Summary: This is an initial project note that aims to address organismal clinical complexity focusing on acinetobacter and it's case based clinical complexity associations. Previously an organismal perspective on acinetobacter has been published by Dr Faraz from our institute's microbiology department in 2023 and we attempt to carry that forward focusing specially on the clinical complexity around those organisms. In this current report we share links to the clinical complexity around two patients, one a 75 year old man who grew acinetobacter in his synovial fluid as he had severe arthritic knee effusion among other comorbidities and another, a 60 year old man with post operative delirium due to stroke who grew acinetobacter both in his peripheral blood as well as from his central line on two occasions. Our eventual goal is to establish any possible causality between the organism and the patient's clinical outcome events.
Acinetobacter horcrux EHR case report 1:
Subsequently redone with more image data here: https://www.facebook.
This horcrux of the same person is to just focus on his organismal complexity due to acinetobacter along with clinical images of the arthritic joint from which the synovial fluid that grew the acinetobacter was isolated along with an image of it's sensitivity pattern.
Sharing the real time PaJR group conversational transcripts of this 75M below:
[02/07, 08:05] image: Visceral fat and sarcopenia
[02/07, 08:06] image: Posterior pericarditis
[02/07, 08:06] image: Progressed anteriorly yesterday
[02/07, 08:13] PaJR moderator: Initial history appears to be more consistent with a posterior circulation stroke? Any cranial MRI images?
[02/07, 08:15] PaJR moderator: OA flare, aspiration done, results? Did we ask them to look for crystals?
[03/07, 08:45] PaJR moderator: Yesterday's update:
His sensorium is better along with his sodium at 130
@Pushed Communicator 1N21 please share his updated timelines
[03/07, 09:10] Pushed Communicator 1N21: Yes sir his sensorium improved
Acc to GCS:
His sensorium on July 1:E4V2M6
On July 2:E4V5M5
Today his sensorium is E4V5M6,sir..
His vitals:
BP:80/60mmHg,on inotropic support sir..
His fever Spikes subsided
Pulse rate is under control 84bpm
His Acute kidney injury is resolving sir,with urea 126>>156>>135
Creatinine:.1.9>>1.6>>1.2 sir
His urine output is adequate 3400/2000
His serum sodium levels:Today it's 130sir..
Synovial aspirate cultures isolated acinetobacter sir
[03/07, 09:12] PaJR moderator: Well shared update 👏👏
Can you share the updated fever chart?
Also the acinetobacter report. It will be very useful for our acinetobacter sepsis thesis too
[03/07, 09:19] PaJR moderator: Resistant only to aminoglycosides!
Review the literature and share if this kind of resistance pattern is commonly reported by other PIs studying acinetobacter
[03/07, 09:22] PaJR moderator: Check out our college Project PI's thesis on acinetobacter as that would have two year valid data from our college. He was @Sai Charan Kulkarni 2020 KIMS Pg 's batchmate and he may even ask him to share the public link to his thesis.
[03/07, 10:18] PaJR moderator: @Meta AI Please thematically analyse this thesis and share what are the codes, subcategories and themes emerging with learning points from acinetobacter sepsis outcomes and conclude by identifying a triad and call it the Narketpally acinetobacter triad
[03/07, 10:18] Meta AI: Based on the thesis, I'll perform a thematic analysis and identify codes, subcategories, and themes related to Acinetobacter sepsis outcomes.
*Codes:*
1. Mortality rates
2. ICU stay duration
3. Organ dysfunction
4. Antibiotic resistance
5. Delayed diagnosis
6. Inadequate treatment
7. Comorbidities
8. Sepsis severity
*Subcategories:*
1. Clinical outcomes (mortality rates, ICU stay duration)
2. Microbiological characteristics (antibiotic resistance, bacterial load)
3. Diagnostic challenges (delayed diagnosis, inadequate treatment)
4. Patient factors (comorbidities, sepsis severity)
*Themes:*
1. *Poor outcomes*: High mortality rates and prolonged ICU stays are associated with Acinetobacter sepsis.
2. *Antibiotic resistance*: Acinetobacter's ability to develop resistance to antibiotics hinders effective treatment.
3. *Diagnostic difficulties*: Delayed diagnosis and inadequate treatment are common, leading to poor outcomes.
4. *Patient vulnerability*: Comorbidities and sepsis severity increase the risk of poor outcomes.
*Learning points:*
1. Early diagnosis and appropriate treatment are crucial.
2. Antibiotic stewardship is essential to combat resistance.
3. Patient-specific factors, such as comorbidities, should be considered.
*Narketpally Acinetobacter Triad:*
Based on the themes and learning points, I propose the Narketpally Acinetobacter Triad:
1. *Delayed diagnosis*
2. *Antibiotic resistance*
3. *Patient vulnerability*
This triad highlights the critical factors contributing to poor outcomes in Acinetobacter sepsis. Addressing these factors can improve patient outcomes and guide targeted interventions.
[03/07, 10:20] PaJR moderator: @Meta AI Please thematically analyse this thesis and share what are the factors that influence acinetobacter sepsis and their patient's recovery or mortality outcomes and conclude by identifying a triad and call it the Narketpally acinetobacter triad
[03/07, 10:20] Meta AI: Based on the thesis, I'll perform a thematic analysis to identify factors influencing Acinetobacter sepsis outcomes and propose the Narketpally Acinetobacter Triad.
_Factors influencing Acinetobacter sepsis outcomes:_
1. _Microbiological factors_:
- Antibiotic resistance
- Bacterial load
- Virulence factors
2. _Patient factors_:
- Comorbidities (e.g., diabetes, chronic liver disease)
- Age and frailty
- Sepsis severity
- Immunosuppression
3. _Clinical factors_:
- Delayed diagnosis
- Inadequate antibiotic therapy
- Organ dysfunction (e.g., renal, respiratory)
- ICU stay duration
4. _Environmental factors_:
- Healthcare-associated infections
- Contaminated medical devices
- Poor infection control practices
_Themes:_
1. _Microbiological challenges_: Acinetobacter's ability to develop antibiotic resistance and produce virulence factors hinders treatment.
2. _Patient vulnerability_: Comorbidities, age, and immunosuppression increase susceptibility to poor outcomes.
3. _Clinical inefficiencies_: Delayed diagnosis and inadequate treatment contribute to mortality.
4. _Environmental risks_: Healthcare-associated infections and poor infection control practices exacerbate the risk of Acinetobacter sepsis.
_Narketpally Acinetobacter Triad:_
Based on the themes and factors, I propose the Narketpally Acinetobacter Triad:
1. _Antibiotic resistance_
2. _Patient vulnerability_
3. _Clinical inefficiencies_
This triad highlights the critical interplay between microbiological, patient, and clinical factors that influence Acinetobacter sepsis outcomes. Addressing these factors can improve patient recovery and reduce mortality rates.
[03/07, 20:25] PaJR moderator: Today's pericardial fluid has reduced. Heart failure or inflammation?
[03/07, 21:41] PaJR moderator: @Meta AI please go through table 5 in this document and share your thoughts on if the 81 isolates with provisional diagnosis were actually pathogenic or commensal
[03/07, 21:41] Meta AI: Based on Table 5, which shows the characteristics of 81 Acinetobacter isolates with provisional diagnosis, I'll share my thoughts on whether they were likely pathogenic or commensal.
The table presents the following information:
- 45 isolates (55.6%) were identified as Acinetobacter baumannii
- 21 isolates (25.9%) were identified as Acinetobacter nosocomialis
- 15 isolates (18.5%) were identified as other Acinetobacter species
- 71 isolates (87.7%) were multidrug-resistant (MDR)
- 63 isolates (77.8%) produced biofilm
- 46 isolates (56.8%) had a high virulence score
Considering these findings, it's likely that a significant portion of these isolates were pathogenic. Here's why:
- High prevalence of MDR and biofilm production: These traits are commonly associated with pathogenic Acinetobacter strains, which can persist in the hospital environment and cause infections.
- High virulence score: This suggests that many isolates had the potential to cause disease.
- Species distribution: A. baumannii and A. nosocomialis are known to be pathogenic species, and their presence in a majority of isolates suggests that these isolates were likely pathogenic.
However, it's important to note that some Acinetobacter species can be commensal, and the presence of multidrug resistance and biofilm production doesn't necessarily confirm pathogenicity.
To confirm whether these isolates were pathogenic or commensal, additional tests would be needed, such as:
- In vitro virulence assays
- Animal model studies
- Genomic analysis for virulence genes
- Clinical data linking the isolates to specific infections or diseases
In summary, while the characteristics in Table 5 suggest that many of the 81 isolates were likely pathogenic, further investigation is needed to definitively determine their pathogenic potential.
[03/07, 22:15] Meta AI: Based on the analysis of Table 5, I propose the Narketpally 81 Isolate Pathogenicity Triad:
1. *Multidrug Resistance (MDR)*: 87.7% of isolates were MDR, indicating a high likelihood of pathogenicity.
2. *Biofilm Production*: 77.8% of isolates produced biofilm, which is a key virulence factor in Acinetobacter species.
3. *High Virulence Score*: 56.8% of isolates had a high virulence score, suggesting a strong potential for causing disease.
This triad suggests that the majority of the 81 isolates were likely pathogenic, based on their multidrug resistance, biofilm production, and high virulence scores. However, it's important to note that additional testing would be needed to confirm pathogenicity.
The Narketpally 81 Isolate Pathogenicity Triad can be used as a framework for evaluating the pathogenic potential of Acinetobacter isolates in future studies.
[05/07, 09:51] Pushed Communicator 1N21: Sensorium according to GCS is E4V2M6 sir
His vitals:
BP maintaining on Dual inotropic support sir
PR:100 bpm
4 Fever spikes since yesterday sir.
Urea:126>>156>>135>118
Creatinine:1.9>1.6>1.2>1.3>1
Urine output adequate sir:3200/2900
Serum sodium levels:
130(wed)>>133(Thurs)>135 Today sir
[05/07, 10:17] PaJR moderator: Thanks
Please share the updated fever chart
For more details on this patient please visit the earlier shared link, pasted again below:
Subsequently redone with more image data here: https://www.facebook.
