LABORATORIES: Her prenatal labs showed her to be O positive. Initial hematocrit 38%. In the second trimester, it dropped to 35.3%. Rubella titer is immune. Her RPR is nonreactive. GC and Chlamydia tests were negative. Urine culture was negative. Hepatitis B antigen was negative and HIV was negative. In the second trimester, her diabetes screen was 138. End of third trimester, she had a positive GBS test.
SUMMARY OF LABORATORIES: D-dimer is elevated at 1.5. CT of the chest is suggestive of acute pulmonary emboli, bilateral. A 2-D echocardiogram was within normal limits. INR is 3 at the time of discharge. Hemogram was within normal limits. Metabolic panel was with normal limits. Lipid panel: Cholesterol is elevated at 208. Lupus anticoagulant and other serological tests for hypercoagulopathy ordered.
LABORATORIES: Basic metabolic profile done on the day of admission was normal with BUN and creatinine of 7 and 0.2 respectively. Urinalysis was normal on hospital day #3 and the urine culture collected on hospital day #3 has grown no organisms till today. Due to the febrile peak, CBC was done on hospital day #3 that showed white count of 5400, H and H 11.4 and 33, and a platelet count of 242,000, differential of 16 neutrophils, 15 bands, and 58 lymphos.
LABORATORIES: Potassium 3.6, BUN 23, creatinine 1.3, and glucose 82. The rest of the profile, including liver enzymes, is normal. The CPK is 234, but the MB CPK is 3.5. Troponin is normal. EKG shows no significant ischemic changes. There is an inverted T wave in V3 and V4. INR is 0.95, PTT 29.7, hemoglobin 13.4, white blood cell count 3700, normal differential, and platelets are 154,000.
DIAGNOSTIC LABORATORIES: CBC; WBC 6.5, hemoglobin 10.2, hematocrit 29.6, platelets 144,000, sodium 139, potassium 4.1, chloride 101, CO2 of 27, glucose 94, BUN 14, creatinine 0.5, and calcium 8.9. The patient's troponin was 135, which is down from 178.6. HDL 51, LDL 60, cholesterol/HDL ratio 2.6, triglycerides 100, and cholesterol 131.
DIAGNOSTIC/LABORATORY DATA: Chest x-ray; there is no acute process. Serum electrolytes; potassium is 5. BUN and creatinine 19 and 1 respectively. CPK is 63 and troponin is 0.04 on first check. Hemoglobin and hematocrit are 14.7 and 43.1. LDL was 151 and HDL 32. Carotids show mild bilateral plaquing, not hemodynamically significant. Echo shows LVH with EF normal with mild MR, TR, and mild pulmonary hypertension.
LABORATORY DATA: Most recent laboratory studies include an arterial blood gas demonstrating a pH of 7.44, pCO2 30, pO2 126. Currently on FiO2 of 30%. CBC in the morning; white count 10,200, hemoglobin 7.5, and platelet count 163,000. Protime in the morning was 16, INR 1.3. Comprehensive panel demonstrating BUN of 18, creatinine 1, alkaline phosphatase elevated at 163, SGOT elevated at 152, SGPT normal at 42, total bilirubin 2.1, and albumin low at 1.9. Alcohol level was less than 5. Ammonia was 34.
LABORATORY DATA: Most recent ABG; pH 7.39, pCO2 56.8, pO2 534.7, bicarbonate 32.3, O2 saturation 99.8%. This was done on assist control of 20, tidal volume 700, FiO2 100%. The patient is currently on IMV of 12 with 40% FiO2 and is maintaining saturation above 94%. PT 12.9, INR 1, aPTT 33.1. Sodium 142, potassium 4.8, chloride 95, bicarbonate 45, BUN 14, creatinine 0.9, glucose 145. ALP 67, AST 18, ALT 22, total protein 6.3, albumin 3.9, calcium 8.8. CPK 107, MB 6.8, MB% 6.3, this is slightly positive with troponin I of 0.35, that is slightly elevated also. White count 5300, hemoglobin 12.5, hematocrit 40.3 with an MCV of 105.5.
