1

USTH-Clinical Division Hematology-Oncology-Rheumatology Census April 20, 2010 (Tuesday)

HEMATOLOGY / ONCOLOGY / RHEUMATOLOGY
Total Number of patients: 4
Main: 4
Co-managed:
Referrals:
Admissions:
Discharged:
Expired:
DAMA:
Transferred: / Main:
205A
205B
205G
205H
Referral: / Total Number of patients: 6
Main: 6
Co-managed:
Referrals:
Admissions:
Discharged:
Expired:
DAMA:
Transferred: / Main:
205E
205F
207H
211F
213B
213E
Referrals: / Total Number of patients: 5
Main: 2
Co-managed:
Referrals: 3
Admissions:
Discharged:
Expired:
DAMA:
Transferred: / Main:
205C
217F
Referrals:
207B
213A
213G

HEMA-MAIN

PATIENT / DIAGNOSIS / MEDICATIONS / LABORATORIES/ANCILLARIES / PENDING / REFERRAL
205A
Santos, Teresita
55/F
10D00391
06-22-26
Admitted: April 17, 2010
CC: Easy fatigability
CIC: Jessy
Alt: Ampee/Martin/Arvin / CLL / Prednisone 40 mg/tab OD
Omeprazole 20mg/tab OD
Hydroxyurea 500mg/tab TID
Allopurinol 300mg/tab OD
NaHCO3 tab TID / 4/19 hgb 90, rbc 2.78, hct 0.28, mcv 100.5, mch 32.5, mchc 32.3, rdw 15.6, mpv 7.4, platelet 100, wbc 133.80
4/17 hgb 38, rbc 1.00, hct 0.12, mcv 116.40, mch 37.8, mchc 32.5, platelet 112 wbc 105.5
4/17 ABO Group/Rh typing “O” positive
4/13 hgb 43, rbc 1.20, hct 0.14, mcv 115.40, mch 36, mchc 31.2, platelet 105 wbc 103.1
205B
Pahuwayan, Margarita
63/F
10D00392
06-64-36
Admitted: April 17, 2010
CC: generalized body weakness
CIC: Pai
Alt: Aby/Joanne/Pam / Acute myelogenous leukemia / Paracetamol 500mg/tab
Diphenhydramine 50mg/cap
Buscapan 10mg/tab q8h / 4/19 hgb 95 rbc 3.71, hct 0.31, mcv 82.3, mch 25.5, mchc 31.0, rdw 16.6, mpv 7.0, plt 40, wbc 4.90
4/19 Na 136.18 K 3.69, ionized calcium 1.68
4/19 hgb 99, rbc 3.44, hct 0.29, mcv 85.5, mch 28.70, mchc 33.5, rdw 16.7, mpv 5.9, platelet 313, wbc 11
4/19 Left perirenal fat stranding maybe secondary to an inflammatory process. Splenomegaly. Possible uterine myoma, sonographic correlation is suggested. Atheromatous aorta. Interstitial pneumonitis, both lung bases with a small calcified pulmonary nodule, right lower lobe that can be due to a ghranuloma. Degenerative changes with slight levoscoliiosis.
4/19 Na 137.21, K 3.44, ionized calcium 1.77