Case 2:
Sharing the deidentified horcrux EMR case summary prepared by our anonymous intern (warts and all)
ALTERED SENSORIUM
BLOOD CULTURE FROM CENTRAL LINE - ACINETOBACTER ISOLATED. SENSITIVE TO COTRIMOXAZOLE
ON 29/05/2024
URINE CULTURE - ENTEROCOCCUS SPS. >10^5 CFU/ML OF URINE ISOLATED, SENSITIVE TO LINOZOLID . INTERMEDIATELY SENSITIVE TO NITROFURONTINE AND PIPTAZ
BLOOD CULTURE FROM CENTRAL AND PERIPHERAL LINES WERE NEGATIVE 29/05/2024
Case History and Clinical Findings
CHIEF COMPLAINTS:
A 60YR OLD MALE PATIENT CAME TO CASUALITY WITH ALTERED SENSORIUM ON 04/05/2024
HISTORY OF PRESENTING ILLNESS:
PATIENT WAS Apparently ALRIGHT AND ASYMPTOMATIC LAST NIGHT AND HE EXPERIENCED SLIP &FALL ON 15/04/2024 TAKEN TO GOVT.HOSPITAL. I/V/O RIGHT IT HIP FRACTURE AND HAD SURGERY AND THEN ON 25/04/2024 SUDDENLY DEVELOPED SHORTNESS OF BREATH AND THEN ADMITTED HOSPITAL AGAIN THEN HE DEVELOPED ALTERED SENSORIUM IN HOSPITAL .AFTER SURGERY PATIENT Developed ALTERED SENSORIUM &SO IRRITABLE AFTER 4 DAYS .CONCERNED DOCTORS Did Not INFORM ACCURATE CAUSE TO ATTENDERS &DISCHARGED THE PATIENT. AFTER DISCHARGE HE WAS AT HOME WITH SAME IRRITABLE CONDITION &ALTERED SENSORIUM FOR 4 DAYS &SUDDENLY HE DEVELOPED SHORTNESS OF BREATH .UNDERGONE CT BRAIN SUGGESTED AGE RELATED CHANGES.ON 4/5/24 AT 2AM PATIENT LOST CONSCIOUSNESS
SO THEY SHIFTED PATIENT TO OUR CASUALITY AROUND 5PM
COURSE IN HOSPITAL:
ON DAY1 A 60YR OLD MALE PATIENT CAME TO CASUALITY WITH COMPLAINTS OF ALTERED SENSORIUM SINCE 2AM
THE VITALS AT PRESENTATION WERE PR:116 BPM RR: 20 CPM BP: 110/60 MMHG SPO2:88% @ RA AND 96% ON 2 LITRES O2 GRBS: 116 MG/DL,GCS E4V2M3 ON FURTHER EALUATION HE WAS DIAGNOSED WITH ALTERED SENSORIUM SECONDARY TO ?METABOLIC ? HYPOXIC ENCEPHALOPATHY
TREATMENT WAS STARTED WITH OXYGEN SUPPLEMENTATION AND ANTIOBIOTICS WERE STARTED I/V/O ELEVATED TOTAL COUNTS AND FEVER SPIKES AND SUPPORTIVE TREATMENT WAS GIVEN.2D ECHO WAS DONE,IT SHOWED NO RWMA, MILD LVH+ MODERATE TR + WITH MILD PIH, MILD AR TRIVIAL MR+,MAC+ SCLEROTIC AV,EF=64 RVSP 38+10 48MMHG GOOD IV SYSTOLIC FUNCTIONS GRADE I DIASTOLIC DYSFUNCTIONIVC SIZE
0.7 CM COLLAPSING
ON DAY 3 GCS E3V2M4 UROLOGY REFERRAL WAS DONE I/V/O HEMATURIA ADVISED FOR CT KUB - AND IRRIGATION OF BLADDER WAS DONE AND ADVISED TO CONTINUE SAME TREATMENTMENT AND ADDED INJ TRANEXAMIC ACID TO STOP BLEEDING. PSYCHIATRY REFERRAL WAS DONE I/V/O ALCOHOL WITHDRAWL SYNDROME DIAGNOSED IT AS ENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF ALCOHOL HARMFUL USE TOBACCO DEPENDENCE SYNDROME WITH ? DELIRIUM DUE TO ORGANICITY AND WAS TREATED ACORDINGLY . ORTHOPEDICS REFERRAL WAS DONE I/V/O PREVIOUS RIGHT HIP FRACTURE AND NO ACTIVE INTERVENTION WAS ADVISED.OPHTHAL REFERRAL WAS I/V/O RAISED ICT, IMPRESSION= RGHT EYE- NO EVIDENCE OF PAPILLOEDEMA LEFT EYE- OPTIC ATROPHY. ON DAY 5 PATIENT WAS INTUBATED I/V/O SUDDEN GFALL IN SATURATIONS AND CONNECTED TO MECHANICAL VENTILATOR ON FIO 60% .BLOOD CULTURE REPORTS SHOWED GROWTH OF ACINETOBACTER ,SO APPROPRIATE ANTIBIOTICS WAS STARTED. ON 14/5/2024 AS SATURATIONS WERE MAINTAING ON FIO2 -21% .WEANING OFF TRIAL WAS DONE AND PATIENT WAS EXTUBATED .EXTUBATION PROCESS WAS UNEVENTFUL.POST EXTUBATION COURSE IN THE HOSPITAL WAS UNEVENTUL. BED SORE DEVELEOPED AND REGULAR DRESSING FOR IT WAS DONE AND SUPPORTIVE TREATMENT WAS GIVEN .
Age/Gender : 60 Years/Male
Address :
Discharge Type: Relieved
Admission Date: 04/05/2024 05:35 PM
Discharge Date Date: 3/06/2024 Ward: MMW Unit:GM-6
Address :
Discharge Type: Relieved
Admission Date: 04/05/2024 05:35 PM
Discharge Date Date: 3/06/2024 Ward: MMW Unit:GM-6
Readmitted:26/6/2024
Diagnosis
ALTERED SENSORIUM
POST OP DELIRIUM (following intertrochanteric fracture fixation)
STROKE with motor aphasia
risk factors: Alcoholism, Smoking
ASPIRATION PNEUMONIA ? VAP
ASPIRATION PNEUMONIA ? VAP
ANEMIA SECONDARY TO HEMATURIA [ RESOLVED]
HIGH ANION GAP METABOLIC ACIDOSIS MIXED ACIDOTIC PATTERN (RESOLVED), ACUTE KIDNEY INJURY(POST RENAL AND PRE RENAL) [RESOLVED]
GRADE 3 BED SORE ON RIGHT GLUTEAL REGION GRADE 2 BED SORE ON LEFT GLUTEAL REGION DE NOVO HYPERTENSION
POST EXTUBATION DAY-19
HIGH ANION GAP METABOLIC ACIDOSIS MIXED ACIDOTIC PATTERN (RESOLVED), ACUTE KIDNEY INJURY(POST RENAL AND PRE RENAL) [RESOLVED]
GRADE 3 BED SORE ON RIGHT GLUTEAL REGION GRADE 2 BED SORE ON LEFT GLUTEAL REGION DE NOVO HYPERTENSION
POST EXTUBATION DAY-19
Organisms isolated during course of hospitalization with sepsis indicators such a fever, tachycardia, tachypnoea etc:ON 18/05/2024
BLOOD CULTURE FROM PERIPHERAL LINE - ACINETOBACTER ISOLATED. SENSITIVE TO COTRIMOXAZOLEBLOOD CULTURE FROM CENTRAL LINE - ACINETOBACTER ISOLATED. SENSITIVE TO COTRIMOXAZOLE
ON 29/05/2024
URINE CULTURE - ENTEROCOCCUS SPS. >10^5 CFU/ML OF URINE ISOLATED, SENSITIVE TO LINOZOLID . INTERMEDIATELY SENSITIVE TO NITROFURONTINE AND PIPTAZ
BLOOD CULTURE FROM CENTRAL AND PERIPHERAL LINES WERE NEGATIVE 29/05/2024
Case History and Clinical Findings
CHIEF COMPLAINTS:
A 60YR OLD MALE PATIENT CAME TO CASUALITY WITH ALTERED SENSORIUM ON 04/05/2024
HISTORY OF PRESENTING ILLNESS:
PATIENT WAS Apparently ALRIGHT AND ASYMPTOMATIC LAST NIGHT AND HE EXPERIENCED SLIP &FALL ON 15/04/2024 TAKEN TO GOVT.HOSPITAL. I/V/O RIGHT IT HIP FRACTURE AND HAD SURGERY AND THEN ON 25/04/2024 SUDDENLY DEVELOPED SHORTNESS OF BREATH AND THEN ADMITTED HOSPITAL AGAIN THEN HE DEVELOPED ALTERED SENSORIUM IN HOSPITAL .AFTER SURGERY PATIENT Developed ALTERED SENSORIUM &SO IRRITABLE AFTER 4 DAYS .CONCERNED DOCTORS Did Not INFORM ACCURATE CAUSE TO ATTENDERS &DISCHARGED THE PATIENT. AFTER DISCHARGE HE WAS AT HOME WITH SAME IRRITABLE CONDITION &ALTERED SENSORIUM FOR 4 DAYS &SUDDENLY HE DEVELOPED SHORTNESS OF BREATH .UNDERGONE CT BRAIN SUGGESTED AGE RELATED CHANGES.ON 4/5/24 AT 2AM PATIENT LOST CONSCIOUSNESS
SO THEY SHIFTED PATIENT TO OUR CASUALITY AROUND 5PM
GENERAL EXAMINATION:
NO SIGNS OF PALLOR,ICTERUS,CYANOSIS,
PR:116 BPM RR: 20 CPM
BP: 110/60 MMHG SPO2 : 88%@ RA GRBS: 116 MG/DL
SYSTEMIC EXAMINATION:
CVS: S1S2 HEARD RS: BAE (+)
CNS: NFND
NO SIGNS OF PALLOR,ICTERUS,CYANOSIS,
PR:116 BPM RR: 20 CPM
BP: 110/60 MMHG SPO2 : 88%@ RA GRBS: 116 MG/DL
SYSTEMIC EXAMINATION:
CVS: S1S2 HEARD RS: BAE (+)
CNS: NFND
COURSE IN HOSPITAL:
ON DAY1 A 60YR OLD MALE PATIENT CAME TO CASUALITY WITH COMPLAINTS OF ALTERED SENSORIUM SINCE 2AM
THE VITALS AT PRESENTATION WERE PR:116 BPM RR: 20 CPM BP: 110/60 MMHG SPO2:88% @ RA AND 96% ON 2 LITRES O2 GRBS: 116 MG/DL,GCS E4V2M3 ON FURTHER EALUATION HE WAS DIAGNOSED WITH ALTERED SENSORIUM SECONDARY TO ?METABOLIC ? HYPOXIC ENCEPHALOPATHY
TREATMENT WAS STARTED WITH OXYGEN SUPPLEMENTATION AND ANTIOBIOTICS WERE STARTED I/V/O ELEVATED TOTAL COUNTS AND FEVER SPIKES AND SUPPORTIVE TREATMENT WAS GIVEN.2D ECHO WAS DONE,IT SHOWED NO RWMA, MILD LVH+ MODERATE TR + WITH MILD PIH, MILD AR TRIVIAL MR+,MAC+ SCLEROTIC AV,EF=64 RVSP 38+10 48MMHG GOOD IV SYSTOLIC FUNCTIONS GRADE I DIASTOLIC DYSFUNCTIONIVC SIZE
0.7 CM COLLAPSING
ON DAY 3 GCS E3V2M4 UROLOGY REFERRAL WAS DONE I/V/O HEMATURIA ADVISED FOR CT KUB - AND IRRIGATION OF BLADDER WAS DONE AND ADVISED TO CONTINUE SAME TREATMENTMENT AND ADDED INJ TRANEXAMIC ACID TO STOP BLEEDING. PSYCHIATRY REFERRAL WAS DONE I/V/O ALCOHOL WITHDRAWL SYNDROME DIAGNOSED IT AS ENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF ALCOHOL HARMFUL USE TOBACCO DEPENDENCE SYNDROME WITH ? DELIRIUM DUE TO ORGANICITY AND WAS TREATED ACORDINGLY . ORTHOPEDICS REFERRAL WAS DONE I/V/O PREVIOUS RIGHT HIP FRACTURE AND NO ACTIVE INTERVENTION WAS ADVISED.OPHTHAL REFERRAL WAS I/V/O RAISED ICT, IMPRESSION= RGHT EYE- NO EVIDENCE OF PAPILLOEDEMA LEFT EYE- OPTIC ATROPHY. ON DAY 5 PATIENT WAS INTUBATED I/V/O SUDDEN GFALL IN SATURATIONS AND CONNECTED TO MECHANICAL VENTILATOR ON FIO 60% .BLOOD CULTURE REPORTS SHOWED GROWTH OF ACINETOBACTER ,SO APPROPRIATE ANTIBIOTICS WAS STARTED. ON 14/5/2024 AS SATURATIONS WERE MAINTAING ON FIO2 -21% .WEANING OFF TRIAL WAS DONE AND PATIENT WAS EXTUBATED .EXTUBATION PROCESS WAS UNEVENTFUL.POST EXTUBATION COURSE IN THE HOSPITAL WAS UNEVENTUL. BED SORE DEVELEOPED AND REGULAR DRESSING FOR IT WAS DONE AND SUPPORTIVE TREATMENT WAS GIVEN .
 |
Investigation HEMOGRAM 4/5/24 HB:12
TLC:13,800 PLT:2.74 PCV:34% RBC:3.93
RFT 04-05-2024 06:53:PMUREA 25 mg/dl 42-12 mg/dlCREATININE 0.9 mg/dl 1.3-0.9 mg/dlURIC
ACID 2.4 mmol/L 7.2-3.5 mmol/LCALCIUM 9.5 mg/dl 10.2-8.6 mg/dlPHOSPHOROUS 3.4 mg/dl 4.5-
2.5 mg/dlSODIUM 138 mmol/L 145-136 mmol/LPOTASSIUM 3.5 mmol/L. 5.1-3.5 mmol/L.CHLORIDE
101 mmol/L 98-107 mmol/L
LIVER FUNCTION TEST (LFT) 04-05-2024 06:53:PMTotal Bilurubin 1.12 mg/dl 1-0 mg/dlDirect Bilurubin 0.20 mg/dl 0.2-0.0 mg/dlSGOT(AST) 21 IU/L 35-0 IU/LSGPT(ALT) 25 IU/L 45-0
IU/LALKALINE PHOSPHATASE 191 IU/L 119-56 IU/LTOTAL PROTEINS 5.8 gm/dl 8.3-6.4
gm/dlALBUMIN 2.88 gm/dl 4.6-3.2 gm/dlA/G RATIO 0.99
HBsAg-RAPID 04-05-2024 06:53:PM Negative
Anti HCV Antibodies - RAPID 04-05-2024 06:53:PM Non Reactive HIV:NON REACTIVE
HEMOGRAM 5/5/24 HB:11.2
PCV:31.9 TLC:11,300 RBC:3.69 PLT:2.64
USG ABDOMEN AND PELVIS DONE ON 4/5/24
E/O IRREGULAR WALL THICKENING MEASURING 4-5MM WITH THICK ECHOGENIC INTERNAL ECHOES NOTED IN THE PARTIALLY DISTENDED URINARY BLADDER AND E/O 6MM SLUDGE NOTED AT THE BASE OF BLADDER WITH NO VASCULARITY LIKELY SLUDGE / BLOOD CLOT.