LABORATORY DATA: Chemistry; glucose 136, BUN 54, creatinine 2.6, up from 1.8. Sodium 130, potassium 5.4, chloride 100, CO2 of 24, ALP 360, AST 46, ALT 54. Total bilirubin 0.3, total protein 5.6, albumin 2, calcium 7.9. RPR is negative. Cytomegalovirus IgG was elevated, IgM was negative. Epstein-Barr virus was negative for acute infection. Hepatitis A, B, C were essentially negative.
LABORATORY DATA: CBC upon admission revealed a white cell count of 9600, RBC of 2.17, hemoglobin 8.2, hematocrit 24.4, platelets 318,000, MCV elevated at 110.2, MCH elevated at 37.4, MCHC 33.9. His hemoglobin dropped to 7.8 and hematocrit to 22.8 a couple of days later. The last CBC this morning reveals white cell count of 6200, hemoglobin 9.2, hematocrit 27.6, and platelets 386,000. The initial CMP revealed chloride of 111, glucose 122, BUN 46, creatinine 2.1, calcium 8.2, albumin 2.7, SGOT 65, SGPT 72, other values unremarkable. The last CMP this morning was unremarkable except for potassium of 5.3, chloride 108, BUN 39, creatinine 1.4, protein 6.3, albumin 2.6, calcium 8.2, glucose 102, SGOT 31, SGPT 64. PT was 12.2 seconds, INR 1.2, PTT 39.4. Lipids revealed cholesterol of 62, LDL of 38, HDL low at 10, and triglycerides 60. Serum iron was 35 at the low normal range, iron binding capacity low at 113, iron saturation 31%, serum ferritin elevated at 1527.2 ng/mL. The patient was on iron therapy prior to admission. Serum B12 and folate levels were within normal limits. PSA upon admission was 12.33 ng/mL, normal being 0 to 2.5. T4 and TSH were within normal limits. Total CPK upon admission was 86. CPK, CPK-MB, and troponin when last checked were all within normal limits. Urinalysis revealed presence of protein, 1 wbc, few bacteria, otherwise unremarkable. Urine culture revealed no growth. Sputum smear revealed few neutrophils, few gram-positive cocci in clusters, few gram-positive rods, and moderate gram-negative rods. Culture grew moderate normal respiratory flora. Stool for occult blood obtained this morning came back negative.
DIAGNOSTIC DATA: Additional tests included a dobutamine stress echo, which was reported negative for ischemia. CT scan of the abdomen and pelvis with contrast revealed mild compressive atelectasis in the lung bases bilaterally, small bilateral pleural effusion, cardiomegaly, small bilateral renal cysts, gallstones, apparent thickening of the antrum of the stomach, probable bladder diverticulum, sigmoid diverticulosis, as well as enlarged prostate with a possible mass in the prostate on the right, possibly representing a displaced urethra. Last duplex Doppler venous ultrasound of lower extremities was unremarkable; however, the arterial flow study of lower extremities revealed nonocclusive plaque disease in the right dorsalis pedis, right posterior tibial, left popliteal, left dorsalis pedis, and left posterior tibial arteries. Upper and lower endoscopies revealed small colonic polyps reported as hyperplastic on past exam, severe left-sided diverticulosis, small internal hemorrhoids, enlarged prostate, atrophic gastritis, duodenitis, and moderate-sized hiatal hernia; however, special stains for H. pylori were negative. EKG revealed rate of 82 per minute, first-degree AV block, and nonspecific ST-T abnormality. Repeat EKG revealed rate of 96 per minute, cannot rule out posterior infarct, possibly acute, and ST-T wave abnormality, consider inferolateral ischemia. Final EKG revealed rate of 62 per minute, normal sinus rhythm. Chest x-ray, PA and lateral, as an outpatient revealed cardiac enlargement, mild emphysema, and mild chronic scarring along right minor fissure, unchanged from before. Repeat chest x-ray, PA and lateral, revealed COPD, persistent atelectasis in the right mid lung field with slightly increased atelectasis from the prior study and aorta was calcified. Repeat chest x-ray, AP, revealed mildly enlarged heart, mild atelectatic changes or infiltrate in the right lower lung zone, resolved, and there was no evidence of acute consolidation.
