p*r 发帖数: 548 | 1 一岁小孩,晚上低烧(100~101F)两三天,白天没事,然后高烧(105~106F),精神
状态一直还好。周末在urgent care查尿诊断为尿道感染,见附件。后来去看儿医,说
喉咙有一点点发炎,身上还有疹子,可能还有病毒感染。
urgent care开了口服的cephalexin。儿医建议外加注射(ceftriaxone)以快速退烧,
于是打了三天针。去打第三针时已经不发烧了,儿医order了ultrasound,检查无异样。
几个疑问:
1)医生的处理是否合理?
2)kidney是否受到感染?ultrasound后问过儿医,kidney是没被感染,还是感染后治
好了,他答不上来,说结果都是一样的。
3)我要求口服药吃完后(10天),再查尿,儿医拒绝,说没有必要。说如用导尿管太
痛苦,直接接尿可能有污染影响结果。有必要坚持查尿或做别的检查吗?当初在urgent
care就是直接接的尿。 |
V**y 发帖数: 788 | 2 医生做的很合理,相信你的医生。
样。
【在 p*r 的大作中提到】![](/moin_static193/solenoid/img/up.png) : 一岁小孩,晚上低烧(100~101F)两三天,白天没事,然后高烧(105~106F),精神 : 状态一直还好。周末在urgent care查尿诊断为尿道感染,见附件。后来去看儿医,说 : 喉咙有一点点发炎,身上还有疹子,可能还有病毒感染。 : urgent care开了口服的cephalexin。儿医建议外加注射(ceftriaxone)以快速退烧, : 于是打了三天针。去打第三针时已经不发烧了,儿医order了ultrasound,检查无异样。 : 几个疑问: : 1)医生的处理是否合理? : 2)kidney是否受到感染?ultrasound后问过儿医,kidney是没被感染,还是感染后治 : 好了,他答不上来,说结果都是一样的。 : 3)我要求口服药吃完后(10天),再查尿,儿医拒绝,说没有必要。说如用导尿管太
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m****g 发帖数: 42 | 3 还行吧。但根据guideline,应该做个VCUG。再有,尿培养的结果如何?不要告诉我没送
培养吧?有培养结果和药敏结果的话,确实不需复查尿检。
样。
【在 p*r 的大作中提到】![](/moin_static193/solenoid/img/up.png) : 一岁小孩,晚上低烧(100~101F)两三天,白天没事,然后高烧(105~106F),精神 : 状态一直还好。周末在urgent care查尿诊断为尿道感染,见附件。后来去看儿医,说 : 喉咙有一点点发炎,身上还有疹子,可能还有病毒感染。 : urgent care开了口服的cephalexin。儿医建议外加注射(ceftriaxone)以快速退烧, : 于是打了三天针。去打第三针时已经不发烧了,儿医order了ultrasound,检查无异样。 : 几个疑问: : 1)医生的处理是否合理? : 2)kidney是否受到感染?ultrasound后问过儿医,kidney是没被感染,还是感染后治 : 好了,他答不上来,说结果都是一样的。 : 3)我要求口服药吃完后(10天),再查尿,儿医拒绝,说没有必要。说如用导尿管太
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r*****2 发帖数: 309 | 4 Boy or girl? First UTI or recurrent?
Per AAP guideline "Urinalysis cannot substitute for urine culture to document the presence of UTI but needs to be used in conjunction with culture."
Gold standard is urine catherization.
New UTI guideline is that if this is this child's first episode of UTI and
renal US is negative, VCUG is not necessory. However I just has a similar case on
the floor: 1 mo M with 1st episode of UTI. Discuss the case with PMD. Per
PMD, she discussed the new guideline with urologist. Most urologists highly
against the new UTI guideline (not sure if finance or politics involved in that, means no business to urologist any more?). Well to do VCUG or not, it's your PMD's call. Per new guideline, |
p*r 发帖数: 548 | 5 谢谢大家的回复,是一岁的男孩,第一次UTI,也是第一次生病。
有做urine Culture: Greater than 100,000 cfu/ml Escherichia coli
urgent care的医生和小孩自己的pediatrician都提到VCUG,跟你说的一样:第一次UTI
并且ultrasound检查没问题就不用做VCUG。
一个困惑的问题是:urgent care的医生好像是说等10天药吃完后再去做ultrasound;
为什么儿医地上天就叫做?
凭目前的检查到底能不能判断肾脏有没有受到感染?有没有后遗症?
还有,怎么预防复发?平时小孩照看得挺好的,小孩每天的奶喝得挺多的(~24oz).
document the presence of UTI but needs to be used in conjunction with
culture."
case on
highly
that, means no business to urologist any more?). Well to do VCUG or not, it
's your PMD's call. Per new guideline,
【在 r*****2 的大作中提到】![](/moin_static193/solenoid/img/up.png) : Boy or girl? First UTI or recurrent? : Per AAP guideline "Urinalysis cannot substitute for urine culture to document the presence of UTI but needs to be used in conjunction with culture." : Gold standard is urine catherization. : New UTI guideline is that if this is this child's first episode of UTI and : renal US is negative, VCUG is not necessory. However I just has a similar case on : the floor: 1 mo M with 1st episode of UTI. Discuss the case with PMD. Per : PMD, she discussed the new guideline with urologist. Most urologists highly : against the new UTI guideline (not sure if finance or politics involved in that, means no business to urologist any more?). Well to do VCUG or not, it's your PMD's call. Per new guideline,
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r*****2 发帖数: 309 | 6 same dilemma: Per AAP guildeline: prophylaxis is unnecessary.
However urologist still recommend. All depend on which doc u r seeing |
r*****2 发帖数: 309 | 7 same dilemma: Per AAP guildeline: prophylaxis is unnecessary.
However urologist still recommend. All depend on which doc u r seeing |
L*****i 发帖数: 237 | |