4/17 BT reaction (+) patient’s oxalated blood pre and post-transfusion, no hemolysis in patient’s clotted and oxalated blood
4/17 ABO Group/ Rh typing “O” positive, crossmatching compatible in 3 phases
4/17 CBC hgb 65 rbc 2.86 hct 0.23 mcv 80.7 mch 22.9 mchc 28.3 platelet 30 wbc 4.5
4/17 BUN 14.13 crea 0.78
4/17 ECG normal sinus rhtyhm
4/17 urinalysis urine yellow slightly turbid pH 5 pus cell 3-6/hpf / Gynecology
205G
Abucayon, Melania
61/F
10CC00708
064203
Admitted: March 31, 2010
CC: edema of R lower extremity
CIC: Charx
Alt: Kevin/Mark/Ivan/Jan / R lower extremity lymphedema 2 to obstruction by right inguinal multiple lymphadenopathies
t/c Lymphoma
HTN st 1
DM type 2
Immature cataract OU
HPN retinopathy gr 1 OU
Pathologic diagnosis: acute and chronic non-specific inflammation w/ liquefactive necrosis (abscess) / Metformin 500mg/tab TID
Omeprazole 40mg/tab OD
Lactulose 30cc OD
Paracetamol 500mg/tab q4 for temp >38.5
Dexamethasone 4mg/tab TID
Allopurinol 300mg/tab OD
Calcitonin 40 ‘U’/SC TID
Furosemide 10mg/tab BID
Clindamycin300mg/IV q6hr. / 4/19 Na 134.66, K 3.76
4/17 Na 137.21K3.44 iCa 1.77
4/15 Na 134 K 2.53 iCa1.69
4/12 uric acid 2.20, iCa 1.48
Hgb 92, hct 0.28, plt 248, wbc 7.10, neut 0.84, lymp 0.15
4/10 Na 131 K 3.91 iCa 1.46
4/8 Na 137.22 K 3.54 Crea 0.75
4/8: iCa 1.72
4/6: Na 140 K 3.58 iCa 1.81
4/5 Crea 0.72
4/4 iCa 1.64, PTH 1.2
4/2 Chol 132.39 Trigly 114.85 HDL 18.52 LDL 91.6 Na 135 K 3.79
4/1 SGPT 8.49 LDH 404.06 iCa 1.61 HbA1C 7.8
3/31 Hgb 100 Hct 0.29 wbc 3.5 plt 365 seg 0.68 lympho 0.29 eos 0.03
3/31 BUN 12.41 Crea 0.76 Na 130.96 K 3.77 iCa 1.58
3/31 UA yellow sl turbid ph 5(-) albumin (++) sugar few sq cell few bacteria (+) mucus (++) calcium oxalate / For chest CT with contrast
For Venous duplex scan and CT scan / Referral: GS
Optha Dietary
205H
Alabat, Ricardo
53,M
10D85433
06-50-54
Admitted: April 19, 2010
CC: generalized body weakness
CIC: Kevin
Alt: Charx, Ivan, Mark, Jan / t./c Acute leukemia vs. aplastic leukemia / 4/19 hgb 36, rbc 1.31, hct 0.11, mcv 80.10, mch 27.3, mchc 34.10, rdw 26.7, mpv 6.10, platelet 20, wbc 8.70
4/19 Dark yellow clear urine. Ph 5, sp. Gr. 1.025, (-)albumin, (-) sugar, 0-2/hpf pus cell, bacteria few, mucus threads few