DIAGNOSTIC/LABORATORY DATA: EKG showed T wave inversion in V1 to V3 and T wave inversion in V1 to V6. Labs; hemoglobin 12.4, hematocrit 37.1, white count was 11,500, and platelet count was 512,000 with neutrophils of 63% and lymphocytes 28%. PT was 14.1 and INR was 1.1. Pregnancy test was negative. UA showed pH of 8, otherwise negative. Sodium 138, potassium 5, chloride 100, bicarbonate 24, BUN 17, creatinine 0.7, and blood sugar of 92. Alkaline phosphatase was 124, SGOT 33, and SGPT 37. Troponin T was less than 0.11 x2.
LABORATORY DATA: CBC on admission included a white blood cell of 15.5, hemoglobin 11.3, hematocrit 33.6, and platelet count of 366. Prior to discharge, her white blood cell count has decreased to 7.2, hemoglobin was 8.7, and hematocrit 27.1. Today's H&H of 9 and 27.8. BMP on admission included a sodium of 130, potassium 3.9, chloride 92, CO2 of 26, glucose 129, BUN 36, creatinine 2, alkaline phosphatase was 72, ALT 15, and AST 25. Her TSH also on that day was 118. Repeat BMP; sodium 132, potassium 3.5, chloride 99, CO2 of 23, BUN 8, creatinine 1.1, and glucose of 125. Amylase on admission was 87 and lipase was 29. Initial urinalysis was positive for 1+ leukocytes, 0-4 rbc's, 20-50 wbc's, 1+ wbc clumps, 4+ bacteria, 5-10 squamous epithelial cells and 0-4 renal epithelial cells. Repeat showed 1+ albumin, 1+ leukocytes, rbc's 0-4, wbc's down to 5-10, bacteria 1+, squamous epithelial cells 5-10, and yeast +1.
LABORATORY DATA: Workup obtained during this admission include serial HEMGPDs with the most recent identifying white blood cell count of 9300 with an H&H of 12 and 37 and a platelet count of 193,000. On the differential, there are 30% neutrophils, 6% bands, 46% lymphocytes, 13% monocytes, and 4% eosinophils. Serial BMPs were obtained with the most recent identifying sodium of 138, potassium of 3.6, chloride of 103, CO2 of 25, BUN of 6, creatinine of 0.4, glucose of 103, and calcium of 8.8. Amylase and lipase of 40 and 24 respectively. Urinalysis was obtained and identified 1+ albumin, trace blood with 3+ leukocyte esterase. On the microscopic exam, there are 21 rbc's, greater than 182 wbc's, with 1+ bacteria. RSV was obtained and was negative. Stool studies were sent for rotavirus and adenovirus, both of which were negative. Occult blood was negative. There were no fecal wbc's noted.
LABORATORY DATA: On admission showed CBC with elevated white count of 16.8, hemoglobin was 7.8, hematocrit 24.7 with platelet count of 796,000. The patient received a couple of units of packed RBCs. At discharge, the patient's white count is 11.2, hemoglobin 9.4, hematocrit 29.2, and his platelet count down to 538,000. The patient's PT, PTT, and INR were elevated on admission with his INR being therapeutic at 2.68 for a history of DVTs. The patient was on Coumadin. Chemistry profile on admission showed low level of potassium at 2.1 and sodium of 131, also an elevated alkaline phosphatase of 135. ALT is 53, AST is 45, magnesium was 1.2. The patient received potassium supplements. By discharge, the patient's sodium is 132. His potassium was 4.2, chloride 102, CO2 of 25, BUN 11, creatinine 0.5. No other abnormalities were noted. The patient had cardiac enzymes on admission that were negative x3. His ferritin was low at 26 indicating iron deficiency anemia. Total iron binding capacity was 229. His percent saturation is 11. His folate was 5.2. B12 of 1375. Iron level was 26. He had a hepatitis panel that was nonreactive. His urinalysis was within normal limits. No cultures were done. Serology workup was completed at that time.
