Download Course in the ward

Course in the ward
Day 1 (01-26-10)
• Patient was hydrated and placed under diet
– 1800 kcal/day, 270g CHO, 15g CHON, 25g fats
divided into 3 meals and 2 snacks.
• CBC with platelet count:
– WBC of 35.5 predominantly neutrophils.
• Urinalysis
– Yellow, slightly turbid, pH 6.5 sp gr 1.005, albumin
(-), sugar (-), RBC 0-2/hpf, pus cell 8-12/hpf and
bacteria +++.
Day 1 (01-26-10)
• Chest X-ray was requested
• Spot sputum AFB stain showed no acid fast
bacilli
• Ceftriaxone (2g/IV OD) and Paracetamol
(500mg/tab, 1 tab q4h prn) were both started
Day 2 (01-27-10)
• Spot sputum AFB stain still showed no acid fast
bacilli.
• Urine and blood specimen were taken for urine
GS/CS and Blood Culture.
• There were still episodes of fever and cough, with
no dysuria
• Crackles were heard bilaterally on both lung fields
• Ceftriaxone was continued and Erdosteine
(300mg/cap, 1 cap BID) was started.
Day 2 (01-27-10)
• Serum sodium and potassium levels were
requested
– Hyponatremia and hypokalemia
• Kalium durule, 2 durules TID x 6 doses was
given and hydration with PNSS was continued.
• A repeat CBC showed WBC of 11.80. (35.5 in
Day 1)
• FBS was also requested showing normal value.
Day 3 (01-28-10)
• Spot sputum AFB stain still showed no acid fast bacilli.
• Patient was referred to DOTS for further evaluation and
management.
• Patient was afebrile, with stable vital signs, no dysuria
but still has cough and (+) bilateral crackles
• Ceftriaxone was shifted to Cefixime 200mg/cap, 1 cap
BID for 5 days (until Feb 1, 2010)
• Patient had stable vital signs. The rest of the hospital
stay was unremarkable. Patient was then discharged
improved and stable.
• Discharge Medications:
– Cefixime 200mg/cap, 1 cap BID for 5 days (until
Feb 1, 2010)
• Special Instructions
– Refer back to DOTS with X-ray and sputum AFB
results as outpatient, increase oral fluid intake
• Follow-up or Transfer Instruction
– To come back at Med OPD on Feb 11, 2010 (Thurs,
8am) with DOTS referral.
LABORATORY RESULTS
CBC
Date
Hgb (NV: 120-170 g/dl)
RBC (NV: 3.8-5.5x106/µL )
Hct (NV: 0.37-0.54)
MCV (NV: 78-101 fL)
MCH (NV: 27-31 pg)
MCHC (NV: 32-36 g/dl)
RDW (NV: 11.6-14.6)
MPV (NV: 7.4-10.4 fL)
Plt (NV: 150-450x109/L
WBC (NV: 4.5-10x109/L
Neutro (NV: 0.5-0.9)
Bands (NV: 0-0.05)
Segmenters (NV: 0.5-0.7)
Lym (NV: 0.20-0.40)
Mono (NV: 0-0.07)
Eos (NV: 0-0.01)
Baso (NV: 0-0.01)
Jan 26 2010
127
4.41
0.37
84.3
28.9
34.3
12.6
5.5
320
35.5
0.92
0.09
0.83
0.08
-
Jan 28 2010
113
3.98
0.33
83.7
28.3
33.8
12.9
5.3
298
11.8
0.63
0.63
0.34
0.02
0.01
-
Abnormal Findings
Hgb (NV: 120-170
g/dl)
Hct (NV: 0.37-0.54)
WBC
(NV: 4.5-10x109/L)
Neutro (NV: 0.5-0.9)
Segmenters
(NV: 0.5-0.7)
Jan 26
2010
127
Jan 28
2010
113
0.37
35.5
0.33
11.8
0.92
0.83
0.63
0.63
Blood Chemistry
Date
Jan 27, 2010
(Day 2)
Sodium (NV: 137-147 mmol/L)
133
Potassium (NV: 3.8-5 mmol/L)
3.3
FBS (NV: <100mg/dl)
87
Urinalysis
Date
Color
Transparency
pH
Specific Gravity
Albumin
Sugar
Hyaline casts
RBC
Pus cell
Squamous cell
Bacteria
Jan 26 2010
Yellow
Turbid
6.5
1.005
Negative
Negative
0-2/coverslip
0-2/hpf
8-12/hpf
++
+++
Urine GS/CS
• Urine culture showed no growth after 2 days
of incubation
• Urine gram stain showed no findings on
centrifuged and on uncentrifuged urine.
Blood Culture
• Blood culture showed no growth after 5 days
of incubation.