LABORATORY STUDIES: White count of 4.6, hemoglobin 12.8, platelet count 320. Sodium 142, potassium 3.8, chloride 108, carbon dioxide 28, BUN 11, creatinine 0.9, glucose 82, calcium 9.4, magnesium 1.8. Total bilirubin 1.4, AST 20, ALT 15. Total protein 6.4, albumin 3.6. TSH 2.14. Alkaline phosphatase 60. Triglycerides 36, cholesterol 143, LDL 57, HDL 69. The patient had three sets of cardiac enzymes with a peak CK of 78, troponin less than 0.06 x4. PT of 12.8, INR 1.0, PTT 25. D-dimer 0.79. The patient had an MRI of the T-spine which was a normal exam.
LABORATORY STUDIES: Normal hemoglobin, normal white cells. White count of 9, hemoglobin 13.1. Sodium 138, potassium 3.6, chloride 98, bicarbonate 26. CK initially was elevated to 914, then 640, and normalized to 70. CPK and MB fraction negative. Triglycerides 84, cholesterol 156, LDL 102, and HDL 39. Albumin 3.4. Dilantin level on the day of admission was 3.6, subsequently raised up to 4.2, and when the dose was increased, to 11.1, 13.9, and 16.1 on the day of discharge.
LAB AND DIAGNOSTIC STUDIES: White count was 12.3, hemoglobin 10.6, platelets 196. Sodium 132, potassium 5.2, chloride 98, bicarb 28. BUN and creatinine 24 and 1.8. Alkaline phosphatase 154, total protein 5.2. BNP 540. Troponins were positive at 0.9 and CPK is 48.
EKG showed no acute changes. The patient was in sinus rhythm. A chest x-ray showed underlying chronic interstitial fibrosis, stable in appearance, slightly improved aeration, left base. No evidence of development or recurrence of consolidation or new infiltrate. On the CAT scan of her chest, the patient had pulmonary fibrotic changes and central lobar emphysema, hazy, ground glass opacities within the mid lung zone, perihilar region, bilaterally. Essentially unchanged in appearance from the prior study. There was no evidence of bronchiectasis or new focal consolidation or atelectasis. There was no pleural effusion. A 14 mm nodule in the left costophrenic angle, previously described mildly enlarged anteromedial mediastinal nodes were stable.
LABORATORY STUDIES: Showed hemoglobin 7.8, hematocrit 23.6, which remained stable during this hospitalization. White count of 6.4, 5.2, 7.2. Normal platelets from 286,000 to 350,000. There was no symptom of acute decompensation. Anemia was asymptomatic. His INR initially was 9.2 and then he received vitamin K x3 and subsequently INR came to 9.7, 7.5, 5.1 and 2.1. Microbiology data showed urine cultures with contamination as well as wound culture was VRE, which was sensitive to ampicillin, ceftriaxone, cefepime, imipenem, Levaquin as well as tobramycin. VRE was sensitive to ampicillin, but the patient has allergy to penicillin as well as cephalosporin, but most exclusively to Keflex.
LABORATORY STUDIES: White count 8.4, hemoglobin 12.2, hematocrit 36.2, platelet count 266,000. On admission, white count was 9.2 with a peak of 11. The patient's hemoglobin on admission was 15.2. The patient's sodium was 135, potassium 3.8, chloride 100, carbon dioxide 28, BUN 20, creatinine 1.1, glucose 120, calcium 8.6. Magnesium level pending. Total bilirubin 12.8, was 14.2 on admission, peaking at 15.8 two days after ERCP. Direct bilirubin 7.3, down from 8.6 on admission. Indirect bilirubin 5.4, down from peak of 6.8 after ERCP. AST 41, down from 142 on admission. ALT 48, down from 204 on admission. Total protein 4.6, albumin 2.2, alkaline phosphatase 274, down from 360 on admission. Amylase 34, lipase 22. CA 19-9 antigen 534, which was markedly elevated. The patient's sodium on admission was 131. PT 13.6, INR 1.1, PTT 24. D-dimer 0.74. The patient's urine was amber in appearance, 25 mg estimated protein, large amount of bilirubin, negative leukocyte esterase, 2-4 white cells, 10-14 granular casts, and 3-4 white cell casts.
