fever projr 202419709

 Diagnosis

ALTERED SENSORIUM SECONDARY TO METOBOLIC ENCEPHALOPATHY ( HYPOXIA/SEPSIS),

POST OP DELIRIUM,

ANEMIA SECONDARY TO HEMATURIA,

THROMBOCYTOPENIA UNDER EVALUATION,

HIGH ANION GAP METABOLIC ACIDOSIS MIXED ACIDOTIC PATTERN(RESOLVED),

ACUTE KIDNEY INJURY(POST RENAL AND PRE RENAL)RESOLVED

ASPIRATION PNEUMONIA RESOLVED

GRADE 2 BED SORE ON GLUTEAL REGION

POST EXTUBATION DAY-2

Case History and Clinical Findings

CHIEF COMPLAINTS:

A 60YR OLD MALE PATIENT CAME TO CASUALITY WITH LOSS OF CONSCIOUSNESS ON 04/05/2024

HISTORY OF PRESENTING ILLNESS:

PATIENT WAS APPARTENTLY 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 DEVELOPRD ALTERED SENSORIUM &SO IRRITABLE AFTER 4 DAYS .CONCERNED DOCTORS DIDNOT 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

HISTORY OF PAST ILLNESS:

NOT A KNOWN CASE OF HTN,DM,TB,EPILEPSY,ASTHAMA,CAD.

GENERAL EXAMINATION:

NO SIGNS OF PALLOR,ICTERUS,CYANOSIS,CLUBBING,OEDEMA.

TEMP: AFEBRILE

PR:116 BPM

RR: 20 CPM

BP: 110/60 MMHG

SPO2 : 98 % @ 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 CASUALITYWITH LOSS OF CONSCIOUSNESS AT 2AM

THE VITALS WERE

PR:116 BPM

RR: 20 CPM

BP: 110/60 MMHG

SPO2: 98%

GRBS: 116 MG/DL

ON DAY1 HE WAS DIAGNOSED WITH ALTRED SENSORIUM SECONDARY TO METABOLIC ENCEPHALOPATHY (HYPOXIA)

INJ.PIPTAZ 4.5 MG/IV/TID

INJ.PAN 40MG/IV/OD

INJ.OPTINEURON 1 AMP IN 100 ML NS IV/OD

INJ.THIAMINE 200MG /IV/BD(IN100ML NS)

ON DAY 3 HE WAS SENT FOR 2D ECHO FINDINGS ARE

NO RWMA, MILD LH+

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 DYSFUNCTION

IVC SIZE 0.7 CM COLLAPSING

IAS ANUERYSMS

ON DAY 3:

UROLOGY REFERRAL WAS DONE I/V/O HEMATURIA AND PLAN WAS GIVEN TO CONTINUE INJ PIPTAZ,ADD INJ TRANEXA 500IV BD,STOP BLOOD THINNERS IF NOT INDICATED

PSYCHIATRY REFERRAL WAS DONE I/V/O ALCOHOL WITHDRAWL SYNDROME AND FOLLOWING ADVICE WAS GIVEN D/M LIGHTING,ORIENTATION CUES,PLAN TO START ANTIPSYCHOTIC,CORRECT UNDERLYING ORGANIC CAUSE.FOLLOWING PLAN WAS GIVEN:ATTENDER COUNSELLED,ADVICE TO TAPER TOT.CHLORDIAZEPOXIDE 25 MG,NICOTINE LOZENGES 2 MG,CONTINUE THIAMINE SUPPLEMENTATION,VITALS AND OREINTATION MONITORING 6TH HOURLY

ON DAY 4 ORTHOPEDICS REFERRAL WAS DONE I/V/O SURGERY DONE ON 25TH APRIL FOR RIGHT HIP FRACTURE AND FOLLOWING ADVICE WAS GIVEN XRAY RIGHT HIP WITH THIGH AP AND LATERAL VIEW:25 DAYS OLD NON UNITED FRACTURE WITH IMPLANT INSITUI(PFN)WITH CALLUS SEEN

