Puzzler for the holiday weekend

[Guest guest]

You are called to a local nursing home for a non-emergency transfer to the

local hospital for a 90 year old female long-term resident who is recovering

from multiple spinal fractures. Today her chief complaint is abdominal pain

and

constipation. She has a Foley in place, and you note that the urine in the

bag is a purple color.

She is afebrile and all vital signs within normal limits.

What's wrong with her?

Gene G.

**************

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[Guest guest]

WOW! Good going!

100% correct.

GG

**************

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[Guest guest]

Excellent questions. Read down for the answers.

GG

>

> Hmm, as others noted purple urine bag syndrome is definitely a factor

> here (likely secondary to the constipation with the foley cath). But,

> for the sake of being thorough, if it were my patient i'd probably get a

> bit more information about the abd pain/constipation, particularly if

> that was the chief complaint. Some things that would interest me.....

>

> Is she on any meds for her spinal issues (particularly narcotics)? Yes.

> She is on oxycontin.

> Last bowel movement / Stool discolorations? Last BM several days ago.

> Stool color not available from nursing home staff.

>

> Bowel sounds? Not done by ambulance crew. Location of abdominal

> pain?.General area of lower abdomen...rebound tenderness? Absent.

>

> As far as the urine...I'd be interested in knowing how often she has had

> foleys, when she got this one, when was the last time it was exchanged,

> etc. Foley last exchanged " several days ago. " Nursing home records do not

> record when the last change occurred. A good ol' fashioned UTI is probably

> at the heart of this

> problem, but that's the ED's job to do a culture. Yes, it turns out that

> culture grew p. aeruginosa and e. coli. After Foley was changed and she was

> put on anti-biotics this cleared up in three days and she was discharged back

> to the NH.

>

Thanks to all who participated. You are VERY SHARP.

GG

>

> wegandy1938@wegandy wrote:

> >

> > You are called to a local nursing home for a non-emergency transfer to

> > the

> > local hospital for a 90 year old female long-term resident who is

> > recovering

> > from multiple spinal fractures. Today her chief complaint is abdominal

> > pain and

> > constipation. She has a Foley in place, and you note that the urine in

> > the

> > bag is a purple color.

> >

> > She is afebrile and all vital signs within normal limits.

> >

> > What's wrong with her?

> >

> > Gene G.

> >

> > ************ *

> > Gas prices getting you down? Search AOL Autos for

> > fuel-efficient used cars.

> > (http://autos.http://autos.http://autos.<wbhttp://au

> > <http://autos.http://autos.http://autos.<wbhttp://au>)

> >

> >

[Guest guest]

PUBS....Purple Urine Bag syndrome.....seen in woman who are constipated, and

have been cathed..usually over an extended period.

The urine becomes alkaline and there is believed to be a urinary infection

(bacterial)

that produce sulphatase/phosphatase.

It is a rare syndrome seen most often in

women with chronic constipation and catheterization, as would probably take

place in a female with multiple spinal fractures.

jules

> You are called to a local nursing home for a non-emergency transfer to

> the

> local hospital for a 90 year old female long-term resident who is

> recovering

> from multiple spinal fractures. Today her chief complaint is abdominal pain

> and

> constipation. She has a Foley in place, and you note that the urine in the

> bag is a purple color.

>

> She is afebrile and all vital signs within normal limits.

>

> What's wrong with her?

>

> Gene G.

>

> **************

> Gas prices getting you down? Search AOL Autos for

> fuel-efficient used cars.

> (http://autos.aol.com/used?ncid=aolaut00050000000007)

>

>

[Guest guest]

Hmm, as others noted purple urine bag syndrome is definitely a factor

here (likely secondary to the constipation with the foley cath). But,

for the sake of being thorough, if it were my patient i'd probably get a

bit more information about the abd pain/constipation, particularly if

that was the chief complaint. Some things that would interest me.....

Is she on any meds for her spinal issues (particularly narcotics)?

Last bowel movement / Stool discolorations?

Bowel sounds? Location of abdominal pain?...rebound tenderness?

As far as the urine...I'd be interested in knowing how often she has had

foleys, when she got this one, when was the last time it was exchanged,

etc. A good ol' fashioned UTI is probably at the heart of this

problem, but that's the ED's job to do a culture.

wegandy1938@... wrote:

>

> You are called to a local nursing home for a non-emergency transfer to

> the

> local hospital for a 90 year old female long-term resident who is

> recovering

> from multiple spinal fractures. Today her chief complaint is abdominal

> pain and

> constipation. She has a Foley in place, and you note that the urine in

> the

> bag is a purple color.

>

> She is afebrile and all vital signs within normal limits.

>

> What's wrong with her?

>

> Gene G.

>

> **************

> Gas prices getting you down? Search AOL Autos for

> fuel-efficient used cars.

> (http://autos.aol.com/used?ncid=aolaut00050000000007

> <http://autos.aol.com/used?ncid=aolaut00050000000007>)

>

>