B/L GRADE 1 RPD CHANGES IN KIDNEYS
ABG 05-05-2024 01:05:AMPH 7.43PCO2 34.2PO2 83.1HCO3 22.6St.HCO3 23.8BEB -0.7BEecf -
1.1TCO2 45.7O2 Sat 95.9O2 Count 15.6
COMPLETE URINE EXAMINATION (CUE) 05-05-2024 10:40:AMCOLOUR reddishAPPEARANCE cloudyREACTION AcidicSP.GRAVITY 1.010ALBUMIN ++++SUGAR NilBILE SALTS NilBILE PIGMENTS NilPUS CELLS 10-15EPITHELIAL CELLS 4-6RED BLOOD CELLS loadedCRYSTALS NilCASTS +AMORPHOUS DEPOSITS AbsentOTHERS Nil
RFT 05-05-2024 11:19:PMUREA 53 mg/dl 42-12 mg/dlCREATININE 1.1 mg/dl 1.3-0.9 mg/dlURIC
ACID 3.1 mmol/L 7.2-3.5 mmol/LCALCIUM 9.6 mg/dl 10.2-8.6 mg/dlPHOSPHOROUS 3.1 mg/dl 4.5-
2.5 mg/dlSODIUM 135 mmol/L 145-136 mmol/LPOTASSIUM 4.1 mmol/L. 5.1-3.5 mmol/L.CHLORIDE
97 mmol/L 98-107 mmol/L HEMOGRAM 6/5/24
2D ECHO WAS DONE -
NO RWMA, MILD LVH PRESENT (1.25 CM) MODERATE TR PRESENT, MILD PAH
MILD AR PRESENT (PHT = 518 M/SEC); TRIVIAL MR PPRESENT MAC PRESENT, SCLEROTIC AV, NO AS/MS
EF = 62% TVSP = 48 MM HG GOOD IV SYSTOLIC FUNCTION
GRADE 1 DIASTOLIC DYSFUNCTION IVC SIZE 0.7CM COLLAPSING
IAS - ANEURYSM
REVIEW 2D ECHO WAS DONE ON 18/5/24 NO PR/IV CLOT
IVC SIZE 0.8 CM COLLAPSING HB:11.7
TLC:12,500 PCV:34.2 RBC:3.98 PLT:2.86
ABG 06-05-2024 09:20:AMPH 7.43PCO2 27.3PO2 69.0HCO3 18.2St.HCO3 20.7BEB -4.5BEecf -
5.2TCO2 36.9O2 Sat 94.3O2 Count 15.1
COMPLETE URINE EXAMINATION (CUE) 06-05-2024 11:14:AMCOLOUR reddishAPPEARANCE cloudyREACTION AcidicSP.GRAVITY 1.010ALBUMIN ++++SUGAR NilBILE SALTS NilBILE PIGMENTS NilPUS CELLS 1-2EPITHELIAL CELLS nilRED BLOOD CELLS 12-14CRYSTALS NilCASTS NilAMORPHOUS DEPOSITS AbsentOTHERS Nil
RFT 06-05-2024 10:07:PMUREA 52 mg/dl 42-12 mg/dlCREATININE 1.0 mg/dl 1.3-0.9 mg/dlURIC
ACID 3.8 mmol/L 7.2-3.5 mmol/LCALCIUM 9.9 mg/dl 10.2-8.6 mg/dlPHOSPHOROUS 3.4 mg/dl 4.5-
2.5 mg/dlSODIUM 138 mmol/L 145-136 mmol/LPOTASSIUM 4.1 mmol/L. 5.1-3.5 mmol/L.CHLORIDE
104 mmol/L 98-107 mmol/L
COMPLETE URINE EXAMINATION (CUE) 06-05-2024 10:07:PMCOLOUR ReddishAPPEARANCE HazyREACTION AcidicSP.GRAVITY 1.010ALBUMIN ++SUGAR NilBILE SALTS NilBILE PIGMENTS NilPUS CELLS 2-4EPITHELIAL CELLS NilRED BLOOD CELLS loadedCRYSTALS NilCASTS NilAMORPHOUS DEPOSITS AbsentOTHERS Nil
HEMOGRAM 7/5/24 HB:11.6 TLC:15,200 PCV:33.6
RBC:3.91 PLT:3.45
COMPLETE URINE EXAMINATION (CUE) 07-05-2024 10:04:PMCOLOUR ReddishAPPEARANCE CloudyREACTION AcidicSP.GRAVITY 1.010ALBUMIN +++SUGAR NilBILE SALTS NilBILE PIGMENTS NilPUS CELLS 2-4EPITHELIAL CELLS 0-1RED BLOOD CELLS plentyCRYSTALS few
triple phosphate crystals seenCASTS NilAMORPHOUS DEPOSITS AbsentOTHERS Nil
RFT 07-05-2024 10:04:PMUREA 55 mg/dl 42-12 mg/dlCREATININE 1.2 mg/dl 1.3-0.9 mg/dlURIC
ACID 2.9 mmol/L 7.2-3.5 mmol/LCALCIUM 10.0 mg/dl 10.2-8.6 mg/dlPHOSPHOROUS 3.5 mg/dl 4.5-
2.5 mg/dlSODIUM 139 mmol/L 145-136 mmol/LPOTASSIUM 3.9 mmol/L. 5.1-3.5 mmol/L.CHLORIDE
104 mmol/L 98-107 mmol/L
HEMOGRAM 8/5/24 HB:11.4 TLC:17,800 PCV:32.9RBC:3.7 PLT:3.8
ABG 08-05-2024 02:42:PMPH 7.49PCO2 25.1PO2 42.3HCO3 19.3St.HCO3 22.3BEB -2.1BEecf -
3.6TCO2 37.6O2 Sat 79.7O2 Count 15.1
ABG 08-05-2024 02:43:PMPH 7.17PCO2 43.4PO2 96.4HCO3 15.3St.HCO3 14.7BEB -12.7BEecf -
11.6TCO2 32.2O2 Sat 93.0O2 Count 17.9
RFT 08-05-2024 11:37:PMUREA 105 mg/dl 42-12 mg/dlCREATININE 3.2 mg/dl 1.3-0.9 mg/dlURIC
ACID 5.5 mmol/L 7.2-3.5 mmol/LCALCIUM 10.0 mg/dl 10.2-8.6 mg/dlPHOSPHOROUS 6.9 mg/dl 4.5-
2.5 mg/dlSODIUM 137 mmol/L 145-136 mmol/LPOTASSIUM 4.5 mmol/L. 5.1-3.5 mmol/L.CHLORIDE
102 mmol/L 98-107 mmol/L
ABG 08-05-2024 11:37:PMPH 7.385PCO2 30.7PO2 183HCO3 18.0St.HCO3 19.8BEB -5.6BEecf -
6.1TCO2 36.8O2 Sat 98.0O2 Count 16.2 HEMOGRAM 9/5/24
HB:11.3 TLC:22,900 PCV:33.7 RBC:3.8 PLT:3.3
COMPLETE URINE EXAMINATION (CUE) 09-05-2024 12:18:PMCOLOUR BrownishAPPEARANCE CloudyREACTION AcidicSP.GRAVITY 1.010ALBUMIN ++++SUGAR NilBILE SALTS NilBILE PIGMENTS NilPUS CELLS 2-3EPITHELIAL CELLS 1-2RED BLOOD CELLS loadedCRYSTALS
triple phosphate crystals presentCASTS NilAMORPHOUS DEPOSITS AbsentOTHERS Bacteria- present
ABG 09-05-2024 12:37:PMPH 7.19PCO2 46.1PO2 83.7HCO3 17.2St.HCO3 16.2BEB -10.3BEecf -
9.5TCO2 36.9O2 Sat 91.9O2 Count 14.6
SERUM ELECTROLYTES (Na, K, C l) 09-05-2024 12:43:PMSODIUM 135 mmol/L 145-136
mmol/LPOTASSIUM 4.7 mmol/L 5.1-3.5 mmol/LCHLORIDE 98 mmol/L 98-107 mmol/L COMPLETE URINE EXAMINATION (CUE) 09-05-2024 11:48:PMCOLOUR reddishAPPEARANCE CloudyREACTION AcidicSP.GRAVITY 1.010ALBUMIN +++SUGAR NilBILE SALTS NilBILE
PIGMENTS NilPUS CELLS 1-2EPITHELIAL CELLS 1-2RED BLOOD CELLS 3-5CRYSTALS triple
phosphate crystalsCASTS NilAMORPHOUS DEPOSITS AbsentOTHERS Nil
RFT 09-05-2024 11:48:PMUREA 144 mg/dl 42-12 mg/dlCREATININE 3.5 mg/dl 1.3-0.9 mg/dlURIC
ACID 5.0 mmol/L 7.2-3.5 mmol/LCALCIUM 9.8 mg/dl 10.2-8.6 mg/dlPHOSPHOROUS 6.7 mg/dl 4.5-
2.5 mg/dlSODIUM 136 mmol/L 145-136 mmol/LPOTASSIUM 4.5 mmol/L. 5.1-3.5 mmol/L.CHLORIDE
101 mmol/L 98-107 mmol/L
ABG 09-05-2024 11:48:PMPH 7.26PCO2 33.2PO2 49.2HCO3 14.7St.HCO3 15.5BEB -10.9BEecf - 10.9TCO2 33.2O2 Sat 84.2O2 Count 6.5
HEMOGRAM 10/5/24 HB:9.9
TLC:16,400 PCV:29.7 RBC:3.27 PLT:3.12
ABG 10-05-2024 10:24:AMPH 7.26PCO2 39.5PO2 27.1HCO3 17.2St.HCO3 16.6BEB -8.8BEecf -
8.5TCO2 37.3O2 Sat 42.5O2 Count 6.0
ABG 10-05-2024 08:49:PMPH 7.39PCO2 28.7PO2 50.6HCO3 17.1St.HCO3 19.0BEB -6.4BEecf -
6.9TCO2 35.3O2 Sat 87.3O2 Count 13.1
ABG 10-05-2024 11:18:PMPH 7.35PCO2 33.3PO2 40.9HCO3 18.1St.HCO3 18.9BEB -6.5BEecf -
6.4TCO2 41.2O2 Sat 81.5O2 Count 3.8
RFT 10-05-2024 11:18:PMUREA 123 mg/dl 42-12 mg/dlCREATININE 2.4 mg/dl 1.3-0.9 mg/dlURIC
ACID 4.3 mmol/L 7.2-3.5 mmol/LCALCIUM 9.9 mg/dl 10.2-8.6 mg/dlPHOSPHOROUS 5.4 mg/dl 4.5-
2.5 mg/dlSODIUM 135 mmol/L 145-136 mmol/LPOTASSIUM 3.8 mmol/L. 5.1-3.5 mmol/L.CHLORIDE
97 mmol/L 98-107 mmol/L HEMOGRAM 11/5/24 HB:9.2
TLC:15,700 PCV:26.3 RBC:2.9 PLT:3.0
ABG 11-05-2024 11:31:PMPH 7.42PCO2 22.0PO2 136HCO3 14.1St.HCO3 17.4BEB -8.8BEecf -
9.6TCO2 29.2O2 Sat 97.7O2 Count 13.7
RFT 11-05-2024 11:31:PMUREA 112 mg/dl 42-12 mg/dlCREATININE 2.2 mg/dl 1.3-0.9 mg/dlURIC
ACID 4.6 mmol/L 7.2-3.5 mmol/LCALCIUM 9.0 mg/dl 10.2-8.6 mg/dlPHOSPHOROUS 3.7 mg/dl 4.5-
2.5 mg/dlSODIUM 135 mmol/L 145-136 mmol/LPOTASSIUM 4.0 mmol/L. 5.1-3.5 mmol/L.CHLORIDE
103 mmol/L 98-107 mmol/L HEMOGRAM 12/5/24
HB:9.6 TLC:19,400 PCV:28.3 RBC:3.25 PLT:3.35 ABG: PH:7.42 PCO2:22.0 PO2:136 HCO3:14.1
ST.HCO3:17.4 BEB:-8.8 BEECF:-9.6 TCO2:29.2
02 SAT:97.7
O2 COUNT:13.7 RFT:
UREA:112 CREATININE:2.2 URIC ACID:4.6 CA:9.0
P:3.7 NA:135 K:4 CL:103
HEMOGRAM 13/5/24 HB:8.4
TLC:19,400 PCV:25.2 RBC:2.86 PLT:2.65
RFT 13-05-2024 12:00:AMUREA 109 mg/dl 42-12 mg/dlCREATININE 2.4 mg/dl 1.3-0.9 mg/dlURIC
ACID 5.1 mmol/L 7.2-3.5 mmol/LCALCIUM 8.6 mg/dl 10.2-8.6 mg/dlPHOSPHOROUS 5.1 mg/dl 4.5-