LABORATORY DATA: Most recent CBC shows a reticulocyte count of 4%, hemoglobin 7.2 with WBC of 17.5%. Factor Xa levels are therapeutic at 0.77 corresponding to 70 mg daily of Lovenox and considered therapeutic and adequate. Hemoglobin is 7.5 and platelets are approximately 702,000. The rest of the chemistries are essentially unchanged.
SUMMARY OF LABORATORIES: D-dimer is elevated at 1.5. CT of the chest is suggestive of acute pulmonary emboli, bilateral. A 2-D echocardiogram was within normal limits. INR is 3 at the time of discharge. Hemogram was within normal limits. Metabolic panel was with normal limits. Lipid panel: Cholesterol is elevated at 208. Lupus anticoagulant and other serological tests for hypercoagulopathy ordered.
LABORATORIES: Basic metabolic profile done on the day of admission was normal with BUN and creatinine of 7 and 0.2 respectively. Urinalysis was normal on hospital day #3 and the urine culture collected on hospital day #3 has grown no organisms till today. Due to the febrile peak, CBC was done on hospital day #3 that showed white count of 5400, H and H 11.4 and 33, and a platelet count of 242,000, differential of 16 neutrophils, 15 bands, and 58 lymphos.
LABORATORIES: Potassium 3.6, BUN 23, creatinine 1.3, and glucose 82. The rest of the profile, including liver enzymes, is normal. The CPK is 234, but the MB CPK is 3.5. Troponin is normal. EKG shows no significant ischemic changes. There is an inverted T wave in V3 and V4. INR is 0.95, PTT 29.7, hemoglobin 13.4, white blood cell count 3700, normal differential, and platelets are 154,000.
DIAGNOSTIC LABORATORIES: CBC; WBC 6.5, hemoglobin 10.2, hematocrit 29.6, platelets 144,000, sodium 139, potassium 4.1, chloride 101, CO2 of 27, glucose 94, BUN 14, creatinine 0.5, and calcium 8.9. The patient's troponin was 135, which is down from 178.6. HDL 51, LDL 60, cholesterol/HDL ratio 2.6, triglycerides 100, and cholesterol 131.
DIAGNOSTIC/LABORATORY DATA: Chest x-ray; there is no acute process. Serum electrolytes; potassium is 5. BUN and creatinine 19 and 1 respectively. CPK is 63 and troponin is 0.04 on first check. Hemoglobin and hematocrit are 14.7 and 43.1. LDL was 151 and HDL 32. Carotids show mild bilateral plaquing, not hemodynamically significant. Echo shows LVH with EF normal with mild MR, TR, and mild pulmonary hypertension.
LABORATORY DATA: Most recent laboratory studies include an arterial blood gas demonstrating a pH of 7.44, pCO2 30, pO2 126. Currently on FiO2 of 30%. CBC in the morning; white count 10,200, hemoglobin 7.5, and platelet count 163,000. Protime in the morning was 16, INR 1.3. Comprehensive panel demonstrating BUN of 18, creatinine 1, alkaline phosphatase elevated at 163, SGOT elevated at 152, SGPT normal at 42, total bilirubin 2.1, and albumin low at 1.9. Alcohol level was less than 5. Ammonia was 34.
LABORATORY DATA: Most recent ABG; pH 7.39, pCO2 56.8, pO2 534.7, bicarbonate 32.3, O2 saturation 99.8%. This was done on assist control of 20, tidal volume 700, FiO2 100%. The patient is currently on IMV of 12 with 40% FiO2 and is maintaining saturation above 94%. PT 12.9, INR 1, aPTT 33.1. Sodium 142, potassium 4.8, chloride 95, bicarbonate 45, BUN 14, creatinine 0.9, glucose 145. ALP 67, AST 18, ALT 22, total protein 6.3, albumin 3.9, calcium 8.8. CPK 107, MB 6.8, MB% 6.3, this is slightly positive with troponin I of 0.35, that is slightly elevated also. White count 5300, hemoglobin 12.5, hematocrit 40.3 with an MCV of 105.5.
LABORATORY DATA: Chemistry; glucose 136, BUN 54, creatinine 2.6, up from 1.8. Sodium 130, potassium 5.4, chloride 100, CO2 of 24, ALP 360, AST 46, ALT 54. Total bilirubin 0.3, total protein 5.6, albumin 2, calcium 7.9. RPR is negative. Cytomegalovirus IgG was elevated, IgM was negative. Epstein-Barr virus was negative for acute infection. Hepatitis A, B, C were essentially negative.