ON DAY 5 TAB METXL 50MG PO/OD AND TAB TELMA 40 MG PO/OD ADDED AND INTUBATION WAS DONE AFTER TAKING CONSENT

ON DAY 6 CLINDAMYCIN 600MG IV/BD ADDED

ON DAY 7 T.CINOD 10 MG RT/OD 8 AM AND INJ LASIX 20 MG /IV/BD WAS ADDED

ON DAY 8 T METXL WAS STOPPED

ON DAY 9 T MET XL ADDED AGAIN

ON DAY 11 PATIENT WAS EXTUBATED AND POST EXTUBATION 2 RESPULES MUCOMIST NEBULISATION/PN/STAT WAS GIVEN AND CHEST PHYSIOTHERAPY WAS DONE,EXTUBATION PROCESS WAS UNEVENTFUL

ON DAY 12 INJ.MONOCEF 1 GM/IV/BD STARTED AND INJ NEOMOL IGM/IV/BD

ON DAY 13 INJ. MEROPENEM 1G IV/BD

ON DAY14 INJ MONOCEF WAS STOPPED

ON DAY 15 2D ECHO- NO RWMA , MILD LVH

TRIVIAL AR+, NO MR

MAC+, SCLEROTIC AV NO AS/MS

EF-64%RVSP-35

GOOD LV SYSTOLIC FUNCTION

GRADE I DIASTOLIC FUNCTION

NO PE/LV CLOT

IAS- INTACT/ ANEURYSMS

IVC SIZE COLLASPING

ON DAY 16-OPHTHAL REFERRAL WAS I/V/O RAISED ICT, IMPRESSION= RGHT EYE- NO EVIDENCE OF PAPILLOEDEMA

LEFT EYE- OPTIC ATROPHY

ON DAY 16- SIMILAR TREATMENT WAS FOLLOWED; URINE CYTOLOGY REORT REVEALED FEW SCATTERED DSIPERSED EPITELIAL CELLS IN THE BACKGROUND SHOWING NUMEROUS DEGENERATED NEUTROPHILS, BACTERIAL COLONIES HAEMORHHAGIC , NONATYPICAL CELLS WERE SEEN.

ON DAY 17- TAB COTRIMAXOZOLE 800/160MG RT/BD WAS STARTED

ON DAY 18- ENT REFERRAL WAS DONE I/V/O INABILITY TO SPEAK POST EXTUBATION ; IDL AND VIDEORGID VIDEO LARYNGOSCOPY WASNT DONE AS PATIENT WAS NOT COOPERATIVE , POOR ORAL HYGIENE WAS THERE , ORAL HYGIENE TO BE MAINTAINED WAS ADVICED.

ON DAY 19- INJ. CLINDAMYCIN WAS STOPPED; CECT ABDOMEN SHOWED - BILATERAL MILD HYDROURETERONEPHROSIS(R>L), OVERLY DISTENDED URINARY BLADDER WITH INCREASED THICKNESS

ON DAY 20 - INJ. LASIX WAS STOPPED

ON DAY 21- SAME TREATMENT WAS FOLLOWED

ON DAY 22- PSCHIATRIC REFERRAL I/V/O POST OP DELIRIUM,TAB. OLANZAPINE 2.5MG PO/OD/8PM AND NICOTINE LOSANGES PO/SOS

ON DAY 23-INJ. MEROPENEM WAS STOPPED 

ONN DAY 24-TAB. SPORALC, C-PAP INTERMITTENTLY.

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

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

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

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

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

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

Treatment Given(Enter only Generic Name)

RYLES FEEDS: 100ML WATER 2ND HOURLY

200ML MILK 4TH HOURLY

IV FLUIDS -NS &RL @ 50ML/HR

INJ. NEOMOL 1GMIV/SOS

INJ.TRANEXA 500 MG /IV/BD

INJ.THIAMINE 200MG IN 100ML NS /IV/BD

INJ.OPTINEURAN 1AMP IN 100 ML NS/IV/OD

INJ.PAN 40MG IV/OD

TAB.DOLO 650 MG /PO/SOS

TAB. COTRIMAXAZOLE 800/160MG RT/BD

NEB.MUCOMIST 2 RESP 6TH HOURLY

NEOSPORIN POWDER L/A GLUTEAL REGION

ORAL SUCTION 2ND HOURLY

POSITION CHANGE 2ND HOURLY

CHEST PHYSIOTHERAPY

C-PAP INTERMITTENTLY

TAB SPOROLAC RT/TID