HEMA referral

PATIENT / DIAGNOSIS / MEDICATIONS / LABORATORIES/ANCILLARIES / PENDING / MAIN SVC

ONCO-MAIN

PATIENT / DIAGNOSIS / MEDICATIONS / LABORATORIES/ANCILLARIES / PENDING / REFERRAL
205E
Nucum, Edilberto
57,M
10D00441
04-51-57
Admitted: April 19, 2010
CC for chemotherapy
CIC: Arvin
Alt: Ampee, Bobby, Marts / Recurrent fibrous histiocytoma thigh, left s./p above the knee amputation; SAH stage I, controlled / 4/19 hgb 124, rbc 5.69, hct 0.39, mcv 69.3, mch 21.7, mchc 31.4, rdw 15.1, mpv 6.60, plt 332, wbc 8.70
4/19 creatinine 1.31, SGOT 18.69, SGPT 20.12
205F
Chagan, Ronald
44/M
10D00450
05-40-16
Admitted: April 19, 2010
CC: for 4th cycle of chemotherapy
CIC: Mark
Alt: Iva, Charx, Kev, Jan / Spindle Cell Sarcomsa right posterior thigh s/p 25 cycle radiotherapy and 3 cycles of chemotheraphy / 4/19 hgb 109, rbc 3.87, hct 0.34, mcv 86.8, mch 28.3, mchc 32.6, rdw 19.7, mpv 5.7, platelet 572, wbc 6.8
4/19 creatinine 0.69 SGOT 17.35, SGPT 15.03 / Sodium, Potassium
207H
Cuevas, Jayson
20/M
06-47-89
10-00268
Admitted: April 14, 2010
CC: difficulty of breathing
CIC: Kevin
Alt: Charx/Ivan/Jan/Mark / Anterior mediastinal mass probably 1) lymphoma
2) malignant GCT
r/o SVC syndrome vs cardiac tamponade / Flumicil 600,g/tab TID
NaHCO3 gr x tab 1 tab BID
Allopurinol 300mg/tab 1 tab OD
Lactulose 30cc ODHS
Dexamethasone 5mg/IV
Paracetamol 500mg/tab PRN for pain / 4/17: crea 0.6 mg/dl, Na 142.21 mmol/l, K 4.2 mmol/l
4/13: Hgb 119 hct 0.36 wbc 6.60 plt 339 seg 0.15 lympho 0.23 eos 0.02
BUA 7.09 crea 3.79 LDH 973.48 Na 135.52 K3.79 AFP 1.47 B-HCG 0.65
BUA: 8.8 iPo4 4.29 iCa 1.24
UA: dark yellow, sl turbid, 5.0, 1.025, albumin (-), sug (-), rbc 0-3, pus 0-1, sq cell few, BAC FEW, mt ++++, au ++
Uric acid 8.80 iPO4 4.29 iCa 1.24 / Results from incisional biopsy of cervical LN / Comanaged: Cardio
Referral:
TCVS, Anes
211F
Galicha, Emilia
61/F
06-30-15
10D00311
Admitted: April 16, 2010
CC: Dyspnea
CIC: Joanne
Alt: Pai/Abi/Pam / Metastatic Breast Ca Stage IV
Community-Acquired Pneumonia / Flumicil 600mg/tab TID
T>38.5C
Losartan 50mg/tab OD
Amlodipine 5mg/tab / 4/19 Culture: Klebsiella pneumoniaesensitive to co-amoxiclav, ciprofloxacin, sulbactam-ampicillin, cefazoling, gentamycin, tobramycin, imipenem, piperacillin-tazxobactam,
tmp-sulfamethoxazole
4/19 Na 138.63 K 3.92
4/19 hgb 110, rbc 3.82, hct 0.34, Mcv 87.8, mch 28.8, mchc 32.8, rdw 15, mpv 6.9, plt 244, wbc 7.6