LABORATORY DATA: CBC upon admission revealed a white cell count of 9600, RBC of 2.17, hemoglobin 8.2, hematocrit 24.4, platelets 318,000, MCV elevated at 110.2, MCH elevated at 37.4, MCHC 33.9. His hemoglobin dropped to 7.8 and hematocrit to 22.8 a couple of days later. The last CBC this morning reveals white cell count of 6200, hemoglobin 9.2, hematocrit 27.6, and platelets 386,000. The initial CMP revealed chloride of 111, glucose 122, BUN 46, creatinine 2.1, calcium 8.2, albumin 2.7, SGOT 65, SGPT 72, other values unremarkable. The last CMP this morning was unremarkable except for potassium of 5.3, chloride 108, BUN 39, creatinine 1.4, protein 6.3, albumin 2.6, calcium 8.2, glucose 102, SGOT 31, SGPT 64. PT was 12.2 seconds, INR 1.2, PTT 39.4. Lipids revealed cholesterol of 62, LDL of 38, HDL low at 10, and triglycerides 60. Serum iron was 35 at the low normal range, iron binding capacity low at 113, iron saturation 31%, serum ferritin elevated at 1527.2 ng/mL. The patient was on iron therapy prior to admission. Serum B12 and folate levels were within normal limits. PSA upon admission was 12.33 ng/mL, normal being 0 to 2.5. T4 and TSH were within normal limits. Total CPK upon admission was 86. CPK, CPK-MB, and troponin when last checked were all within normal limits. Urinalysis revealed presence of protein, 1 wbc, few bacteria, otherwise unremarkable. Urine culture revealed no growth. Sputum smear revealed few neutrophils, few gram-positive cocci in clusters, few gram-positive rods, and moderate gram-negative rods. Culture grew moderate normal respiratory flora. Stool for occult blood obtained this morning came back negative.
DIAGNOSTIC DATA: Additional tests included a dobutamine stress echo, which was reported negative for ischemia. CT scan of the abdomen and pelvis with contrast revealed mild compressive atelectasis in the lung bases bilaterally, small bilateral pleural effusion, cardiomegaly, small bilateral renal cysts, gallstones, apparent thickening of the antrum of the stomach, probable bladder diverticulum, sigmoid diverticulosis, as well as enlarged prostate with a possible mass in the prostate on the right, possibly representing a displaced urethra. Last duplex Doppler venous ultrasound of lower extremities was unremarkable; however, the arterial flow study of lower extremities revealed nonocclusive plaque disease in the right dorsalis pedis, right posterior tibial, left popliteal, left dorsalis pedis, and left posterior tibial arteries. Upper and lower endoscopies revealed small colonic polyps reported as hyperplastic on past exam, severe left-sided diverticulosis, small internal hemorrhoids, enlarged prostate, atrophic gastritis, duodenitis, and moderate-sized hiatal hernia; however, special stains for H. pylori were negative. EKG revealed rate of 82 per minute, first-degree AV block, and nonspecific ST-T abnormality. Repeat EKG revealed rate of 96 per minute, cannot rule out posterior infarct, possibly acute, and ST-T wave abnormality, consider inferolateral ischemia. Final EKG revealed rate of 62 per minute, normal sinus rhythm. Chest x-ray, PA and lateral, as an outpatient revealed cardiac enlargement, mild emphysema, and mild chronic scarring along right minor fissure, unchanged from before. Repeat chest x-ray, PA and lateral, revealed COPD, persistent atelectasis in the right mid lung field with slightly increased atelectasis from the prior study and aorta was calcified. Repeat chest x-ray, AP, revealed mildly enlarged heart, mild atelectatic changes or infiltrate in the right lower lung zone, resolved, and there was no evidence of acute consolidation.
