A new case study in which the patient, D.C., a 52-year-old, white, married college professor wakes up to severe and intensifying pain. Though the coronavirus pandemic is sweeping the nation, his pain is so severe his wife drives him to the ER.
D. C., a 52-year-old, married, white college professor, woke up to severe and increasing pain in his right flank this morning. He came to the ER in acute distress with pallor, diaphoresis and significant anxiety (over his pain and over having to come to ER during coronavirus pandemic). He was in so much pain, he couldn't sit still on the bed in the ER but continued to move around, constantly repositioning himself, groaning in pain and grimacing. He even vomited twice from the pain. He was given promethazine hydrochloride IV for nausea by the nurse. Due to his allergy to meperidine he was also given morphine IV for pain.
Okay super sleuths, what are all the possible reasons for right flank pain? As always, imagine you only get 5 questions. With that limit in mind, what information could you ask for that would give you the most information for a diagnosis? What labs do you want? What other diagnostic tests should we run? Ask me some questions!
A few other fun questions to think about:
What is the pathophysiology behind pallor and diaphoresis?
How does promethazine relieve nausea and vomiting?
Specializes in Education, Informatics, Patient Safety.
One in 10 people in the US will have a kidney stone at some point in their lives. Men have a lifetime risk of 19% compared to women’s risk of 9%.
Clinical Course:
The stone passed spontaneously within three hours and the patient was released. Stone analysis revealed that the primary component was calcium oxalate. The urologist ordered a blood Chemistry panel and a 24-hour urine collection test.
Treatment and recommendations:
If the stones had not passed, extracorporeal shock wave lithotripsy (ESWL) could be done. Surgery is also an option, or removal with a scope.
Patients should focus on increasing fluids in diet as well as limit foods that are high in oxalate, protein and salt. The patient should also reduce the amount of vitamin C consumed since Excess vitamin C is excreted from the body as oxalate, a bodily waste product that can increase the amount of oxalate in the urine.
Foods high in oxalate: Spinach, leafy green vegetables, rhubarb, almonds, beets, navy beans, chocolate, okra, potatoes, nuts and seeds, soy products, tea, strawberries and raspberries.
Also be aware that gamma globulins can be nephrotoxic – their impact on the kidneys may have implications in D.C.’s future.
Medications:
To prevent calcium stones, thiazide diuretics or phosphate-containing preparation. Allopurinol is only useful for uric acid stones. For uric acid stones, an alkalinizing agent may help prevent uric acid stones.
Citrate is a powerful force in preventing calcium stones and D. C. has very low citrate, so adding potassium citrate pills would be helpful.
Answers to questions:
Risk factors for kidney stones:
Increased levels of vitamin C
Dehydration from running extra miles, not drinking enough, difficulty swallowing
Personal history of kidney stones
Symptoms of kidney stones no matter the type include blood in the urine, urine that smells bad or is cloudy. Pain is often in the lower back, sides, abdomen or groin due to blockage inside the kidneys. They are often accompanied by fever and chills as well as nausea and vomiting.
A uric acid stone would come with a high uric acid level, and D.C. has a normal uric acid level
The high pH of the urine and the low citrate levels are consistent with calcium oxalate stones.
SafetyNurse1968, BSN, MSN, PhD
60 Articles; 529 Posts
Some of the more common causes of flank pain include:
Less common causes of flank pain include: