Patients come with altered mental status from NH, neurological symptoms resembling stroke, fever, sepsis, weakness, N/V, Abdomen pain, altered mental status [encephalopathy]
ER:
Routine labs, EKG, CXR, CT head is done lot of times due to altered mental status
IV Fluids as lot of patients present with decreased renal function with this condition
Blood Cultures
UA
First dose antibiotic-IV Ceftriaxone preferred in hospitals than IV Cipro due to higher resistance to Cipro. [These sensitivities depend on your institution]
Hospitalist:
Continue IV fluids if required based on Kidney function
Continue IV antibiotics – Cipro, Ceftriaxone, or Levofloxacin,
NPO if altered mental status
PT/OT if too weak
Foley catheter and Urology evaluation for obstruction/Hydronephrosis
Some patients may have Hematuria on admission which usually gets better with treatment of UTI
If patient has chronic indwelling foley, document “UTI due to chronic indwelling foley” in your notes. The ER usually exchanges old foley catheter with a new one in these cases.