4/17 sputum gram stain: few gram (+) cocci in pairs, 15-20/lpf PMNs, >25/lpf squamous epithelial cells
4/16 CBC hgb 122 rbc 4.25 hct 0.38 mcv 89.1 mch 28.8 mchc 32.3, platelet 247
4/16 Na 137.57 K 3.68
4/16 ABG pH 7.49, pCO2 40.3 pO2 66.7, Temp 37C, FiO2 21% / For discharge
213B
Domingo, Artemio
55/M
10D00158
06-45-55
Admitted 4/7/10
CC: RUQ pain
CIC Arvin
Alt: Martin/Jessy/Ampee / Rectal Adenocarcinoma / Godex 2caps TID
Tramadol 80mg/cap
Vit K 10mg/tab
Omeprazole 10 mg/tab TID
Domperidone 10mg TID / 4/16: hgb 108 hct 0.34 plt 200 wbc 17.70, neut 0.79 lymp 0.18, eosino 0.01 Alk phos 926.71, ALT 101.93 AST 295.65, TB 29.43, B1 20.68, B2 5.11
4/13: HbsAG 0.699 non reactive Anti-HCV 0.241 non reactive
4/12 PT 31.7 NC 12.1 PR 2.6 INR 2.6
4/11 hgb 122 hct 0.36 plt 290 wbc 19.80, neut 0.9 lymp 0.08, eosino 0.02
4/8 UA: dark yellow, slightly turbid, pH 5.0, SP Gr 1.020, (+) alb, (-) sugar, 8/coverslip hyaline cast, 25/coverslip granular cast, 0-1 RBC/hpf, 6-8 pus/hpf, (+) sq cell, (++) bactéria, (++) muçus threads, (++) AM urates
4/8: CT(official): Anterior rectal wall mass partially filling the rectal lumen, w/ minimal anterior perirectal fat extension, soft tissue stranding and small nodularities; hepatomegaly w/ mulitple nodularities that may represent metastases; minimal diffuse ascites; ileal and slight fecal retension; enhancing nodules at the visulaized basal lung areas, consuder pulmonary metastases; subtle L4 & S4 osteosclerotic features, as described.
4/7: Crea 0.52, Alk phos 879.55, ALT 87.04, AST 240.08, TB 18.38, B1 3.31, B2 16.07, Na 131, K 4.88,
Hgb 114, Hct 0.36, plt 220, WBC 20.90, Neutrophils 0.85, lympho 0.0.12
UA RBC 0-1/hpf, Pus 6-8/hpf / Referral: Derma
213E
Catuluna, Joseph
50/M
10D00357
04-83-73
Admitted 4/16/10
CC: vomiting
CIC Ampee
Alt: Martin/Jessy/Arvin / Esophageal squamous cell CA (T4N1M0)
Infected tracheostomy tube / Flumucil 600mg/tab TID
Piperacillin-Tazobactam 4.5g/IV
Paracetamol 500mg/tab q4 for temp >38.5
Dolcet tab q8 for pain / 4/19: Heavy growth of Pseudomonas aeruginosa, sensitive to amikacin, imipenem, tobramycin, ceftazidime, gentamycin, meropenem, cefepime, piperacillin-tazobactam
4/17: wound specimen, gram stain showed few gram (+) cocci in pairs, pus cells
4/16: Na 134 mmol/l, K 4 mmol/l
4/16: BUN 22.04, crea 1.18 / Referral:
Neurology

