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Acute pyelonephritis with vomiting — ABEM Board MCQ

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ModerateInfectious disease emergenciesAcute pyelonephritis with vomitingABEM Board

A 39-year-old woman arrives as ESI 2 with severe left flank pain, fever, and vomiting. BP 110/66, HR 118. Urinalysis shows pyuria; CT shows pyelonephritis without obstruction. She cannot tolerate oral intake. Which of the following is the most appropriate disposition?

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Correct answer: C — Admit or observe for IV antibiotics and hydration

Pyelonephritis with persistent vomiting and systemic signs requires IV antibiotics, hydration, and admission or observation depending on stability.

Reference: IDSA pyelonephritis guidance; ACEP infectious disease resources