CRRT, and advanced antibiotics for anti infection treatment. However, the condition is still unstable.
The local doctor urgently contacted Zhang Lianhua, the head of the urology emergency department at Renji Hospital, and hoped to be transferred for treatment. The family rushed to Shanghai Renji Hospital overnight, holding the last glimmer of hope. After a 6-hour long journey, at around 1:30 am, Grandma Zhu was taken to Renji Hospital. Xu Yunze, a resident urologist on duty in the emergency department that night, immediately rushed to the rescue hall to check on the patient after receiving a notice of 120 arrival.
At this time, Grandma Zhu's condition is critical: she is in a deep coma, with a body temperature as high as 39 degrees Celsius. She needs to undergo thyroidectomy to maintain blood pressure, while undergoing tracheal intubation and assisted breathing with a ventilator. Her platelet count is extremely low.
The condition is so dangerous, and Zhang Lianhua, the deputy chief physician of the urology department, is trying to find the source of danger from various symptoms. On the one hand, Grandma Zhu is an elderly woman with a clear history of diabetes and poor long-term blood sugar control; On the other hand, with acute onset and persistent high fever, blood routine tests indicate significant increases in white blood cells, C-reactive protein, procalcitonin, and other factors. Abdominal CT examination suggests a right renal perirenal fluid accumulation lesion.
The final diagnosis was that Grandma Zhu's acute shock was caused by poor blood sugar control leading to pneumococcal infection in the right renal parenchyma.
Zhang Lianhua explained that infectious diseases around the kidney are mostly related to diabetes. Diabetes patients with high blood sugar concentration, the formation of culture medium, easy to make bacteria multiply. Diabetes can also lead to changes in the immune defense system of patients, including neutrophil dysfunction. High glucose can reduce the function of T cells and weaken the resistance. However, high sugar increases the fragility of blood vessels, leading to poor local blood supply and tissue ischemia, which is not conducive to the elimination of pathogens.
At the same time, infectious diseases around the kidney mostly occur in female patients. Because the female urethra is shorter than the male urethra, the probability of retrograde infection in the urinary system is higher, and the proportion of men and women with perirenal abscess is 4:13. Especially after menopause, due to the decrease in estrogen levels, female urethral mucosa atrophy, weakened defense against bacteria, and increased susceptibility to perirenal abscess.
To rely on one's life is to bear the weight of life. Grandma Zhu's infection is severe, accompanied by septic shock, respiratory failure, and renal function damage. The most severe cases are likely to be accompanied by cerebral hemorrhage, which can be life-threatening at any time. After discussing with the intensive care department, the patient was immediately transferred to the surgical intensive care unit for emergency treatment.
The joint efforts of "elite soldiers" to urgently rescue rare and critical cases
To rely on one's life is to bear the weight of life. Grandma Zhu's infection is severe, accompanied by septic shock, respiratory failure, and renal function damage. The most severe cases are likely to be accompanied by cerebral hemorrhage, which can be life-threatening at any time. After discussing with the intensive care department, the patient was immediately transferred to the surgical intensive care unit for emergency treatment.
After identifying the cause, a special rescue plan tailored for Grandma Zhu was released: physical cooling, optimized antibiotic use plan, meropenem+metronidazole+fluconazole anti infection, insulin pump control of blood sugar, respiratory and circulatory support, and improvement of the internal environment. At the same time, an emergency invitation was made to the Department of Cerebrology for consultation on intracranial hemorrhage, and a CT scan of the head revealed the possibility of subarachnoid hemorrhage.
