Physical Examination and Workup
Upon physical examination, the patient has a temperature of 98.2 °F (36.8 °C) and a heart rate of 83 beats/min, with a sinus rhythm. His blood pressure is 147/68 mm Hg, and his respiration rate is 18 breaths/min, with unlabored breathing. His oxygen saturation level on room air is 97%.
The patient is awake, alert, and oriented. His head is normocephalic, and no evidence of trauma is noted. The lungs are clear to auscultation grossly throughout and bilaterally. No heart murmurs are detected. Pedal edema is not present upon inspection. The patient has active bowel sounds. Suprapubic fullness is noted, along with tenderness to palpation of that region.
Urinalysis shows no abnormalities aside from the presence of red blood cells (RBCs). RBC casts are not present. Figure 1 shows a similar gross urine specimen.
A CT of the abdomen and pelvis with contrast reveals bilateral hydronephrosis. Further evaluation reveals distention of the bladder, which contains a large volume of clot. A small collection of hemorrhage is noted in the posterior aspect of the clot.
Laboratory studies reveal the following values:
White blood cell (WBC) count: 10,000 cells/µL (reference range, 4000-11,000 cells/µL)
Hemoglobin level: 7.7 g/dL (reference range, 13.5-17.5 g/dL)
Hematocrit: 23.1% (reference range, 41%-50%)
Creatinine level: 1.7 mg/dL (reference range, 0.9-1.3 mg/dL)
Blood urea nitrogen level: 34 mg/dL (reference range, 8-24 mg/dL)
International normalized ratio: 1 (reference range, 0.9-1.2)
Prothrombin time: 11 sec (reference range, 11.0-12.5 sec)
Partial thromboplastin time: 35 seconds (reference range, 60-70 sec)
Creatine kinase level: 25 U/L (reference range, 55-170 U/L)
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