Next patient leon gardiner 1177229 plate generally unwell and weak past medical history duchenne muscular dystrophy 6 at baseline potassium and sodium within normal range lymph function 17 from baseline of 3 and was 12 during recent admission urea 2.2 from baseline of naught 0.5 blood count neutrophilia 7.19 urine mcns sent during previous admission on the 09/16/2025 e coli from urine cultures is sensitive to amoxicillin fosfomycin and nitrofurantoin last medical history duchenne muscular scoliosis nonambulance since august 2016 osteopenia sleep breathing disorder trial of nocturnal noninvasive ventilation under derek ventilation team celiac disease 02/2007 medications history ferris fumarate hundred and 40 mg per ml oral solution 2 spoonfuls per day leuphorbec 100 x 6 micrograms 2 puffs once or twice a day spironolactone 12.5 once a day enalapril 2.5 mg twice a day bisoprolol 0.5 mg once a day salbutamol nebulizer 1 to be inhaled twice a day when required carbocysteine 750 mg 3 times a day salbutamol 100 micrograms per day inhaler 1 or 2 puffs to be inhaled 4 times a day when required dead veno 150 mg tablets 2 to be taken 3 times a day due to stock january 2021 so don't we won't observations knees of 1 pulse of a 100 temperature 36.5 blood pressure a 111 over 69 respiratory rate 17 saturation is a 100% hi can you give me a mic hi I'm a a I'm I'm a mic it's a they sent you home and it's not good enough mhmm which I just tried medicine we do so mhmm k no you don't wanna be in hospital but you don't wanna be in like a laboratory so they tested the the e coli to amoxicillin which we can poke that on and it is a bit better I think it probably is an infection stressing your system more than the renal stone already to lose it and obviously being carrying a few of the suppositories that you had more community for that while you're the hospital get the salt team to see you and talk about what can go down the wrong way but it still takes time actually that's that's the other option exactly a tube problem with a cough assist but it would be a probably recommend a long feed overnight okay you can't I've got a lot of food so in that case bonus doing small feeds during the day maybe is something that sensible off and obviously that's temporary that tube feeding but mhmm in the context of what's going on with an infection off board a lot of function a 10 disease or if it is before 1 and I don't know if that was concerning it feels like there's something yeah you lost your bone you've got a problem you lost actually when you're in the the yeah it's the inflammation because it's speaking quite fast got a of fluid each time because your vessels are dilated and is leaking so up through the infection which is what makes it leaky and bloody harder it makes more blood flow does that kind of make sense that is very high why I was saying why that the ejection fraction came back higher and it's above normal so I think normal would be 55% so it's indicative of a of a hyperdynamic secondary side she can see it mhmm and that's brilliant yeah but obviously it's week you can look at the number but unless you understand you'll stay it's it's very different isn't it so this seems to be grouping this is the tongue the middle of the throat it's the of we call it but I think it's even worse with that but but in tender it's on that side can you see on the other side of this she's in it no well okay I don't know why that is it's not green what I might do is ask the urology doctor sha there's a chance that by a different management not just antibiotics I'll ask is quite right yeah that's something for a bit of pain is that a bit more is that what you want that makes sense that's what makeshift pills oh jeez she'll come and see you where is though does that make sense I. Think. I that's the don't know whereabouts I think that's here that they gave you which is schedule it and that's what he's doing want to check his infection this was all over his back and shoulders so and he started bleeding yeah and then been an hour of the urine he's been doing it since I know that the fact that you've got an infection it's seems like nothing else yes what do want to do yeah yeah I've got a seclusion the blood is 3 years later mhmm and he's got some catheter to wire those which is obviously very protective that'll be due to the amount of okay because of the stool that's gone in because of delayed urinary flow yeah mhmm so they can become from inside all the time the anesthesia yeah so you you always may suggest doing a ct scan to look into the the hydro nephrosis is what I read before yeah before the the extraction oh can I take the yes I will gaze into the next chapter I will go to see you tomorrow thank you mate alright take care yeah I know he's been in no I'm alright thanks thanks on examination scoliotic good regular peripheral pulses weak arms hyperdynamic thrusting apex normal heart sounds but with systolic flow murmur heard throughout the precordium quiet lung bases bilaterally but no focal signs of infection on the chest abdomen soft but with left renal angle tenderness on the kidney no peripheral edema no rashes depression deterioration in muscular dystrophy secondary to urinary tract infection obstructed renal system in with concomitant infection raises possibility of infected obstructed kidney massively decreased nutrition in the context of poor swallow due to muscular dystrophy needs further consideration by salt, dietetics and gastroenterology to consider tube feeding in the short term plan number 1 iv antibiotics sensitive to amoxicillin would suggest starting with co amoxiclav given comorbidity and unwellness number 2 general surgery review regarding potential for infected obstructed kidney number 3 analgesia number 4 continue overnight bipap as tolerated number 5 laxatives and enemas number 6 salt review number 7 dietetic review number 8 input output charting number 9