Autonomic Dysreflexia - Possible UTI

[akaltz]

We have been having some problems this past week with out six-year-old daughter (T3-complete) and episodes of autonomic dysreflexia. On Monday she had a UA/C&S done because she was incontinent last weekend and her pediatrician thought maybe a UTI was causing AD (she had no other symptoms other than incontinence). On Tuesday night we started her on Septra; the sensitivities came back yesterday and she has an e-coli infection that is sensitive to Septra. But, she is still having problems with AD and incontinence. The past two days, we have also been having some problems with her urine volumes being inconsistent. We saw her physiatrist yesterday regarding the AD and he felt the cause could be a UTI and we should give the antibiotics more time to work. After our appointment with him Emma had another AD episode from a distended bladder 30 minutes after her previous cath. The past 24 hours we have kept a log of her urine output and I cathed her at the following times:
5 pm - 40 cc's
7pm - 20 cc's,
8 pm - 300 cc's (she was having AD);
9:30pm - 10 cc's
12am - 100 cc's and her pull-up was wet
3am - 40cc's and her pull-up was very wet
6:45am - 50cc's and her pull up was very wet
9:30am - 250cc's (she was dysreflexic again)

This morning we called her physiatrist and the Urology NP to talk again about what is going on. Her doctor thinks that for some reason her bladder is not draining properly and the UTI is not being resolved because of this. Since 10am we have been cathing her every 2 hours and tonight her doctor and urology nurse want us to use a foley catheter.

My questions are -
Emma has never had AD before with a UTI, why would this UTI cause so may problems with AD?

Emma didn’t have any other UTI symptoms besides incontinence, is it possible she doesn’t have a UTI and the AD and incontinence are being caused by something else irritating her bladder?

Do you know what could be keeping her bladder from draining completely during caths? Is it possible she may have an obstruction in her bladder that is blocking the flow of urine?

Thanks for your help.

Alison

[SCI-Nurse]

You are asking great questions and I am not sure what is going on. When your daughter does urinate and you cath her, her bladder emties pretty well. Yet, I see your concern in that the bladder is filling up again quickly or in fact you are not emptying the bladder with the catheterization. A blockage does not make sense, especially for it to occur all of a sudden. The indwelling catheter would eliminate the wetness, and in theory the AD, but would not help the UTI.

But, in saying that, if you put the indwelling catheter in for 24 hours, it would allow some respite for what you have been going through and if it did eliminate the AD, tell you that the AD was related to the bladder emptying.

Good luck.

Jm

[SCI-Nurse]

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