One mystery down...another just started

My mystery lady has died.
She died on Friday, about 3 hours after I left the ward.
As we did not know what she had died of, she was required by law to have a post-mortem (PM). I have not heard the full report of the PM, but from what I hear, she died of uro-sepsis - ie a urinary tract infection that went on to infect her blood, and thus effectively the rest of her body. And where did she get the urinary tract infection from? From her 'back passage' as the anus is euphemistically known - the commonest place of origin for most UTIs.
Also lurking in her anus, as I mentioned earlier was a lot of faeces.
So basically, this lady had a lot of waste matter, which would have impeded the flow of urine and simultaneously was a source of infection, and in her debilitated state, it became a bacteraemia.
Could anything have been done?
She had been treated, just a few days before she suddenly went downhill, for a UTI. But she was catheterised, and so was prone to infections. Removing the catheter was not an option, as when it was done the last time, she went into retention, and was not able to tell whether or not her bladder was full. So I don't think anything could have been done. In fact I'm wondering whether she would have met a more merciful death had we not gone full steam ahead with all our investigations and treatments. But, in the end, she has passed away. I hope she rests in peace.

As for the other mystery. He is pretty much like this lady - he was really ill when he came in - about 2 months ago. Since then, he has been well over the past 2-3 weeks, and was able to come out of isolation (he had had MRSA, and so was in a room on his own, until the infection was cleared). We were getting ready to send him to a nursing home, and were making sure he was well nourished (a lot of hospital patients are under-nourished - await a posting on this) and giving him some physiotherapy, as his muscles were quite wasted after lying in bed for weeks.
Then all of a sudden, he stopped responding - calling out his name, rubbing over his chest with my knuckles (painful), pressing over his eyebrow (even more painful), did not even elucidate a grunt. And he was having episodes where he would just stop breathing, and his heart would start racing and then he would breath again and his heart rate would slow down.
As with the other lady, we did a battery of tests - ECG-normal, chest x-ray- ?normal, full blood count - normal, U&Es - not so bad, arterial blood gases - metabolic alkalosis!
But the question is - why does he have a metabolic alkalosis.
The commonest causes of metabolic alkalosis are:
(i) losing acid
- via the GIT - due to: vomiting, villous adenomas (a mostly benign type of tumour) or ileal conduits (where a loop of ileum is used as a bypass for the bladder).
- via the kidneys - due to: severe potassium depletion, diuretics, hyperaldosteronism, Cushings or cystic fibrosis (due to Bartter's syndrome - no idea what that is)
(ii) gaining alkali
- taking too much sodium bicarbonate (either over prescribed, or I assume eating it?)
(iii) early sepsis (not really sure how)
(iv) ethylene glycol poisoning (definitely not the cause in this case)
On reivewing his bloods, the only issue is that he has a low potassium of 2.8 - the normal is between 3.5 and 5.5; and he was on diuretics. So we've stopped the diuretics and are giving him potassium.
But now he is not swallowing, and is choking. I think he also has a bit of a droop on one side of his mouth, but that is the only weakness I can see, although it is difficult to assess him, as he is drowsy (? due to the high potassium) and cannot co-operate.
So today he had a nasogastric tube, so that he can get some calories, as he is only going to get even more weaker if he continues on like this.
Its such a heartsink case, because I've seen him deteriorate over months (he was here when I was shadowing) and I have a feeling that he is going to remain on the ward until he passes away. I hope that the rest of his mortal life will not be too harrowing.