2.5 mg/dlSODIUM 138 mmol/L 145-136 mmol/LPOTASSIUM 4.1 mmol/L. 5.1-3.5 mmol/L.CHLORIDE
104 mmol/L 98-107 mmol/L
ABG 13-05-2024 12:01:AMPH 7.34PCO2 30.8PO2 55.1HCO3 16.5St.HCO3 18.0BEB -7.7BEecf - 8.0TCO2 35.3O2 Sat 87.1O2 Count 11.1
POST LUNCH BLOOD SUGAR 13-05-2024 10:08:AM 170 mg/dl 140-0 mg/dl
ABG 13-05-2024 10:10:AMPH 7.36PCO2 33.0PO2 80.0HCO3 18.5St.HCO3 19.9BEB -5.5BEecf -
5.8TCO2 37.7O2 Sat 95.3O2 Count 16.2
ABG 13-05-2024 10:37:PMPH 7.37PCO2 27.2PO2 139HCO3 15.3St.HCO3 17.6BEB -8.5BEecf -
8.9TCO2 32.3O2 Sat 98.0O2 Count 13.3
RFT 13-05-2024 10:37:PMUREA 85 mg/dl 42-12 mg/dlCREATININE 1.7 mg/dl 1.3-0.9 mg/dlURIC
ACID 4.1 mmol/L 7.2-3.5 mmol/LCALCIUM 8.7 mg/dl 10.2-8.6 mg/dlPHOSPHOROUS 3.4 mg/dl 4.5-
2.5 mg/dlSODIUM 137 mmol/L 145-136 mmol/LPOTASSIUM 3.9 mmol/L. 5.1-3.5 mmol/L.CHLORIDE
103 mmol/L 98-107 mmol/L HEMOGRAM 14/5/24 HB:8.7
TLC:13,800 PCV:26.1 RBC:2.9 PLT:1.36
ABG 14-05-2024 06:24:PMPH 7.41PCO2 26.8PO2 66.8HCO3 16.9St.HCO3 19.4BEB -6.0BEecf -
6.8TCO2 34.3O2 Sat 94.2O2 Count 15.3 HEMOGRAM 15/5/24
HB:8.9 TLC:16,800 PCV:26.5 RBC:3.0 PLT:1.3
ABG 15-05-2024 12:29:AMPH 7.40PCO2 26.5PO2 130HCO3 16.4St.HCO3 18.8BEB -6.9BEecf -
7.4TCO2 34.3O2 Sat 98.3O2 Count 13.1
RFT 15-05-2024 12:29:AMUREA 71 mg/dl 42-12 mg/dlCREATININE 1.3 mg/dl 1.3-0.9 mg/dlURIC
ACID 3.9 mmol/L 7.2-3.5 mmol/LCALCIUM 9.0 mg/dl 10.2-8.6 mg/dlPHOSPHOROUS 3.3 mg/dl 4.5-
2.5 mg/dlSODIUM 136 mmol/L 145-136 mmol/LPOTASSIUM 3.7 mmol/L. 5.1-3.5 mmol/L.CHLORIDE
102 mmol/L 98-107 mmol/L
ABG 15-05-2024 09:47:PMPH 7.37PCO2 31.7PO2 41.7HCO3 18.3St.HCO3 19.5BEB -5.6BEecf -
5.9TCO2 37.9O2 Sat 76.8O2 Count 11.6
RFT 15-05-2024 09:47:PMUREA 73 mg/dl 42-12 mg/dlCREATININE 1.4 mg/dl 1.3-0.9 mg/dlURIC
ACID 3.2 mmol/L 7.2-3.5 mmol/LCALCIUM 9.7 mg/dl 10.2-8.6 mg/dlPHOSPHOROUS 3.3 mg/dl 4.5-
2.5 mg/dlSODIUM 136 mmol/L 145-136 mmol/LPOTASSIUM 3.8 mmol/L. 5.1-3.5 mmol/L.CHLORIDE
99 mmol/L 98-107 mmol/L LIPID PROFILE:
TOTAL CHOLESTROL:127 TRIGLYCERIDES:346 HDL:30
LDL:67 VLDL:69.2
APTT 31
BLEEDING TIME :2 MIN CLOTTING TIME:4 MIN CRP:1.2 MG/DL
DENGUE NS1,IGM,IGG:NEGATIVE ESR:130
PT:15 SEC INR:1.11
D-DIMER:660
HEMOGRAM 16/5/24 HB:9.4
TLC:22,500 PCV:27.6 RBC:3.1 PLT:1.0
CUE 16/5/24 COLOUR:PALE YELLOW REACTION:ACIDIC SPEC GRAV:1.010
ALBUMIN:+ PUS CELLS:2-3
EPITHELIAL CELLS:2-3
RFT 16/5/24 UREA:73 CREAT:1.4 URIC ACID:3.2 CA:9.7
P:3.3 NA:136 K:3.8 CL:99
ABG 16/5/24 PH:7.37 PCO2:31.7 PO2:41.7 HCO3:18.3 STHCO3:19.5 BEB:-5.6 BEECF:-5.9 TCO2:37.9 O2 SAT:76.8
CULTURE REPORTS:
BLOOD FROM CENTRAL LINE FOR CULTURE:DIRECT SMEAR 1ST S/C,REPORT:ACINETOBACTER SPECIES ISOLATED
BLOOD FROM PERIPHERY FOR CULTURE :DIRECT SMEAR 1ST S/C,REPORT:ACINETOBACTER ISOLATED
VENOUS DOPPLER DONE ON 16/5/24
NO E/O DVT NOTED IN RIGHT LOWER LIMB
HEMOGRAM 17/5/24 HB:8.4
TLC:14,500 PLT:1.5 PCV:23.7 RBC:2.78 PH:7.43 PCO2:29.2 PO2:62.3 HCO3:19.5 STHCO3:21.6 BEB:-3.3 BEECF:-4.0 TCO2:39.6 O2 SAT:93.8
THROAT SWAB CULTURE AND SESNIIVITY DONE ON 17/5/24. PSEUDOMONAS AERUGINOSA ISOLATED SENSITIVE TO PIPERCILLIN, TOBRAMYCIN, CIPROFLOXACIN, AMIKACIN, PIPTAZ, MEROPENEM.
HEMOGRAM 18 /5/24 HB:8.4
TLC:14,500 PLT:1.5 PCV:23.7 RBC:2.78 RFT UREA:53
CREATININE:1.3 URIC ACID: 3.8 CALCIUM:9.0 P:3.6
NA:135 K:3.9 CL:103
HEMOGRAM 19/5/24 HB:8.5
TLC:14,300 PLT:1.5 PCV:23.8 RBC:2.7
COMPLETE URINE EXAMINATION: COLOR : PALE YELLOW APPEARANCE:CLEAR
REACTION: CLEAR SP GRAVITY: 1.010 ALBUMIN: +
BILE SALTS :NIL BILE PIGMENTS: NIL SUGAR:NIL
PUS CELLS:5-6 EPITHELIAL CELLS:2-3 RBC:8-10 CRYSTALS:NIL CASTS:NIL
AMORPHOUS DEPOSITS:ABSENT HEMOGRAM 20/5/24
HB:8.1 TLC:13,600 PLT:1.54 PCV:24.0 RBC:2.36 ABG PH:7.47 PCO2:32.9 PO2:97.6 HCO3:23.7
ST.HCO3:25.2 BEB:0.9 BEECF:0.4 TCO2:47.8
O2 SAT:97.8
HEMOGRAM 21 /5/24 HB:8.8
TLC:15,800 PLT:1.65 PCV:25.2 RBC:2.93 CUE:
COLOR: PALE YELLOW APPEARANCE : CLEAR REACTION : ACIDIC SP.GRAVITY:1.01 ALBUMIN: ++++ SUGAR: NIL
BILE SALTS: NIL BILE PIGMENTS: NIL PUS CELLS: 14-15 EPITHELIAL:2-3 RBC:2-3
CRYSTALS: NIL CAST:NIL
RFT UREA:38
CREATININE:0.9 URIC ACID:3.2 CA:9.7
P:2.8 NA:136 K:3.8 CL:101
HEMOGRAM 22 /5/24 HB:8.8
TLC:15000 PLT:1.65 PCV:25.2 RBC:2.93
HEMOGRAM 22/5/24 HB:8.0
TLC:12,300 PLT:1.57 PCV:23.6 RBC:2.69
COMPLETE URINE EXAMINATION: 22/05/2024 COLOR : PALE YELLOW APPEARANCE:CLEAR
REACTION: CLEAR SP GRAVITY: 1.010 ALBUMIN: NIL
BILE SALTS :NIL BILE PIGMENTS: NIL SUGAR:NIL
PUS CELLS:2-3 EPITHELIAL CELLS:1-2 RBC:NIL CRYSTALS:NIL CASTS:NIL
AMORPHOUS DEPOSITS:ABSENT RFT
UREA: 27 CREATININE:0.9 URIC ACID:3.0 CA:9.0
P:2.8 NA:136 K:3.7
CL:98
LIVER FUNCTION TEST (LFT) Total Bilurubin 10Direct Bilurubin.20SGOT(AST) 30SGPT(ALT) 32ALKALINE PHOSPHATASE 189 TOTAL PROTEINS 5.0ALBUMIN 2.2A/G RATIO 0.79 HEMOGRAM 22/5/24
HB: 8.2 TLC:12,900 PLT:1.70 PCV:23.8 RBC:2.77 23/05/2024 HEMOGRAM HB: 7.7 TLC:11700 PLT:2.07 PCV:22.2 RBC:2.54
LIVER FUNCTION TEST (LFT) Total Bilurubin: 1.41Direct Bilurubin: 0.60SGOT(AST): 40SGPT(ALT)
: 30ALKALINE PHOSPHATASE: 159TOTAL PROTEINS: 5.0ALBUMIN : 1.8A/G RATIO: 0.47 RFT
UREA: 26
CREATININE: 0.9
URIC ACID: 2.6
CA: 7.5
P: 5.6
NA: 130 K:3.6 CL: 98 CUE:
COLOR: PALE YELLOW APPEARANCE : CLEAR REACTION : ACIDIC SP.GRAVITY:1.01 ALBUMIN: +
SUGAR: NIL
BILE SALTS: NIL BILE PIGMENTS: NIL PUS CELLS: PLENTY EPITHELIAL:2-3
RBC NIL CRYSTALS: NIL CAST:NIL
ABG PH:7.51 PCO2:27.2 PO2:59.4 HCO3:21.9
ST.HCO3:24.3 BEB:-0.0 BEECF: -0.7 TCO2:44.8
O2 SAT:92.9
O2 COUNT-12.8 24/05/2024 HEMOGRAM HB: 7.7 TLC:13,700 PLT:1.80
PCV: 21.4
RBC: 2.54
LIVER FUNCTION TEST (LFT) Total Bilurubin: 0.83Direct Bilurubin: 0.16SGOT(AST): 30SGPT(ALT)
: 30ALKALINE PHOSPHATASE:236 TOTAL PROTEINS: 5.2ALBUMIN : 2.2A/G RATIO: 0.75 RFT
UREA: 32 CREATININE:1.2 URIC ACID: 2.9
CA: 9.3
P: 2.9
NA: 130
K:3.7 CL: 97
URINE CULTURE REPORT ON 24/5/24 REVEALED PERINEAL COMMENSALS GROWTH. 25/05/2024
SERUM ELECTROLTYES NA:133
P: 4.0
CL: 102 CA:1.02 HEMOGRAM HB: 7.7 TLC:13,600 PLT:1.80 PCV: 21.4
RBC: 2.52
LIVER FUNCTION TEST (LFT) Total Bilurubin: 0.83Direct Bilurubin: 0.16SGOT(AST): 30SGPT(ALT)
: 30ALKALINE PHOSPHATASE:236 TOTAL PROTEINS: 5.2ALBUMIN : 2.2A/G RATIO: 0.75 RFT
UREA: 32 CREATININE:1.2 URIC ACID: 2.9
CA: 9.3
P: 2.9
NA: 130 K:3.7 CL: 97
26/05/2024
RFT UREA: 28
CREATININE:1.2 URIC ACID: 2.7
CA: 9.8
P: 2.7
NA: 134
K:3.9 CL: 97 LFT
TOTAL BILIRUBIN: 0.70 DIRECT BILIRUBIN:0.16 AST:27
ALY:29
ALKALINE PHOSPAHTASE:230 TOTAL PROTEIN : 5.1 ALBUMIN: 2.2
A/G RATIO- 0.75 HEMOGRAM HB- 7.4
PCV - 21.3 RBC-2.47 PLT-2.39 28/05/2024 HEMOGRAM- HB- 7.0
PC- 19.6
RBC- 2.28
PLT- 2.65 CUE
COLOUR- PALE YELLOW APPEARANCE- CLEAR REACTION- ACIDIC SPECIFIC GRAVITY-1.010 ALBUMIN- +