ONCO-referral

PATIENT / DIAGNOSIS / MEDICATIONS / LABORATORIES/ANCILLARIES / PENDING / MAIN SVC

RHEUMA-Main

PATIENT / DIAGNOSIS / MEDICATIONS / LABORATORIES/ANCILLARIES / PENDING / REFERRAL
205C
Esteban, Paul Ryan Obra
26/M
10D00029
06-43-28
Admitted: April 5, 2010
CIC: Aby
Alt: Pai/Pam/Joanne / HSP, Sepsis secondary to HAP / Betamethasone 1ml/IM
Metoclopramide 10 g in 10cc PNSS/SIVP q8h PRN
Paracetamol 300 mg IV q4h prn for temp >/= 37.8 C
Calmoseptin ointment prn
Vit K 10mg/IV
N-acetylcysteine 600mg/tab q12
Rebamipide 100mg/tab TID
Calcium + Vit D tab BID
Esomeprazole 40mg/tab OD
Azithromycin 500mg OD / 4/19 Creatinine 0.66, Na 150.29, K 2.88, ionized calcium 1.03
4/19 Hgb 136, rbc 4.4, hct 0.4, mcv 90.8, mch 30.8, mchc 34, rdw 14.9, mpv 9.0, platelet 100, wbc 5.50
4/19 hgb 107, rbc 3.49, hct 0.32, mcv 90.80, mch 30.60, mchc 33.70, rdw 14.6, mpv 8.4, platelet 100, wbc 4.0
4/19 hgb 65, rbc 2.02, hct 0.19, mcv 94.60, mch 32.3, mchc 34.20, rdw 13.70, mpv 9.10, platelet 220, wbc 4.0
4/19 Na 144.11 K 2.39
4/17 ABG pH 7.467, pCO2 32.3, pO2 390.1 HCO3 23.3 dFiO2 21.2% P/F 487
4/17 HGB 65 HCT 0.19
4/14 HGB 39 HCT .12
4/13 Na 147.17 K 4.29 HGB 56 HCT 0.18
4/11 Hgb 75 Hct 0.22
Na 137.38 K 2.64 Crea 0.59 BUN 21.30
PT 12.4 INR 1 aPTT 34.7
4/10 Hgb 97 Hct 0.29 Plt 300 WBC 10.30, Seg 0.87 Lym 0.11 Bands 0.02
4/10 UA yellow turbid pH 6.5 sp gr 1.015 albumin +++ sugar negative hyaline 10/coverslip granular 20/coverslip RBC *70-80/hpf pus cell 40-50/hpf sq cell few bacteria + amorphous urate few
4/8 Na 138 K 2.50
4/8 Blood CS no gowth after 5 days
4/7 hgb 77 hct 0.23 crea 0.57 iCa Na 139 K 2.84
4/7 CXR progression of confluent infiltrates over L perihilar region, confluent alveolar densities over R lung, veil-like haziness over R lung field; I> pneumonia in progression and pleural effusion, R
4/5 Hgb 95 hct 0.28 plt 229 WBC 12.60 segs 0.70 band 0.02 lym 0.24 myelo 0.02
4/2 CBC Hgb 27 hct 0.08 plt 368 WBC 32.40 segs 0.56 met 0.02 bands 0.29 lym 0.09 myelo 0.04 retic 64.0 peripheral smear WBC presence of immature cells with marked stabosis and poikilocytosis RBC: hypochromic with anisoytosis
4/2 blood type O+
4/2 BUN 28.67 crea 0.82 Na 121 K 2.5
4/2 U/A yellow turbid 5.0 1.010 Alb + Sugar – gran casts 03/coverslip RBC 2-4/hpf PUS 3-8/hpf epithelial ++ Bac + amorphous urate +++
4/2 PT 28s aPTT 59.6
4/2 ABG 7.4 PCO2 19 PAO2 227 HCO3 13.6 dFiO2 31% p/f 265 / Blood culture and sensitivity at 2 different sites / Co manage GI
Nephro
Pulmo
Refer back to
Gen Surgery
217F
Reyes, Eliseo
47/M
10D0055
06-49-46
Admitted: April 16, 2010
CC: joint pain
CIC: Martin
Alt: Arvin/Ampee/Jessy / Chronic tophaceous gout / Colchicine 0.5mg/tab OD
Paracetamol 500mg/tab q4h for T>=38.5
HR 3 tabs OD
Cold compress over affected joints
Tramadol 50mg/cap q8h / 4/19 Dark yellow, slightly turbid. pH 6.5 sp.gr. 1.010, (+) albumin, (-0 sugar. RBC 2-4/hpf pus cell 0-1/hpf, few squamous cell, bacteria, mucus threads. (++) amorphous urste
4/18 HGB 86 RBC 3.50 HCT 0.26 MCV 75.10 MCH 24.60 MCHC 32.80 RDW 22.50 MPV 6.30 PLATELET 450 WBC 12.30 ; neutron 0.90 seg 0.90 lympho 0.07 mono 0.01 eosino 0.02
4/17 occult blood negative
4/17 crea 1.42 Na 136.4 K 4.22
4/17 ABO group/RH typing “B” positive crossmatching compatible in 3 phases
4/16 CBC hgb 77 rbc 3.4 hct 0.24 mcv 71.5
4/16 synovial fluid yellow 3.5 ml turbid
4/16 rbc hypochromic with anisocytosis and poikilocytosis platelet increased
4/16 synovial fluid afb stain negative
4/16 inorganic PO4 3.74 iCa 1.43
4/16 BUN 19.94 uric acid 15.48 crea 1.79 sgpt-alt 5.9 Na 128.84 K 4.19
4/16 urinalysis dark yellow turbid pH 5 rbc 5-10/lhpf, pus cell 5-10/hpf, bacteria ++
4/16 CXR reticulonodular infiltrates, with fibrosis seen in both upper lobes, PTB with possible granulomas in both upper lobes / Na, K, Crea
FBS$

