Urinary Retention due to sympathomimetic toxicity?

Discussion in 'Medical Students - MD' started by MedStudentM2, Dec 1, 2005.

  1. MedStudentM2

    MedStudentM2 New Member

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    Hi, this is a case study we were given and we need to figure out what's causing the problem. I'd appreciate suggestions! Thanks :)


    An 18-year-old man presented to the ED for evaluation of acute-onset urinary retention. According to the patient, he had attended a party the previous evening, where he consumed large amounts of alcohol. When he awoke the following morning he developed lower abdominal pain and the inability to void. On presentation, he was in mild distress and complained of suprapubic pain and a feeling of bladder fullness. His temperature was 38.3°C, heart rate 144 beats/min, blood pressure 145/93 mm Hg, and respiratory rate 18 breaths/min. The physical examination was significant for regular tachycardia, mydriasis, moist mucus membranes, suprapubic tenderness to palpation, and an obviously distended bladder verified by clinical examination and bedside ultrasonography. The patient had no alteration in sensorium, decreased bowel sounds, or lack of axillary sweat. Upon insertion of a Foley catheter, approximately 1.6 L of clear, yellow urine were obtained, which resulted in marked improvement of his discomfort. Laboratory evaluation showed normal renal function parameters. Urinalysis showed trace proteinuria and trace hematuria. At the request of the urology consultant, an abdominal/pelvis CT scan was obtained that demonstrated no structural abnormality or extravasation of contrast from the bladder. The patient denied ingesting any illegal substances but did state that he had taken two Sudafed tablets (pseudoephedrine hydrochloride 30 mg) within the previous day. He also said that he had been drinking alcohol the previous night and perhaps someone had “spiked” his drink. He was observed in the ED for approximately 8 h, during which time the signs resolved. The catheter was removed and the patient was able to void spontaneously. He returned the following day for scheduled follow-up. He was urinating without pain or hesitancy and had no further complaints.

    Questions:
    1) What do the clinical findings indicate; what physiological state is concomitant with these findings?
    2) What is a possible explanation for the patient's condition?
    3) What additional laboratory tests would you request? (note: certain tests carried out have been deleted from this record)
    4) What is the significance of the finding of normal axillary sweating?
     

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