SUGAR- NIL BILE SALTS- NIL BILE PIGMENT- NIL
PUS CELL-3-4 E CELLS- 2-3 RBC- NIL
CRYSTALS-0 NIL
CAST- NIL
ON 18/05/2024
BLOOD CULTURE FROM PERIPHERAL LINE - ACINETOBACTER ISOLATED. SENSITIVE TO COTRIMOXAZOLE
BLOOD CULTURE FROM CENTRAL LINE - ACINETOBACTER ISOLATED. SENSITIVE TO COTRIMOXAZOLE
ON 29/05/2024
URINE CULTURE - ENTEROCOCCUS SPS. >10^5 CFU/ML OF URINE ISOLATED, SENSITIVE TO LINOZOLID . INTERMEDIATELY SENSITIVE TO NITROFURONTINE AND PIPTAZ
BLOOD CULTURE FROM CENTRAL AND PERIPHERAL LINES WERE NEGATIVE 29/05/2024
CUE
COLOUR Pale yellowAPPEARANCE Clear Clear REACTION Acidic SP.GRAVITY 1.010 ALBUMIN
++ SUGAR Nil BILE SALTS Nil BILE PIGMENTS Nil PUS CELLS 4-5 EPITHELIAL CELLS 3-4 RED BLOOD CELLS Nil CRYSTALS NilCASTS NilAMORPHOUS DEPOSITS AbsentOTHERS Nil HEMOGRAM
HAEMOGLOBIN 7.8 gm/dl TOTAL COUNT 10,000 cells/cumm NEUTROPHILS 76 % LYMPHOCYTES 18 % EOSINOPHILS 02 % MONOCYTES 04 % BASOPHILS 00 % PCV 24.1 vol % M C V 86.9 fl M C H 28.2 pg M C H C 32.4 %RDW-CV 15.8 % RDW-SD 51.5 fl RBC COUNT 2.78
millions/cumm PLATELET COUNT 3.32 lakhs/cu.mm SERUM ELECTROLYTE
SODIUM 134 mmol/L POTASSIUM 4.4 mmol/L CHLORIDE 99 mmol/L CALCIUM IONIZED 1.05
mmol/L 30/05/2024 CUE
COLOUR Pale yellowAPPEARANCE ClearREACTION Acidic SP.GRAVITY 1.010 ALBUMIN ++ SUGAR Nil BILE SALTS Nil BILE PIGMENTS Nil PUS CELLS 3-4 EPITHELIAL CELLS 2-3 RED BLOOD CELLS Nil CRYSTALS Nil
HEMOGRAM
HAEMOGLOBIN 7.2 gm/dl TOTAL COUNT 8,600 cells/cumm NEUTROPHILS 70 % LYMPHOCYTES 20 %EOSINOPHILS 02 %MONOCYTES 08 % BASOPHILS 00 %PCV 21.7 vol % M C V 86.5 fl M C H 28.4 pg M C H C 32.9 % RDW-CV 15.8 % RDW-SD 51.2 fl RBC COUNT 2.51
millions/cumm PLATELET COUNT 3.34 lakhs/cu.mm 31/05/2024
CUE
COLOUR Pale yellowAPPEARANCE ClearREACTION AcidiSP.GRAVITY 1.010 ALBUMIN
++SUGAR NilBILE SALTS NilBILE PIGMENTS NilPUS CELLS 3-4 EPITHELIAL CELL S2-3 RED BLOOD CELLS NilCRYSTALS NilCASTS NilAMORPHOUS DEPOSITS Absent NilOTHERS Nil HEMOGRAM
HAEMOGLOBIN 7.7 gm/dlTOTAL COUNT 10,200 cells/cumm NEUTROPHILS 70 %
LYMPHOCYTES 20 % EOSINOPHILS 02 % MONOCYTES 08 % BASOPHILS 00 % PCV 23.3 vol % M C V 89.3 flM C H 29.5 pg M C H C 33.0 %RDW-CV 14.7 %RDW-SD 48.5 fl 3RBC COUNT 2.61
millions/cumm PLATELET COUNT 3.82 lakhs/cu.mm 1/6/24
CUE
COLOUR Pale yellowAPPEARANCE Clear
REACTION AcidicSP.GRAVITY 1.010 ALBUMIN ++SUGAR NilBILE SALTS NilBILE PIGMENTS NilPUS CELLS 3-4 EPITHELIAL CELLS 2-3 RED BLOOD CELLS NilCRYSTALS NilCASTS NilAMORPHOUS DEPOSITS Absent OTHERS Nil
HEMOGRAM
HAEMOGLOBIN 7.2 gm/dlTOTAL COUNT 8,600 cells/cumm NEUTROPHILS 70 % LYMPHOCYTES 20 % EOSINOPHILS 02 % MONOCYTES 08 % BASOPHILS 00 % PCV 21.7 vol % M C V 86.5 flM C H 28.4 pg M C H C 32.9 %RDW-CV 51.2 %RDW-SD 51.2 fl 3RBC COUNT 2.51 millions/cumm
PLATELET COUNT 3.34 lakhs/cu.mm 2/6/24
HEMOGRAM
HAEMOGLOBIN 7.5 gm/dlTOTAL COUNT 10,100 cells/cumm NEUTROPHILS 70 %
LYMPHOCYTES 20 % EOSINOPHILS 00 % MONOCYTES 18 % BASOPHILS 00 % PCV 22 vol % M C V 86.6 flM C H 29.5 pg M C H C 34.1 %RDW-CV 14.3 %RDW-SD 45.7 fl 3RBC COUNT 2.54
millions/cumm PLATELET COUNT 3.44 lakhs/cu.mm CT KUB PLAIN DONE 13/5/24
B/L MILD HYDROURETERONEPHROSIS [RT>LT]DUE TO OVERLY DISTENDED URINARY BLADDER
DEPENDENT DENSITY NOTED WITHIN THE BLADDER POSTEROLATERALLY
? URINARYBLADDER SLUDGE ? MASS CT KUB CONTRAST DONE ON 24/5/2024
B/L MILD HYDROURETERONBEPHROSIS [RT>LT]
OOVERLY DISTENDED URINARY BLADDER WITH INCREASEED WALL THICKNESS MRI BRAIN PLAIN ON 8/5/2024
HEMOSIDERIN STAINING IN LEFT BASAL GANGLIA
SEQUALAE OF OLD HEMORRHAGE
FEW MICROHEMORRHAGES IN B/L CEREBRAL HEMISPHERES ON SWI LIKE HYPERTENSIVE MICRO HEMORRHAGES
CT BRAIN PLAIN ON 10/5/2024
HYPODENSE LESION IN LEFT BASAL GANGLIA SEQUALAE OF OLD INFARCT OR HEMORRHAGE
URINE CYTOLOGY REPORT ON REVEALED FEW SCATTERED DISPERSED EPITELIAL CELLS IN THE BACKGROUND SHOWING NUMEROUS DEGENERATED NEUTROPHILS, BACTERIAL COLONIES HAEMORHHAGIC , NONATYPICAL CELLS WERE SEEN.
URINE CYTOLOGY REPORT ON 31/5/24 REVEALED NUMEROUD DEGENERATED NEUTROPHILS, EOSINOPHILS, FUNGAL ELEMENTS - HYPHAE, BUDDING YEAST, PROBABLY CANDIDA SPECIES IN BACGROUND SHOWING BACTERIAL COLONIES. NO EVIDENCE OF ATYPICAL CELLS
Treatment Given(Enter only Generic Name)
RYLES FEEDS: 100ML WATER 2ND HOURLY
200ML MILK 4TH HOURLY WITH 2 SPOONS OF PROTEIN POWDER IV FLUIDS -NS &RL @ 50ML/HR
INJ. MEROPENEM 1GM IV/BD INJ. CLINDAMYCIN 500MG IV/BD INJ. PIPTAZ 4.5GM IV/TID
INJ. NEOMOL 1GMIV/SOS INJ.TRANEXA 500 MG /IV/BD
INJ.THIAMINE 200MG IN 100ML NS /IV/BD INJ.OPTINEURON 1AMP IN 100 ML NS/IV/OD INJ.PAN 40MG IV/OD
INJ. MIDAZOLAM 30MG + FENTANYL 200MG IN 16ML NS IV @ 4ML/HR INJ. VECURONIUM 50MG IN 50ML NS IV @3.5 ML/HR
INJ. LEVIPILL 500MG IV/BD INJ. LASIX 20MG IV/BD TAB.DOLO 650 MG /PO/SOS
TAB. OLANZAPINE 2.5MG RT/BD
TAB. COTRIMAXAZOLE 800/160MG RT/BD FOR 12 DAYS
TAB. MET-XL 50ML RT/OD
NEB.MUCOMIST 2 RESP 6TH HOURLY AND BUDECORT 6TH HRLY NEOSPORIN POWDER L/A GLUTEAL REGION
ORAL SUCTION 2ND HOURLY POSITION CHANGE 2ND HOURLY CHEST PHYSIOTHERAPY
C-PAP INTERMITTENTLY TAB SPOROLAC RT/TID
Advice at Discharge
RYLE TUBE FEEDINGS 100ML WATER EVERY 2ND HOURLY,
RYLE TUBE FEEDINGS 200ML MILKEVERY 4TH HOURLY WITH 2 SCOOPS OF PROTEIN POWDER
TAB. COTRIMOXAZOLE 200/160MG RT BD X 1 WEEK TAB. BENFOMET PLUS RT OD X 1 WEEK
TAB. NEUROBION FORTE RT OD X 1 WEEK TAB. PAN 40MG RT OD X 1 WEEK
TAB. DOLO 650MG RT SOS
ROTAHALER FORACORT 200MG 2 PUFFS BD HOME BP MONITORING
T.BACT OINTMENT FOR LA REGULAR BEDSORE DRESSINGS AIR BED
2HRLY POSITION CHANGING
Follow Up
REVIEW TO GM, GS, UROLOGY OPDS AFTER 1 WEEK OR SOS
TLC:13,800 PLT:2.74 PCV:34% RBC:3.93
RFT 04-05-2024 06:53:PMUREA 25 mg/dl 42-12 mg/dlCREATININE 0.9 mg/dl 1.3-0.9 mg/dlURIC
ACID 2.4 mmol/L 7.2-3.5 mmol/LCALCIUM 9.5 mg/dl 10.2-8.6 mg/dlPHOSPHOROUS 3.4 mg/dl 4.5-
2.5 mg/dlSODIUM 138 mmol/L 145-136 mmol/LPOTASSIUM 3.5 mmol/L. 5.1-3.5 mmol/L.CHLORIDE
101 mmol/L 98-107 mmol/L
LIVER FUNCTION TEST (LFT) 04-05-2024 06:53:PMTotal Bilurubin 1.12 mg/dl 1-0 mg/dlDirect Bilurubin 0.20 mg/dl 0.2-0.0 mg/dlSGOT(AST) 21 IU/L 35-0 IU/LSGPT(ALT) 25 IU/L 45-0
IU/LALKALINE PHOSPHATASE 191 IU/L 119-56 IU/LTOTAL PROTEINS 5.8 gm/dl 8.3-6.4
gm/dlALBUMIN 2.88 gm/dl 4.6-3.2 gm/dlA/G RATIO 0.99
HBsAg-RAPID 04-05-2024 06:53:PM Negative
Anti HCV Antibodies - RAPID 04-05-2024 06:53:PM Non Reactive HIV:NON REACTIVE
HEMOGRAM 5/5/24 HB:11.2
PCV:31.9 TLC:11,300 RBC:3.69 PLT:2.64
USG ABDOMEN AND PELVIS DONE ON 4/5/24
E/O IRREGULAR WALL THICKENING MEASURING 4-5MM WITH THICK ECHOGENIC INTERNAL ECHOES NOTED IN THE PARTIALLY DISTENDED URINARY BLADDER AND E/O 6MM SLUDGE NOTED AT THE BASE OF BLADDER WITH NO VASCULARITY LIKELY SLUDGE / BLOOD CLOT.