RHEUMA-Referrals

PATIENT / DIAGNOSIS / MEDICATIONS / LABORATORIES/ANCILLARIES / PENDING / REFERRAL
207B
LACSAMANA, Francisco
55/M
10c00080
DOA: March 5, 2010
CC:bipedal edema
CIC: Pam
Alt: Joanne/Pai/Aby / ASHD, ischemic cardiomyopathy, MR moderate, TR moderate, AR mild, CHF out of congestion, Class IIIC
Acute respiratory failure 2o to pulmonary congestion, resolved
HAP resolved
COPD NIAE
UGIB probably due to ASA use, resolved
Septic arthritis on top of gouty arthritis, resolved.
Post-BT of 2 ‘u’ PRBC, 1 ‘u’ FWB, 4 ‘u’ FFP
Post-CVP insertion / Aldactone 25mg/tab OD
Amiodarone 200mg/tab OD
Omeprazole 40mg/tab OD
Atorvastatin 80mg/tab ODHS
Rebamipide 100mg/tab TID
Carvedilol .25 mg/tab OD- hold
Colchicine 0.5mg/tab OD
Imidapril 5mg/tab OD
Clopidogrel 75mg/tab OD
Allopurinol 100mg/tab OD
Seretide 250mg inhaler 2 puffs BID, gargle after each use
Levofloxacin 750mg/tab OD
Combivent neb q6
Trimetazidine 35mg/tab BID
Dolcet/tab
Furosemide 20mgtab / Hematology
3/20 ESR 57.0 (27.5s elevated)
3/17: CBC Hgb 140, RBC 4.68, Hct 0.44, Plt 460, WBC 11.10, Seg 0.76, Lymph 0.22, Eos 0.02
3/13: CBC Hgb 139, RBC 4.56, Hct 0.43, Plt 277, WBC 12.8, Neut 0.77, Seg 0.77, Lymph 0.21, Eos 0.02
3/10: CBC Hgb 144 Hct 0.45
3/9: CBC Hgb 139, RBC 4.59, Hct 0.43, Plt 280, WBC 13.50, Neut 0.83, Seg 0.83, Lymph 0.15, Eos 0.02
3/8: CBC Hgb 128, RBC 4.23, Hct 0.4, WBC 13.1 Seg 85, Bands 0.82, Lympho 0.12, Plt 260. Eos 0.01
Clinical Chemistry
3/17: Crea 0.67, Na, 132, K 4.71
3/10: Na 143, K 5.10, Mg 1.85, iCa 1.02
3/8: Crea 0.90, Na 146, K 3.52, Mg 2.01, iCa 1.10
Microbiology
3/17 Synovial fluid aerobic culture: no growth after 5 days incubation
3/10 ETA CS: (+) Acinetobacter baumannii: Few; Sensitive to Pip-Tazo, Sulbactam-Ampicillin, Tetracycline
3/8 ETA: no microorganisms seen, PMN leucocytes ++++
ABG
3/17 ABG: pH 7.42, pCO2 61, pO2 76.1, HCO3 39.7, O2Sat 97.3, dFiO2 35
3/16 ABG: pH 7.33, PCO2 67.9, pO2 116.8, HCO3 36.5, O2Sat 97.9, dFiO2 60.69, P/F 146
3/14 ABG: pH 7.34, pCO2 64.7, pO2 166.5, HCO3 35.6, O2Sat 99%, dFiO2 30.36, P/F 3.33
3/12 ABG pH 7,43, pCO2 44.3, pO2 180.2, dfiO2 50.60, P/F 3.56; Crea 0.77, Na 144, K 4.11, iCa 1.13 / Crea, Uric Acid
CBC, Platelet
Na, K, SGPT / Co managed:
Pulmo
GI
Referral:
Rheuma
213A
Estrada, Pedro Jr.
44/M
10B00629
06-04-25
Admitted: Feb. 28, 2010
CC: Generalized weakness
CIC: Jessy
Alt: Arvin/Ampee/Martin / AKI prob 20 to prerenal prob 20 to dehydration 2o to poor oral intake
Acute gouty arthritis on top of CTG; not in flare
Metabolic encephalopathy
ASHD CAD STEMI NIF Class IIIC LVH MR
SAH stage II / Clopidogrel 75 g/tab 1 tab OD
Amlodipine 10 mg/tab BID
Metoprolol 100 mg/tab BID
Colchicine 0.5 mg/tab 1 tab BID
Fluoxetine 20 mg/cap OD
Atorvastatin 40 mg ODHS
Tramadol 50 mg/cap q8h prn for pain
Cefixime 200 mg/cap BID on 14th day
Prednisone 15 mg/tab OD
Celecoxib 200mg/cap BID prn pain
Losartan 100 mg/tab OD
Omeprazole 20mg/tab OD
Fluimucil 600mg/tab dissolve in ½ glass of water BID
Continued cold compress on affected areas / 3/25 Hgb 116 Hct 0.35
3/24: Crea 0.98, iCa 1.04
3/23: CBC: Hgb 85, Hct 0.25, WBC 14.50, Neut 0.86, Seg 0.86, Lympho 0.14, PC 366
Crea 0.98, iCa 1.04
3/21: U/A yellow, turbid, pH 6.0, sp.gr 1.015, albumin +, sugar -, hyaline 0-2, RBC 2-4/hpf, pus cell 15-18/hpf, bacteria +++, mucus threads ++, amorphous urates ++
3/ 17 2D echo LV dilated LV w/ HPN consistent w/ CCLVH RC- N LA dilated w/ NEDT RA N AVL poor oaptate of AVL, RCC is calcified w/ restriction of motion AR severe w/ poor coaptate of AVL ECL LVH w/ 6MMC & RASF dilated LA w/ LEOT MR Mod TR mild EF 61%
