So I know I am being unreasonable but does this seem a bit silly (doctor at hospital £

[Proudandlovable0201]

So DD ( 5 ) who does have complex needs including a central line and suspectiple to sepsis
Came in to hospital 12 days ago with a suspected uti.
Dip stick was positive in a&e and because her central line and history admitted her for iv antibiotics.
Blood cultures were then also positive so ended up having to stay on IV antibiotics.
Anyway after 2 says dip stick etc was clear however she has still been complaining her wee is hurting.
So we have been checking the dipsticks and all good.
Finished iv antibiotics yesterday today the consultant who has now gone home ( specialist one ) asked for a repeat urine dip as she is still complaining.
We are due to go home today.
Got her to eventually wee and is positive again for lueckocytes after 24 hours OFF iv antibiotics.
Nurse rang junior doctor, and they said still send her home if she gets worse again bring her back can’t give her oral antibiotics ( she doesn’t absorb ) and we have already done her discharge summary however they will send the urine off.

How junior was the doctor?!

Speak to a more senior doctor.
If able to, encourage DD to drink lots.
If necessary, refuse to be discharged.

So the issue is she can’t drink she is completely iv dependant. I can’t up fluids to more than she is in without permission.
They have just come back as I demanded to speak to her face to face she said
That just because their is white blood cells doesn’t mean there is an infection
So I asked what would cause the stinging and soreness when she goes plus the positive luekocytes
“ well white blood cells done always mean infection “
Again I repeated but with the symptom of also being in pain when weeing 🙈
We are off home now.

In hospitals there are consultants and junior Drs so a junior Dr can be senior. What level of junior Dr - an foundation y1 ir Y2 or one on the training programme to consultant and what year. If fy Dr then maybe seek second opinion

She was a SHO.

We have SHO , registrars and consultants

Dipsticks are not very accurate so I would be asking for bloods to be done

Presumably the sample sent off to the lab cane back clear?

Have u asked whether there is a home IV service in your area?
In my area both children’s and adult community nurses offer home IV service in order to prevent hospital admissions and obviously some do better in their own environment. May be worth checking if bloods return positive for a further infection

Tricky. That is very positive for leukocytes. Has she got any other signs of infection? Presumably her observations were normal?

Are you in the UK? SHO is equivalent to to FY2, which is a supervised position. Their practice is overseen by a consultant but not to a micro managed level.

I would definitely ask for a 2nd opinion or to speak to the supervising consultant. They are supervised for a reason. It's still only their 2nd year of clinical practice. Taking clinical rotations in to account, best case scenario is they rotated in to Pediatrics in August 18 and will finish this rotation in Feb 19. Worst case, they are on a 3 month rotation pattern and have even less experience.

Parents are the experts in their children when those children have long term complex medical needs.

Actually SHO CAN cover up to and including ST3 in Paediatrics

If the blood cultures are now clear and she isn't requiring IV antibiotics I think it does make sense to send her home. She sounds vulnerable to picking up another infection which she's more likely to do in hospital than at home. Keep a close eye on her at home as they say and if she gets worse and needs a further course of antibiotics she'd need to be readmitted. I know it's an upheaval but better that than a further hospital stay and more IV antibiotics now if she doesn't definitely need them. Reading between the lines of your post it sounds like she has a long term condition which may mean course of antibiotics later down the line. You don't want her becoming resistant to drugs she may depend on later. Hope all goes well for you both.

Is this at your local hospital? You shouldn’t take any risks with a central line and with those levels of leukocytes I would make sure you see someone else.

Actually I would contact your specialist consultant. Which hospital are you linked with? Although my consultant isn’t available at weekend there is always an on call endocrinologist and gastroenterologist to talk to.

What about asking the staff to give the Consultant a ring to check if he’s happy with the discharge? My dh is a Consultant and wouldn’t mind taking a call like that when he’s off duty. Tbh when you’re the Consultant you’re never really off duty as the buck ultimately stops with you.

Are they your own dipsticks? How long have they been open?
I find leukocytes always positive on sticks that have been open too long. Test with a fresh batch. Needs MSU anyway.

(Doctor)

Dipsticks aren't actually hugely useful in the assessment of UTI. There are lots of other factors I'd look at as well (though I'm a GP, not a paediatrician). Was an MSU sent this admission? Has one been sent now the dipstick is positive again? Was the bug found in the blood culture a bug likely to be from a UTI? Lots of other things can cause pain on urinating, like thrush or worms - have they been considered?

If you're not happy, by all means ask to speak to a senior doctor, but do listen to what that senior doctor says. Dipsticks aren't the be-all and end-all.

SHOs and regustrars are still classed as junior Drs - when juniors went on strike it affected all hospital Drs except consultants. Being called a junior Dr is an anomaly as it does include Drs with decades of experience

I have high leukocytes and blood in my urine for months after an infection, and often stinging too. The solution really is to drink more until it goes away. If that's not possible for your DD and she's built like me, it might be that she has positive dipsticks for a while yet.

I had a kidney infection in November and am still getting positive dipsticks now. If they follow the normal pattern; they'll start to clear up in early February. I don't know why, but it always seems to go that way.

Keep a close eye on her, bless her. Did the sepsis results come back clear?