B/L GRADE 1 RPD CHANGES IN KIDNEYS
ABG 05-05-2024 01:05:AMPH 7.43PCO2 34.2PO2 83.1HCO3 22.6St.HCO3 23.8BEB -0.7BEecf -
1.1TCO2 45.7O2 Sat 95.9O2 Count 15.6
COMPLETE URINE EXAMINATION (CUE) 05-05-2024 10:40:AMCOLOUR reddishAPPEARANCE cloudyREACTION AcidicSP.GRAVITY 1.010ALBUMIN ++++SUGAR NilBILE SALTS NilBILE PIGMENTS NilPUS CELLS 10-15EPITHELIAL CELLS 4-6RED BLOOD CELLS loadedCRYSTALS NilCASTS +AMORPHOUS DEPOSITS AbsentOTHERS Nil
RFT 05-05-2024 11:19:PMUREA 53 mg/dl 42-12 mg/dlCREATININE 1.1 mg/dl 1.3-0.9 mg/dlURIC
ACID 3.1 mmol/L 7.2-3.5 mmol/LCALCIUM 9.6 mg/dl 10.2-8.6 mg/dlPHOSPHOROUS 3.1 mg/dl 4.5-
2.5 mg/dlSODIUM 135 mmol/L 145-136 mmol/LPOTASSIUM 4.1 mmol/L. 5.1-3.5 mmol/L.CHLORIDE
97 mmol/L 98-107 mmol/L HEMOGRAM 6/5/24
2D ECHO WAS DONE -
NO RWMA, MILD LVH PRESENT (1.25 CM) MODERATE TR PRESENT, MILD PAH
MILD AR PRESENT (PHT = 518 M/SEC); TRIVIAL MR PPRESENT MAC PRESENT, SCLEROTIC AV, NO AS/MS
EF = 62% TVSP = 48 MM HG GOOD IV SYSTOLIC FUNCTION
GRADE 1 DIASTOLIC DYSFUNCTION IVC SIZE 0.7CM COLLAPSING
IAS - ANEURYSM
REVIEW 2D ECHO WAS DONE ON 18/5/24 NO PR/IV CLOT
IVC SIZE 0.8 CM COLLAPSING HB:11.7
TLC:12,500 PCV:34.2 RBC:3.98 PLT:2.86
ABG 06-05-2024 09:20:AMPH 7.43PCO2 27.3PO2 69.0HCO3 18.2St.HCO3 20.7BEB -4.5BEecf -
5.2TCO2 36.9O2 Sat 94.3O2 Count 15.1
COMPLETE URINE EXAMINATION (CUE) 06-05-2024 11:14:AMCOLOUR reddishAPPEARANCE cloudyREACTION AcidicSP.GRAVITY 1.010ALBUMIN ++++SUGAR NilBILE SALTS NilBILE PIGMENTS NilPUS CELLS 1-2EPITHELIAL CELLS nilRED BLOOD CELLS 12-14CRYSTALS NilCASTS NilAMORPHOUS DEPOSITS AbsentOTHERS Nil
RFT 06-05-2024 10:07:PMUREA 52 mg/dl 42-12 mg/dlCREATININE 1.0 mg/dl 1.3-0.9 mg/dlURIC
ACID 3.8 mmol/L 7.2-3.5 mmol/LCALCIUM 9.9 mg/dl 10.2-8.6 mg/dlPHOSPHOROUS 3.4 mg/dl 4.5-
2.5 mg/dlSODIUM 138 mmol/L 145-136 mmol/LPOTASSIUM 4.1 mmol/L. 5.1-3.5 mmol/L.CHLORIDE
104 mmol/L 98-107 mmol/L
COMPLETE URINE EXAMINATION (CUE) 06-05-2024 10:07:PMCOLOUR ReddishAPPEARANCE HazyREACTION AcidicSP.GRAVITY 1.010ALBUMIN ++SUGAR NilBILE SALTS NilBILE PIGMENTS NilPUS CELLS 2-4EPITHELIAL CELLS NilRED BLOOD CELLS loadedCRYSTALS NilCASTS NilAMORPHOUS DEPOSITS AbsentOTHERS Nil
HEMOGRAM 7/5/24 HB:11.6 TLC:15,200 PCV:33.6
RBC:3.91 PLT:3.45
COMPLETE URINE EXAMINATION (CUE) 07-05-2024 10:04:PMCOLOUR ReddishAPPEARANCE CloudyREACTION AcidicSP.GRAVITY 1.010ALBUMIN +++SUGAR NilBILE SALTS NilBILE PIGMENTS NilPUS CELLS 2-4EPITHELIAL CELLS 0-1RED BLOOD CELLS plentyCRYSTALS few
triple phosphate crystals seenCASTS NilAMORPHOUS DEPOSITS AbsentOTHERS Nil
RFT 07-05-2024 10:04:PMUREA 55 mg/dl 42-12 mg/dlCREATININE 1.2 mg/dl 1.3-0.9 mg/dlURIC
ACID 2.9 mmol/L 7.2-3.5 mmol/LCALCIUM 10.0 mg/dl 10.2-8.6 mg/dlPHOSPHOROUS 3.5 mg/dl 4.5-
2.5 mg/dlSODIUM 139 mmol/L 145-136 mmol/LPOTASSIUM 3.9 mmol/L. 5.1-3.5 mmol/L.CHLORIDE
104 mmol/L 98-107 mmol/L
HEMOGRAM 8/5/24 HB:11.4 TLC:17,800 PCV:32.9RBC:3.7 PLT:3.8
ABG 08-05-2024 02:42:PMPH 7.49PCO2 25.1PO2 42.3HCO3 19.3St.HCO3 22.3BEB -2.1BEecf -
3.6TCO2 37.6O2 Sat 79.7O2 Count 15.1
ABG 08-05-2024 02:43:PMPH 7.17PCO2 43.4PO2 96.4HCO3 15.3St.HCO3 14.7BEB -12.7BEecf -
11.6TCO2 32.2O2 Sat 93.0O2 Count 17.9
RFT 08-05-2024 11:37:PMUREA 105 mg/dl 42-12 mg/dlCREATININE 3.2 mg/dl 1.3-0.9 mg/dlURIC
ACID 5.5 mmol/L 7.2-3.5 mmol/LCALCIUM 10.0 mg/dl 10.2-8.6 mg/dlPHOSPHOROUS 6.9 mg/dl 4.5-
2.5 mg/dlSODIUM 137 mmol/L 145-136 mmol/LPOTASSIUM 4.5 mmol/L. 5.1-3.5 mmol/L.CHLORIDE
102 mmol/L 98-107 mmol/L
ABG 08-05-2024 11:37:PMPH 7.385PCO2 30.7PO2 183HCO3 18.0St.HCO3 19.8BEB -5.6BEecf -
6.1TCO2 36.8O2 Sat 98.0O2 Count 16.2 HEMOGRAM 9/5/24
HB:11.3 TLC:22,900 PCV:33.7 RBC:3.8 PLT:3.3
COMPLETE URINE EXAMINATION (CUE) 09-05-2024 12:18:PMCOLOUR BrownishAPPEARANCE CloudyREACTION AcidicSP.GRAVITY 1.010ALBUMIN ++++SUGAR NilBILE SALTS NilBILE PIGMENTS NilPUS CELLS 2-3EPITHELIAL CELLS 1-2RED BLOOD CELLS loadedCRYSTALS
triple phosphate crystals presentCASTS NilAMORPHOUS DEPOSITS AbsentOTHERS Bacteria- present
ABG 09-05-2024 12:37:PMPH 7.19PCO2 46.1PO2 83.7HCO3 17.2St.HCO3 16.2BEB -10.3BEecf -
9.5TCO2 36.9O2 Sat 91.9O2 Count 14.6
SERUM ELECTROLYTES (Na, K, C l) 09-05-2024 12:43:PMSODIUM 135 mmol/L 145-136
mmol/LPOTASSIUM 4.7 mmol/L 5.1-3.5 mmol/LCHLORIDE 98 mmol/L 98-107 mmol/L COMPLETE URINE EXAMINATION (CUE) 09-05-2024 11:48:PMCOLOUR reddishAPPEARANCE CloudyREACTION AcidicSP.GRAVITY 1.010ALBUMIN +++SUGAR NilBILE SALTS NilBILE
PIGMENTS NilPUS CELLS 1-2EPITHELIAL CELLS 1-2RED BLOOD CELLS 3-5CRYSTALS triple
phosphate crystalsCASTS NilAMORPHOUS DEPOSITS AbsentOTHERS Nil
RFT 09-05-2024 11:48:PMUREA 144 mg/dl 42-12 mg/dlCREATININE 3.5 mg/dl 1.3-0.9 mg/dlURIC
ACID 5.0 mmol/L 7.2-3.5 mmol/LCALCIUM 9.8 mg/dl 10.2-8.6 mg/dlPHOSPHOROUS 6.7 mg/dl 4.5-
2.5 mg/dlSODIUM 136 mmol/L 145-136 mmol/LPOTASSIUM 4.5 mmol/L. 5.1-3.5 mmol/L.CHLORIDE
101 mmol/L 98-107 mmol/L
ABG 09-05-2024 11:48:PMPH 7.26PCO2 33.2PO2 49.2HCO3 14.7St.HCO3 15.5BEB -10.9BEecf - 10.9TCO2 33.2O2 Sat 84.2O2 Count 6.5
HEMOGRAM 10/5/24 HB:9.9
TLC:16,400 PCV:29.7 RBC:3.27 PLT:3.12
ABG 10-05-2024 10:24:AMPH 7.26PCO2 39.5PO2 27.1HCO3 17.2St.HCO3 16.6BEB -8.8BEecf -
8.5TCO2 37.3O2 Sat 42.5O2 Count 6.0
ABG 10-05-2024 08:49:PMPH 7.39PCO2 28.7PO2 50.6HCO3 17.1St.HCO3 19.0BEB -6.4BEecf -
6.9TCO2 35.3O2 Sat 87.3O2 Count 13.1
ABG 10-05-2024 11:18:PMPH 7.35PCO2 33.3PO2 40.9HCO3 18.1St.HCO3 18.9BEB -6.5BEecf -
6.4TCO2 41.2O2 Sat 81.5O2 Count 3.8
RFT 10-05-2024 11:18:PMUREA 123 mg/dl 42-12 mg/dlCREATININE 2.4 mg/dl 1.3-0.9 mg/dlURIC
ACID 4.3 mmol/L 7.2-3.5 mmol/LCALCIUM 9.9 mg/dl 10.2-8.6 mg/dlPHOSPHOROUS 5.4 mg/dl 4.5-
2.5 mg/dlSODIUM 135 mmol/L 145-136 mmol/LPOTASSIUM 3.8 mmol/L. 5.1-3.5 mmol/L.CHLORIDE
97 mmol/L 98-107 mmol/L HEMOGRAM 11/5/24 HB:9.2
TLC:15,700 PCV:26.3 RBC:2.9 PLT:3.0
ABG 11-05-2024 11:31:PMPH 7.42PCO2 22.0PO2 136HCO3 14.1St.HCO3 17.4BEB -8.8BEecf -
9.6TCO2 29.2O2 Sat 97.7O2 Count 13.7
RFT 11-05-2024 11:31:PMUREA 112 mg/dl 42-12 mg/dlCREATININE 2.2 mg/dl 1.3-0.9 mg/dlURIC
ACID 4.6 mmol/L 7.2-3.5 mmol/LCALCIUM 9.0 mg/dl 10.2-8.6 mg/dlPHOSPHOROUS 3.7 mg/dl 4.5-
2.5 mg/dlSODIUM 135 mmol/L 145-136 mmol/LPOTASSIUM 4.0 mmol/L. 5.1-3.5 mmol/L.CHLORIDE
103 mmol/L 98-107 mmol/L HEMOGRAM 12/5/24
HB:9.6 TLC:19,400 PCV:28.3 RBC:3.25 PLT:3.35 ABG: PH:7.42 PCO2:22.0 PO2:136 HCO3:14.1
ST.HCO3:17.4 BEB:-8.8 BEECF:-9.6 TCO2:29.2