3/13 intact PTH 23.2
3/10 Crea1.29, iCa 1.19
3/10 Hgb 103, hct 0.31
3/10 Occult blood: negative
3/8 X-ray of L foot (official): soft tissue swelling involving the 4th& 5th metatarsals; lytic & rarefractive changes involving the phalanges, metatarsal, as well as the tarsal bones
CXR (official): AP chest in the supine view shows increase in the transverse diameter of the heart, LV form. Lungfields are clear. Diaphragm & sinuses are intact.
3/7 “O” positive
3/7 iCa 1.43
3/7 Hgb84, RBC 2.80, Hct 0.25, MCV 90.7, MCH 30, MCHC 33.10, RDW 16.30, MPV 8.20, plt 201, WBC 8.50, neu 0.79, seg 0.79, lym 0.17, eos 0.04
3/6 crea 1.59
3/6 U/A: light yellow, slightly turbid, pH 5.0, SG 1.020, albumin (-), sugar (-), pus 0-2, bacteria +, mucus threads few
3/5 iCa 1.63, urine creatinine 29.07
3/3 iCa: 1.89
3/2 iCa: Urea Nitrogen 59.69, Uric acid: 12.89
3/1: Creatinine 2.8, iCa 2.08, Na 138.3, K 4.36, iPhos 3.15, iCa 2.08,
2/28 CBC hgb 116, hct 0.35, plt 221,wbc 5.9, seg 0.74,lympho 0.24, Na 131, K 5.28, Crea 3.63 UA: yellow, turbid, pH 5.0, sp gr 1.020, albumin +, sugar (-) hyaline (-), rbc over 100/hpf, pus cells 40-50/hpf, bacteria +, squamous cells FEW, mucus threads, amorphous urate: ++, Ca+ ocalate ++ / I: 1320
O: 1402 + 500
FB: -582
UO: 58cc/hr / Main: Nephro
Referrals:
CVMed
NeuroPsych
Surgery
ID
Ortho
Rehab
213G
PIT, Virgilio
56/M
10D00173
06-45-98
DOA: 4/8/10
CC: dizziness
CIC: Mark
Alt: Ivan/Kevin
C Charx/Jan / CKD probably secondary to Gouty nephropathy, r/o GI pathology; DM type 2, at risk; Acute gouty arthritis, Ureterolithiasis, bilateral / Dolcet tab Q8 for pain
Ice Compress on AA Q x 10-15
Colchicine 0.5g/tab OD
NaHCO3 tab TID
Tamsulosin 200 mg/tab ODHS
Ciprofloxacin 500 mg 1 tab OD – D1
Paracetamol 500 mg/tab q4h for T >/= 38.5
EPO 1”u”/SC 2x/wk
Folic acid 5mg/tab 1 tab OD
*1 dose Amlodipine 5 mg/tab given 4/10 / Hematology
4/11 LKJ: yellow, 10mL, supernatant: yellow, clear w/ white sediment, WBC 66.8 x 109 Neut 0.92 Lympho 0.08; RKJ: yellow, 10mL, supernatant: yellow, clear w/ white sediment, WBC 42.8 x 109 Neut 0.88 Lympho 0.12
4/10 Hgb 93 Hct 0.28 Plt 326 WBC 18.30 Seg 0.82 Lympho 0.16 Eo 0.02
4/9 s/p 1 ‘u’ pRBC
4/8 s/p 1 ‘u’ pRBC
4/8 Hgb 63 Hct 0.19 Plt 336 WBC 10.3 Neut 0.59 Seg 0.59 Lympho 0.34 Eo 7; Retic ct: 48
Peripheral smear: WBC: no abnormal WBC seen; RBC: normocytic, normochromic; Plt; Adeq
Blood Chemistry
4/11 HBA1C 5.810
4/10 Crea 2.99, Na 135, K 4.27
4/8 BUN 55.85 iPO4 3.86 iCa 1.20
ABG
4/8 pH 7.380 pCO2 31.8 pO2 94.7 FiO2 21.0 HCO3 18.8 O2sat 97.0% AaDO2 16.7 a/A 0.85 dFiO2 18%
P/F 450
Urinalysis
4/11 Urine GS: no microorganisms seen on both centrifuged and uncentrifugd samples
4/10 lt yellow, sl turbid pH 6 sp gr 1.010, albumin (+), sugar (+), RBC 50-55, pus 5-10, bact (++), mucus threads few, amorphous urates few
Fecalysis
4/11: FOBT: negative
4/10 greenish brown, mushy, muscle cell few, vegetative cell (+), vegetable fiber (+), yeast cell few, blastocystis hominis (++),
Imaging
4/12 CT STONOGRAM 0.8cm stone proximal ureter L, 0.7cm stone distal ureter R, bilateral nephrolithiasis
4/10 N sized kidney with diffuse parenchymal changes and renal cysts, bilateral. Grade 3 hydronephrosis and grade 1 hydroureter, bilateral as descrbed with a proximal ureterolithiasis, left. Marked urinary retention of 70.3%. N sized prostate with concretions. / $