Friday, September 12, 2014

Writing a Character with a Kidney Stone

I have a character with severe abdominal pain and nausea. She is taken to the hospital by ambulance. She has kidney stones.
My questions are:

Would the medic and ER physician suspect kidney stones based on her symptoms?

Yes. Severe flank pain that radiates to the groin; sometimes passing blood in the urine; sometimes passing “Gravel” or “Sand” in the urine. A history of kidney stones also would point the way.

What tests would be administered in the ER to determine the problem?

Urine clean catch with microscopic exam—this will show traces of blood, even if not visible to the naked eye. A CBC (Complete blood count) to look for infection. Kidney stones can contribute to urinary tract infection. A kidney infection (called pyelonephritis) will cause a fever and sometimes cloudy urine, in addition to all the above. These patients need to be admitted for IV antibiotics.

If a fever is present, cultures will be taken from urine and blood.

An X-ray—KUB (Kidneys, ureters, bladder) to look for stones. Some kinds show up on X-ray.

It’s possible an IVP (Intravenous pyelogram) might be ordered. Dye is given through an IV line, and X-ray pictures are taken as the dye is excreted by the kidneys. Stones can appear as negative defects—no dye in those areas. As the dye travels from the kidney to the bladder via the ureter, a stone blocking the ureter will show up as a cut-off—the dye doesn’t get past.

Sometimes an IVP will help pass a stone, but it’s never ordered for that purpose.

I know people with kidney stones are discharged to go home and pass the stone. Not always. A lot of times we’d give them IV fluid to help wash the stone down to the bladder.

Is there ever a time they would be admitted and if so, why? Intractable nausea and vomiting, dehydration, high fever (101 or above), too-low blood pressure would all lead to admission. Kidney infection would lead to admission (see above) because of the need for IV antibiotics.

I want my character to spend the night at the hospital if realistically possible.
Would she be given pain medication to ease the pain? Yes.

If so when would that happen? As soon as they determine there’s no intra-abdominal disaster, like a ruptured appendix or something of that nature. The pain med would likely be morphine or Demerol, and would be given IV.

Would they need to do diagnostic tests first to determine the problem? Yep—see above.
Questions? Comments?
Kelly has worked in the medical field for over twenty years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it.
Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.
**Thanks to for the diagram

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