02 SAT:97.7
O2 COUNT:13.7 RFT:
UREA:112 CREATININE:2.2 URIC ACID:4.6 CA:9.0
P:3.7 NA:135 K:4 CL:103
HEMOGRAM 13/5/24 HB:8.4
TLC:19,400 PCV:25.2 RBC:2.86 PLT:2.65
RFT 13-05-2024 12:00:AMUREA 109 mg/dl 42-12 mg/dlCREATININE 2.4 mg/dl 1.3-0.9 mg/dlURIC
ACID 5.1 mmol/L 7.2-3.5 mmol/LCALCIUM 8.6 mg/dl 10.2-8.6 mg/dlPHOSPHOROUS 5.1 mg/dl 4.5-
2.5 mg/dlSODIUM 138 mmol/L 145-136 mmol/LPOTASSIUM 4.1 mmol/L. 5.1-3.5 mmol/L.CHLORIDE
104 mmol/L 98-107 mmol/L
ABG 13-05-2024 12:01:AMPH 7.34PCO2 30.8PO2 55.1HCO3 16.5St.HCO3 18.0BEB -7.7BEecf - 8.0TCO2 35.3O2 Sat 87.1O2 Count 11.1
POST LUNCH BLOOD SUGAR 13-05-2024 10:08:AM 170 mg/dl 140-0 mg/dl
ABG 13-05-2024 10:10:AMPH 7.36PCO2 33.0PO2 80.0HCO3 18.5St.HCO3 19.9BEB -5.5BEecf -
5.8TCO2 37.7O2 Sat 95.3O2 Count 16.2
ABG 13-05-2024 10:37:PMPH 7.37PCO2 27.2PO2 139HCO3 15.3St.HCO3 17.6BEB -8.5BEecf -
8.9TCO2 32.3O2 Sat 98.0O2 Count 13.3
RFT 13-05-2024 10:37:PMUREA 85 mg/dl 42-12 mg/dlCREATININE 1.7 mg/dl 1.3-0.9 mg/dlURIC
ACID 4.1 mmol/L 7.2-3.5 mmol/LCALCIUM 8.7 mg/dl 10.2-8.6 mg/dlPHOSPHOROUS 3.4 mg/dl 4.5-
2.5 mg/dlSODIUM 137 mmol/L 145-136 mmol/LPOTASSIUM 3.9 mmol/L. 5.1-3.5 mmol/L.CHLORIDE
103 mmol/L 98-107 mmol/L HEMOGRAM 14/5/24 HB:8.7
TLC:13,800 PCV:26.1 RBC:2.9 PLT:1.36
ABG 14-05-2024 06:24:PMPH 7.41PCO2 26.8PO2 66.8HCO3 16.9St.HCO3 19.4BEB -6.0BEecf -
6.8TCO2 34.3O2 Sat 94.2O2 Count 15.3 HEMOGRAM 15/5/24
HB:8.9 TLC:16,800 PCV:26.5 RBC:3.0 PLT:1.3
ABG 15-05-2024 12:29:AMPH 7.40PCO2 26.5PO2 130HCO3 16.4St.HCO3 18.8BEB -6.9BEecf -
7.4TCO2 34.3O2 Sat 98.3O2 Count 13.1
RFT 15-05-2024 12:29:AMUREA 71 mg/dl 42-12 mg/dlCREATININE 1.3 mg/dl 1.3-0.9 mg/dlURIC
ACID 3.9 mmol/L 7.2-3.5 mmol/LCALCIUM 9.0 mg/dl 10.2-8.6 mg/dlPHOSPHOROUS 3.3 mg/dl 4.5-
2.5 mg/dlSODIUM 136 mmol/L 145-136 mmol/LPOTASSIUM 3.7 mmol/L. 5.1-3.5 mmol/L.CHLORIDE
102 mmol/L 98-107 mmol/L
ABG 15-05-2024 09:47:PMPH 7.37PCO2 31.7PO2 41.7HCO3 18.3St.HCO3 19.5BEB -5.6BEecf -
5.9TCO2 37.9O2 Sat 76.8O2 Count 11.6
RFT 15-05-2024 09:47:PMUREA 73 mg/dl 42-12 mg/dlCREATININE 1.4 mg/dl 1.3-0.9 mg/dlURIC
ACID 3.2 mmol/L 7.2-3.5 mmol/LCALCIUM 9.7 mg/dl 10.2-8.6 mg/dlPHOSPHOROUS 3.3 mg/dl 4.5-
2.5 mg/dlSODIUM 136 mmol/L 145-136 mmol/LPOTASSIUM 3.8 mmol/L. 5.1-3.5 mmol/L.CHLORIDE
99 mmol/L 98-107 mmol/L LIPID PROFILE:
TOTAL CHOLESTROL:127 TRIGLYCERIDES:346 HDL:30
LDL:67 VLDL:69.2
APTT 31
BLEEDING TIME :2 MIN CLOTTING TIME:4 MIN CRP:1.2 MG/DL
DENGUE NS1,IGM,IGG:NEGATIVE ESR:130
PT:15 SEC INR:1.11
D-DIMER:660
HEMOGRAM 16/5/24 HB:9.4
TLC:22,500 PCV:27.6 RBC:3.1 PLT:1.0
CUE 16/5/24 COLOUR:PALE YELLOW REACTION:ACIDIC SPEC GRAV:1.010
ALBUMIN:+ PUS CELLS:2-3
EPITHELIAL CELLS:2-3
RFT 16/5/24 UREA:73 CREAT:1.4 URIC ACID:3.2 CA:9.7
P:3.3 NA:136 K:3.8 CL:99
ABG 16/5/24 PH:7.37 PCO2:31.7 PO2:41.7 HCO3:18.3 STHCO3:19.5 BEB:-5.6 BEECF:-5.9 TCO2:37.9 O2 SAT:76.8
CULTURE REPORTS:
BLOOD FROM CENTRAL LINE FOR CULTURE:DIRECT SMEAR 1ST S/C,REPORT:ACINETOBACTER SPECIES ISOLATED
BLOOD FROM PERIPHERY FOR CULTURE :DIRECT SMEAR 1ST S/C,REPORT:ACINETOBACTER ISOLATED
VENOUS DOPPLER DONE ON 16/5/24
NO E/O DVT NOTED IN RIGHT LOWER LIMB
HEMOGRAM 17/5/24 HB:8.4
TLC:14,500 PLT:1.5 PCV:23.7 RBC:2.78 PH:7.43 PCO2:29.2 PO2:62.3 HCO3:19.5 STHCO3:21.6 BEB:-3.3 BEECF:-4.0 TCO2:39.6 O2 SAT:93.8
THROAT SWAB CULTURE AND SESNIIVITY DONE ON 17/5/24. PSEUDOMONAS AERUGINOSA ISOLATED SENSITIVE TO PIPERCILLIN, TOBRAMYCIN, CIPROFLOXACIN, AMIKACIN, PIPTAZ, MEROPENEM.
HEMOGRAM 18 /5/24 HB:8.4
TLC:14,500 PLT:1.5 PCV:23.7 RBC:2.78 RFT UREA:53
CREATININE:1.3 URIC ACID: 3.8 CALCIUM:9.0 P:3.6
NA:135 K:3.9 CL:103
HEMOGRAM 19/5/24 HB:8.5
TLC:14,300 PLT:1.5 PCV:23.8 RBC:2.7
COMPLETE URINE EXAMINATION: COLOR : PALE YELLOW APPEARANCE:CLEAR
REACTION: CLEAR SP GRAVITY: 1.010 ALBUMIN: +
BILE SALTS :NIL BILE PIGMENTS: NIL SUGAR:NIL
PUS CELLS:5-6 EPITHELIAL CELLS:2-3 RBC:8-10 CRYSTALS:NIL CASTS:NIL
AMORPHOUS DEPOSITS:ABSENT HEMOGRAM 20/5/24
HB:8.1 TLC:13,600 PLT:1.54 PCV:24.0 RBC:2.36 ABG PH:7.47 PCO2:32.9 PO2:97.6 HCO3:23.7
ST.HCO3:25.2 BEB:0.9 BEECF:0.4 TCO2:47.8
O2 SAT:97.8
HEMOGRAM 21 /5/24 HB:8.8
TLC:15,800 PLT:1.65 PCV:25.2 RBC:2.93 CUE:
COLOR: PALE YELLOW APPEARANCE : CLEAR REACTION : ACIDIC SP.GRAVITY:1.01 ALBUMIN: ++++ SUGAR: NIL
BILE SALTS: NIL BILE PIGMENTS: NIL PUS CELLS: 14-15 EPITHELIAL:2-3 RBC:2-3
CRYSTALS: NIL CAST:NIL
RFT UREA:38
CREATININE:0.9 URIC ACID:3.2 CA:9.7
P:2.8 NA:136 K:3.8 CL:101
HEMOGRAM 22 /5/24 HB:8.8
TLC:15000 PLT:1.65 PCV:25.2 RBC:2.93
HEMOGRAM 22/5/24 HB:8.0
TLC:12,300 PLT:1.57 PCV:23.6 RBC:2.69
COMPLETE URINE EXAMINATION: 22/05/2024 COLOR : PALE YELLOW APPEARANCE:CLEAR
REACTION: CLEAR SP GRAVITY: 1.010 ALBUMIN: NIL
BILE SALTS :NIL BILE PIGMENTS: NIL SUGAR:NIL
PUS CELLS:2-3 EPITHELIAL CELLS:1-2 RBC:NIL CRYSTALS:NIL CASTS:NIL
AMORPHOUS DEPOSITS:ABSENT RFT
UREA: 27 CREATININE:0.9 URIC ACID:3.0 CA:9.0
P:2.8 NA:136 K:3.7
CL:98
LIVER FUNCTION TEST (LFT) Total Bilurubin 10Direct Bilurubin.20SGOT(AST) 30SGPT(ALT) 32ALKALINE PHOSPHATASE 189 TOTAL PROTEINS 5.0ALBUMIN 2.2A/G RATIO 0.79 HEMOGRAM 22/5/24
HB: 8.2 TLC:12,900 PLT:1.70 PCV:23.8 RBC:2.77 23/05/2024 HEMOGRAM HB: 7.7 TLC:11700 PLT:2.07 PCV:22.2 RBC:2.54
LIVER FUNCTION TEST (LFT) Total Bilurubin: 1.41Direct Bilurubin: 0.60SGOT(AST): 40SGPT(ALT)
: 30ALKALINE PHOSPHATASE: 159TOTAL PROTEINS: 5.0ALBUMIN : 1.8A/G RATIO: 0.47 RFT
UREA: 26
CREATININE: 0.9
URIC ACID: 2.6
CA: 7.5
P: 5.6
NA: 130 K:3.6 CL: 98 CUE:
COLOR: PALE YELLOW APPEARANCE : CLEAR REACTION : ACIDIC SP.GRAVITY:1.01 ALBUMIN: +
SUGAR: NIL
BILE SALTS: NIL BILE PIGMENTS: NIL PUS CELLS: PLENTY EPITHELIAL:2-3
RBC NIL CRYSTALS: NIL CAST:NIL
ABG PH:7.51 PCO2:27.2 PO2:59.4 HCO3:21.9
ST.HCO3:24.3 BEB:-0.0 BEECF: -0.7 TCO2:44.8
O2 SAT:92.9
O2 COUNT-12.8 24/05/2024 HEMOGRAM HB: 7.7 TLC:13,700 PLT:1.80
PCV: 21.4
RBC: 2.54
LIVER FUNCTION TEST (LFT) Total Bilurubin: 0.83Direct Bilurubin: 0.16SGOT(AST): 30SGPT(ALT)
: 30ALKALINE PHOSPHATASE:236 TOTAL PROTEINS: 5.2ALBUMIN : 2.2A/G RATIO: 0.75 RFT
UREA: 32 CREATININE:1.2 URIC ACID: 2.9
CA: 9.3
P: 2.9
NA: 130
K:3.7 CL: 97
URINE CULTURE REPORT ON 24/5/24 REVEALED PERINEAL COMMENSALS GROWTH. 25/05/2024
SERUM ELECTROLTYES NA:133
P: 4.0
CL: 102 CA:1.02 HEMOGRAM HB: 7.7 TLC:13,600 PLT:1.80 PCV: 21.4
RBC: 2.52
LIVER FUNCTION TEST (LFT) Total Bilurubin: 0.83Direct Bilurubin: 0.16SGOT(AST): 30SGPT(ALT)
