What is the workup for dizziness in a 14-year-old with a recent Upper Respiratory Infection (URI), decreased intake, and a confirmed Urinary Tract Infection (UTI)?

Workup for Dizziness in a 14-Year-Old with Recent URI, Decreased Intake, and Confirmed UTI

The primary workup for dizziness in a 14-year-old with recent URI, decreased intake, and confirmed UTI should focus on hydration status assessment and treatment of the underlying UTI, as dehydration is likely the main contributing factor to dizziness in this clinical scenario. 1

Initial Assessment

• Evaluate vital signs including orthostatic blood pressure and heart rate to assess for dehydration-related postural changes 1
• Assess mental status for any changes that could be related to UTI or dehydration 2
• Check for signs of decreased intake and dehydration:
  • Dry mucous membranes
  • Decreased skin turgor
  • Sunken eyes
  • Decreased urine output 2
• Evaluate for UTI-specific symptoms:
  • Dysuria
  • Frequency
  • Urgency
  • Suprapubic pain 2

Laboratory Workup

• Urinalysis to confirm UTI diagnosis and assess hydration status
  • Check for leukocyte esterase and nitrites (positive in UTI) 2, 3
  • Assess urine concentration (specific gravity) to evaluate hydration status 1
• Urine culture to guide antibiotic therapy for the UTI 4
• Basic metabolic panel to assess:
  • Electrolyte abnormalities that may contribute to dizziness
  • Renal function 5
• Complete blood count to evaluate for signs of infection 5

Management Approach

• Initiate oral or IV fluid rehydration based on severity of dehydration 1
• Treat the confirmed UTI with appropriate antibiotics:
  • For a 14-year-old, appropriate options include trimethoprim-sulfamethoxazole (8 mg/kg trimethoprim component daily divided every 12 hours) 6
  • Treatment duration typically 7-10 days for uncomplicated UTI 5, 4
• Monitor response to hydration and antibiotic therapy 2
• Reassess dizziness symptoms after initial hydration 1

Special Considerations

• Dizziness is a recognized symptom that can be associated with UTI, particularly when combined with decreased fluid intake 2
• The combination of recent URI and decreased intake likely exacerbates dehydration, contributing significantly to dizziness 1
• If dizziness persists despite adequate hydration and treatment of UTI, consider additional workup:
  • Evaluation for inner ear involvement from the recent URI
  • Consider neurological examination if symptoms persist 7

Pitfalls to Avoid

• Don't attribute dizziness solely to the UTI without addressing hydration status, as dehydration is likely the primary cause 1
• Avoid unnecessary imaging studies if the clinical picture is consistent with dehydration and UTI 7
• Don't delay antibiotic treatment for the confirmed UTI while working up dizziness 5, 4
• Remember that in adolescents, UTI symptoms may be more typical (dysuria, frequency) compared to the atypical presentations seen in very young children or elderly patients 2, 5