Monday, 28 March 2011

Haematuria

Mr. J, a 45 year old man with Diabetes Mellitus, Hypertension, Congestive Cardiac Failure and Atrial Fibrillation has had multiple admissions to the ward, presenting with scrotal oedema, ascites, bilateral leg swelling and sacral oedema. During this admission, his main complaint was scrotal oedema and pain in the groin area. He's on statins among other medications and had a urinary catheter inserted for input-output charting.
Among the many other problems of his, he developed frank haematuria on the 2nd day of admission. He told the house officer but the medical team didn't seem to be bothered by it. The haematuria didn't stop and accumulated to about 200mls. This was his first episode of haematuria.
This could have been a few of many things, among which trauma from CBD insertion (although perhaps unlikely as he continued to bleed for a whole day), possibly from paraphymosis as he was also complaining of penile pain.
So, I decided to bring this to the attention of the doctor in charge as if the blood clots, this could lead to urinary obstruction resulting in further complications. However, the doctors dismissed it as statin myositis. Upon looking up his investigations that were done on admission (the day before), I found raised CK (3x upper limit), LDH and AST (both raised 2x upper limit), which could be in keeping with myositis. But from the simple knowledge that I have, I understand that even if it were truly statin myositis, it should not be dismissed as it could be fatal in some patients and that the statin should be withdrawn.
In my opinion, this case raises important issues surrounding professionalism and ethics as well as mismanagement and patient safety. What was further upsetting was that despite Mr. J having haematuria and complaining of groin pain, no one had examined the groin area. How could we have made a difference in the management of this Mr. J?

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