: 30ALKALINE PHOSPHATASE:236 TOTAL PROTEINS: 5.2ALBUMIN : 2.2A/G RATIO: 0.75 RFT
UREA: 32 CREATININE:1.2 URIC ACID: 2.9
CA: 9.3
P: 2.9
NA: 130 K:3.7 CL: 97
26/05/2024
RFT UREA: 28
CREATININE:1.2 URIC ACID: 2.7
CA: 9.8
P: 2.7
NA: 134
K:3.9 CL: 97 LFT
TOTAL BILIRUBIN: 0.70 DIRECT BILIRUBIN:0.16 AST:27
ALY:29
ALKALINE PHOSPAHTASE:230 TOTAL PROTEIN : 5.1 ALBUMIN: 2.2
A/G RATIO- 0.75 HEMOGRAM HB- 7.4
PCV - 21.3 RBC-2.47 PLT-2.39 28/05/2024 HEMOGRAM- HB- 7.0
PC- 19.6
RBC- 2.28
PLT- 2.65 CUE
COLOUR- PALE YELLOW APPEARANCE- CLEAR REACTION- ACIDIC SPECIFIC GRAVITY-1.010 ALBUMIN- +
SUGAR- NIL BILE SALTS- NIL BILE PIGMENT- NIL
PUS CELL-3-4 E CELLS- 2-3 RBC- NIL
CRYSTALS-0 NIL
CAST- NIL
ON 18/05/2024
BLOOD CULTURE FROM PERIPHERAL LINE - ACINETOBACTER ISOLATED. SENSITIVE TO COTRIMOXAZOLE
BLOOD CULTURE FROM CENTRAL LINE - ACINETOBACTER ISOLATED. SENSITIVE TO COTRIMOXAZOLE
ON 29/05/2024
URINE CULTURE - ENTEROCOCCUS SPS. >10^5 CFU/ML OF URINE ISOLATED, SENSITIVE TO LINOZOLID . INTERMEDIATELY SENSITIVE TO NITROFURONTINE AND PIPTAZ
BLOOD CULTURE FROM CENTRAL AND PERIPHERAL LINES WERE NEGATIVE 29/05/2024
CUE
COLOUR Pale yellowAPPEARANCE Clear Clear REACTION Acidic SP.GRAVITY 1.010 ALBUMIN
++ SUGAR Nil BILE SALTS Nil BILE PIGMENTS Nil PUS CELLS 4-5 EPITHELIAL CELLS 3-4 RED BLOOD CELLS Nil CRYSTALS NilCASTS NilAMORPHOUS DEPOSITS AbsentOTHERS Nil HEMOGRAM
HAEMOGLOBIN 7.8 gm/dl TOTAL COUNT 10,000 cells/cumm NEUTROPHILS 76 % LYMPHOCYTES 18 % EOSINOPHILS 02 % MONOCYTES 04 % BASOPHILS 00 % PCV 24.1 vol % M C V 86.9 fl M C H 28.2 pg M C H C 32.4 %RDW-CV 15.8 % RDW-SD 51.5 fl RBC COUNT 2.78
millions/cumm PLATELET COUNT 3.32 lakhs/cu.mm SERUM ELECTROLYTE
SODIUM 134 mmol/L POTASSIUM 4.4 mmol/L CHLORIDE 99 mmol/L CALCIUM IONIZED 1.05
mmol/L 30/05/2024 CUE
COLOUR Pale yellowAPPEARANCE ClearREACTION Acidic SP.GRAVITY 1.010 ALBUMIN ++ SUGAR Nil BILE SALTS Nil BILE PIGMENTS Nil PUS CELLS 3-4 EPITHELIAL CELLS 2-3 RED BLOOD CELLS Nil CRYSTALS Nil
HEMOGRAM
HAEMOGLOBIN 7.2 gm/dl TOTAL COUNT 8,600 cells/cumm NEUTROPHILS 70 % LYMPHOCYTES 20 %EOSINOPHILS 02 %MONOCYTES 08 % BASOPHILS 00 %PCV 21.7 vol % M C V 86.5 fl M C H 28.4 pg M C H C 32.9 % RDW-CV 15.8 % RDW-SD 51.2 fl RBC COUNT 2.51
millions/cumm PLATELET COUNT 3.34 lakhs/cu.mm 31/05/2024
CUE
COLOUR Pale yellowAPPEARANCE ClearREACTION AcidiSP.GRAVITY 1.010 ALBUMIN
++SUGAR NilBILE SALTS NilBILE PIGMENTS NilPUS CELLS 3-4 EPITHELIAL CELL S2-3 RED BLOOD CELLS NilCRYSTALS NilCASTS NilAMORPHOUS DEPOSITS Absent NilOTHERS Nil HEMOGRAM
HAEMOGLOBIN 7.7 gm/dlTOTAL COUNT 10,200 cells/cumm NEUTROPHILS 70 %
LYMPHOCYTES 20 % EOSINOPHILS 02 % MONOCYTES 08 % BASOPHILS 00 % PCV 23.3 vol % M C V 89.3 flM C H 29.5 pg M C H C 33.0 %RDW-CV 14.7 %RDW-SD 48.5 fl 3RBC COUNT 2.61
millions/cumm PLATELET COUNT 3.82 lakhs/cu.mm 1/6/24
CUE
COLOUR Pale yellowAPPEARANCE Clear
REACTION AcidicSP.GRAVITY 1.010 ALBUMIN ++SUGAR NilBILE SALTS NilBILE PIGMENTS NilPUS CELLS 3-4 EPITHELIAL CELLS 2-3 RED BLOOD CELLS NilCRYSTALS NilCASTS NilAMORPHOUS DEPOSITS Absent OTHERS Nil
HEMOGRAM
HAEMOGLOBIN 7.2 gm/dlTOTAL COUNT 8,600 cells/cumm NEUTROPHILS 70 % LYMPHOCYTES 20 % EOSINOPHILS 02 % MONOCYTES 08 % BASOPHILS 00 % PCV 21.7 vol % M C V 86.5 flM C H 28.4 pg M C H C 32.9 %RDW-CV 51.2 %RDW-SD 51.2 fl 3RBC COUNT 2.51 millions/cumm
PLATELET COUNT 3.34 lakhs/cu.mm 2/6/24
HEMOGRAM
HAEMOGLOBIN 7.5 gm/dlTOTAL COUNT 10,100 cells/cumm NEUTROPHILS 70 %
LYMPHOCYTES 20 % EOSINOPHILS 00 % MONOCYTES 18 % BASOPHILS 00 % PCV 22 vol % M C V 86.6 flM C H 29.5 pg M C H C 34.1 %RDW-CV 14.3 %RDW-SD 45.7 fl 3RBC COUNT 2.54
millions/cumm PLATELET COUNT 3.44 lakhs/cu.mm CT KUB PLAIN DONE 13/5/24
B/L MILD HYDROURETERONEPHROSIS [RT>LT]DUE TO OVERLY DISTENDED URINARY BLADDER
DEPENDENT DENSITY NOTED WITHIN THE BLADDER POSTEROLATERALLY
? URINARYBLADDER SLUDGE ? MASS CT KUB CONTRAST DONE ON 24/5/2024
B/L MILD HYDROURETERONBEPHROSIS [RT>LT]
OOVERLY DISTENDED URINARY BLADDER WITH INCREASEED WALL THICKNESS MRI BRAIN PLAIN ON 8/5/2024
HEMOSIDERIN STAINING IN LEFT BASAL GANGLIA
SEQUALAE OF OLD HEMORRHAGE
FEW MICROHEMORRHAGES IN B/L CEREBRAL HEMISPHERES ON SWI LIKE HYPERTENSIVE MICRO HEMORRHAGES
CT BRAIN PLAIN ON 10/5/2024
HYPODENSE LESION IN LEFT BASAL GANGLIA SEQUALAE OF OLD INFARCT OR HEMORRHAGE
URINE CYTOLOGY REPORT ON REVEALED FEW SCATTERED DISPERSED EPITELIAL CELLS IN THE BACKGROUND SHOWING NUMEROUS DEGENERATED NEUTROPHILS, BACTERIAL COLONIES HAEMORHHAGIC , NONATYPICAL CELLS WERE SEEN.
URINE CYTOLOGY REPORT ON 31/5/24 REVEALED NUMEROUD DEGENERATED NEUTROPHILS, EOSINOPHILS, FUNGAL ELEMENTS - HYPHAE, BUDDING YEAST, PROBABLY CANDIDA SPECIES IN BACGROUND SHOWING BACTERIAL COLONIES. NO EVIDENCE OF ATYPICAL CELLS
Treatment Given(Enter only Generic Name)
RYLES FEEDS: 100ML WATER 2ND HOURLY
200ML MILK 4TH HOURLY WITH 2 SPOONS OF PROTEIN POWDER IV FLUIDS -NS &RL @ 50ML/HR
INJ. MEROPENEM 1GM IV/BD INJ. CLINDAMYCIN 500MG IV/BD INJ. PIPTAZ 4.5GM IV/TID
INJ. NEOMOL 1GMIV/SOS INJ.TRANEXA 500 MG /IV/BD
INJ.THIAMINE 200MG IN 100ML NS /IV/BD INJ.OPTINEURON 1AMP IN 100 ML NS/IV/OD INJ.PAN 40MG IV/OD
INJ. MIDAZOLAM 30MG + FENTANYL 200MG IN 16ML NS IV @ 4ML/HR INJ. VECURONIUM 50MG IN 50ML NS IV @3.5 ML/HR
INJ. LEVIPILL 500MG IV/BD INJ. LASIX 20MG IV/BD TAB.DOLO 650 MG /PO/SOS
TAB. OLANZAPINE 2.5MG RT/BD
TAB. COTRIMAXAZOLE 800/160MG RT/BD FOR 12 DAYS
TAB. MET-XL 50ML RT/OD
NEB.MUCOMIST 2 RESP 6TH HOURLY AND BUDECORT 6TH HRLY NEOSPORIN POWDER L/A GLUTEAL REGION
ORAL SUCTION 2ND HOURLY POSITION CHANGE 2ND HOURLY CHEST PHYSIOTHERAPY
C-PAP INTERMITTENTLY TAB SPOROLAC RT/TID
Advice at Discharge
RYLE TUBE FEEDINGS 100ML WATER EVERY 2ND HOURLY,
RYLE TUBE FEEDINGS 200ML MILKEVERY 4TH HOURLY WITH 2 SCOOPS OF PROTEIN POWDER
TAB. COTRIMOXAZOLE 200/160MG RT BD X 1 WEEK TAB. BENFOMET PLUS RT OD X 1 WEEK
TAB. NEUROBION FORTE RT OD X 1 WEEK TAB. PAN 40MG RT OD X 1 WEEK
TAB. DOLO 650MG RT SOS
ROTAHALER FORACORT 200MG 2 PUFFS BD HOME BP MONITORING
T.BACT OINTMENT FOR LA REGULAR BEDSORE DRESSINGS AIR BED
2HRLY POSITION CHANGING
Follow Up
REVIEW TO GM, GS, UROLOGY OPDS AFTER 1 WEEK OR SOS
The subsequent horcrux EHR case report focusing on his post discharge neuro rehab is available here:
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