Sally Smith iHuman Case Review – Type 1 Diabetes and Painful Urination
This week, we are reviewing the Sally Smith iHuman case study, which presents a complex clinical scenario involving a 34-year-old woman with type 1 diabetes mellitus (T1DM) experiencing urinary symptoms and systemic complications.
Sally Smith iHuman Case Review Overview
Sally arrives with dysuria, frequency, urgency, dark-colored urine, right flank pain, decreased appetite, new-onset chills, and loss of glycemic control over the past two days. Her physical exam reveals a fever of 101.6°F, tachycardia (HR 110), orthostatic hypotension, suprapubic tenderness, and a positive right flank “punch” test, indicating possible kidney involvement.
Key Considerations
Given Sally’s history of type 1 diabetes and renal calculi, she is at a higher risk for complicated urinary tract infections (UTIs), pyelonephritis, or even urosepsis. Her new sexual partner and inconsistent condom use raise concerns for sexually transmitted infections (STIs), which could present with overlapping symptoms.
Differential Diagnoses
- Pyelonephritis – Fever, flank pain, and urinary symptoms suggest kidney infection, especially in a diabetic patient with poor glycemic control.
- Nephrolithiasis with Infection – A history of renal calculi makes infected kidney stones another possibility.
Clinical Takeaway
This case highlights the importance of rapid diagnosis and treatment in a diabetic patient with urinary symptoms. Delays in care could lead to sepsis, worsening kidney function, and further glycemic instability. It also underscores the need for comprehensive history-taking, targeted testing (urinalysis, urine culture, STI screening), and early antibiotic therapy.
For healthcare students and professionals, the Sally Smith iHuman case study is a great tool for sharpening clinical reasoning skills in infectious diseases, nephrology, and endocrinology.
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