DIAGNOSTIC/LABORATORY DATA: EKG showed T wave inversion in V1 to V3 and T wave inversion in V1 to V6. Labs; hemoglobin 12.4, hematocrit 37.1, white count was 11,500, and platelet count was 512,000 with neutrophils of 63% and lymphocytes 28%. PT was 14.1 and INR was 1.1. Pregnancy test was negative. UA showed pH of 8, otherwise negative. Sodium 138, potassium 5, chloride 100, bicarbonate 24, BUN 17, creatinine 0.7, and blood sugar of 92. Alkaline phosphatase was 124, SGOT 33, and SGPT 37. Troponin T was less than 0.11 x2.
LABORATORY DATA: CBC on admission included a white blood cell of 15.5, hemoglobin 11.3, hematocrit 33.6, and platelet count of 366. Prior to discharge, her white blood cell count has decreased to 7.2, hemoglobin was 8.7, and hematocrit 27.1. Today's H&H of 9 and 27.8. BMP on admission included a sodium of 130, potassium 3.9, chloride 92, CO2 of 26, glucose 129, BUN 36, creatinine 2, alkaline phosphatase was 72, ALT 15, and AST 25. Her TSH also on that day was 118. Repeat BMP; sodium 132, potassium 3.5, chloride 99, CO2 of 23, BUN 8, creatinine 1.1, and glucose of 125. Amylase on admission was 87 and lipase was 29. Initial urinalysis was positive for 1+ leukocytes, 0-4 rbc's, 20-50 wbc's, 1+ wbc clumps, 4+ bacteria, 5-10 squamous epithelial cells and 0-4 renal epithelial cells. Repeat showed 1+ albumin, 1+ leukocytes, rbc's 0-4, wbc's down to 5-10, bacteria 1+, squamous epithelial cells 5-10, and yeast +1.
LABORATORY DATA: Workup obtained during this admission include serial HEMGPDs with the most recent identifying white blood cell count of 9300 with an H&H of 12 and 37 and a platelet count of 193,000. On the differential, there are 30% neutrophils, 6% bands, 46% lymphocytes, 13% monocytes, and 4% eosinophils. Serial BMPs were obtained with the most recent identifying sodium of 138, potassium of 3.6, chloride of 103, CO2 of 25, BUN of 6, creatinine of 0.4, glucose of 103, and calcium of 8.8. Amylase and lipase of 40 and 24 respectively. Urinalysis was obtained and identified 1+ albumin, trace blood with 3+ leukocyte esterase. On the microscopic exam, there are 21 rbc's, greater than 182 wbc's, with 1+ bacteria. RSV was obtained and was negative. Stool studies were sent for rotavirus and adenovirus, both of which were negative. Occult blood was negative. There were no fecal wbc's noted.
LABORATORY DATA: On admission showed CBC with elevated white count of 16.8, hemoglobin was 7.8, hematocrit 24.7 with platelet count of 796,000. The patient received a couple of units of packed RBCs. At discharge, the patient's white count is 11.2, hemoglobin 9.4, hematocrit 29.2, and his platelet count down to 538,000. The patient's PT, PTT, and INR were elevated on admission with his INR being therapeutic at 2.68 for a history of DVTs. The patient was on Coumadin. Chemistry profile on admission showed low level of potassium at 2.1 and sodium of 131, also an elevated alkaline phosphatase of 135. ALT is 53, AST is 45, magnesium was 1.2. The patient received potassium supplements. By discharge, the patient's sodium is 132. His potassium was 4.2, chloride 102, CO2 of 25, BUN 11, creatinine 0.5. No other abnormalities were noted. The patient had cardiac enzymes on admission that were negative x3. His ferritin was low at 26 indicating iron deficiency anemia. Total iron binding capacity was 229. His percent saturation is 11. His folate was 5.2. B12 of 1375. Iron level was 26. He had a hepatitis panel that was nonreactive. His urinalysis was within normal limits. No cultures were done. Serology workup was completed at that time.
LABORATORY DATA: Most recent CBC shows a reticulocyte count of 4%, hemoglobin 7.2 with WBC of 17.5%. Factor Xa levels are therapeutic at 0.77 corresponding to 70 mg daily of Lovenox and considered therapeutic and adequate. Hemoglobin is 7.5 and platelets are approximately 702,000. The rest of the chemistries are essentially unchanged.
