Correct!
2. The abdominal CT scan shows the balloon of the Foley catheter in the penis with a distended bladder.

The chest x-ray does not show any definite areas of consolidation. Although repeated fluid boluses were at one time the gold standard for sepsis care, more recent evidence suggests that this might be harmful (5-8). The abdominal CT scan shows the Foley balloon in the penis and the bladder grossly distended. Replacement of the Foley yielded 2 liters of urine. Despite the intervention the patient did poorly and eventually his family wished to withdraw care. A take home point is that in acute renal failure, some imaging technique (ultrasound is often the easiest) should be done to assess for obstruction (9).

References

  1. Woods CR. Epiglottitis (supraglottitis): Clinical features and diagnosis. UpToDate. May 3, 2017. Available at: https://www.uptodate.com/contents/epiglottitis-supraglottitis-clinical-features-and-diagnosis (requires subscription, accessed 10/23/17).
  2. Geelhoed GC, Macdonald WB. Oral and inhaled steroids in croup: a randomized, placebo-controlled trial. Pediatr Pulmonol. 1995 Dec;20(6):355-61. [CrossRef] [PubMed]
  3. Bjornson CL, Klassen TP, Williamson J, et al. A randomized trial of a single dose of oral dexamethasone for mild croup. N Engl J Med. 2004 Sep 23;351(13):1306-13. [CrossRef] [PubMed]
  4. Bjornson CL, Johnson DW. Croup in children CMAJ. 2013 Oct 15; 185(15):1317-23. [CrossRef] [PubMed]
  5. Durairaj L, Schmidt GA. Fluid therapy in resuscitated sepsis: less is more. Chest. 2008 Jan;133(1):252-63. [CrossRef] [PubMed]
  6. Maitland K, Kiguli S, Opoka RO, et al. Mortality after fluid bolus in African children with severe infection. N Engl J Med. 2011 Jun 30;364(26):2483-95. [CrossRef] [PubMed]
  7. Andrews B, Semler MW, Muchemwa L, et al. Effect of an early resuscitation protocol on in-hospital mortality among adults with sepsis and hypotension: a randomized clinical trial. JAMA. 2017 Oct 3;318(13):1233-40. [CrossRef] [PubMed]
  8. Raschke RA, Kayani A, Sultan S, Fountain S, Abidali M, Henry K.  Fluid resuscitation for septic shock – a 50-year perspective: from dogma to skepticism. Southwest J Pulm Crit Care. 2016;13(2):65-70. [CrossRef]
  9. Biruh T Workeneh BT. Acute kidney injury workup. Medscape. January 13, 2017. Available at: https://emedicine.medscape.com/article/243492-workup (accessed 10/23/17).

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