LABORATORY DATA: WBC 6.6, hemoglobin 11.6, hematocrit at 32.8, MCV 86.6, and platelet count 109,000. PT 11.2. INR 1.0. Sodium 134, potassium 3.6, chloride 104, carbon dioxide 22, glucose 108, calcium 8.2, total protein 5.8, albumin 2.9, and alkaline phosphatase 64. SGPT 52, SGOT 56, total bilirubin 1.0. BUN 48 and creatinine 1.6.
LABORATORY STUDIES: Urine culture was positive for Proteus mirabilis and Pseudomonas aeruginosa. UA with large amount of leukocyte esterase, positive for nitrite, trace amount of blood, protein 25, over 50 wbc's, 1-2 rbc's, many bacteria. PT of 14, INR 1.1, PTT 25. WBC 11.8, hemoglobin 13.2, hematocrit 39.8, platelets 314,000. Bedside glucose ranged from 122 up to 320. Sodium 142, potassium 4.8, chloride 106, carbon dioxide 26, BUN 68, down to 28 by discharge, creatinine 2.1, down to 1.3 by discharge, glucose 184, calcium 9.6. Magnesium 1.4 and 1.7, day of discharge was 1.4. Amylase 58, lipase 18, alkaline phosphatase 58, total bilirubin 0.6, AST 16, ALT 15, total protein 5.4, albumin 2.4.
LABORATORY DATA: Includes a white count of 10.6, hemoglobin 12.4, hematocrit 37.2, and a platelet count 190,000. Chemistries include a sodium 134, potassium 4.2, chloride 104, CO2 of 28. BUN 78 and creatinine 3.6; the initial creatinine was 4.2. Glucose 176. CPK 2024 today and it was 1880 yesterday with MB of 1.3 and a troponin of less than 0.06 and a troponin yesterday 0.6. The CPK from his prior admission was reportedly 312. Protime 11.2, INR 1.0, and PTT 24. Arterial blood gas shows a pH 7.38, PCO2 of 44, and a PO2 of 46 with an oxygen saturation of 79. It is unclear whether that was a venous stick as it does not seem to correlate with his clinical status. The patient had a CAT scan of the brain, which showed chronic periventricular ischemic white matter changes with no acute abnormalities seen. The chest x-ray from his prior admission showed no evidence of congestive heart failure and again today it shows no congestive heart failure, but evidence of cardiomegaly with a pacemaker defibrillator noted. A lung scan was done on the prior admission for similar problems and was low probability for pulmonary emboli.
LABORATORY STUDIES: Still pending are anti-Sjogren's antibody, anti-neutrophil cytoplasmic Ab, anti-single-stranded DNA Ab, anti-double-stranded DNA Ab, angiotensin converting enzyme, rheumatoid factor, Lyme titer, ANA. RPR nonreactive. Rheumatoid factor negative. WBC 8.8, hemoglobin 14.2, hematocrit 42.4, and platelets 234,000. ESR 5. Sodium 141, potassium 3.6, chloride 110, carbon dioxide 26, BUN 16, creatinine 1.1, glucose 88, calcium 9.4. Liver function tests within normal limits. Vitamin B12 of 440, folate 15.6. TSH 0.68.
LABORATORY DATA: Chemistry showed sodium 131, potassium 3.6, chloride 96, CO2 of 29, glucose 134, calcium 9.4, albumin 2, bilirubin 0.3, alkaline phosphatase 144, SGPT 32, SGOT 23, BUN 36, creatinine 1.4, PT 11.4, INR 1.05, and PTT 31. CBC: WBC 14.8, hemoglobin 8.2, hematocrit 24.6, and platelet count 178,000. CT of the brain without contrast was reviewed and shows mild brain atrophy and white matter disease. Carotid ultrasound showed no stenosis.
LABORATORY STUDIES: Normal hemoglobin, normal white cells. White count of 9, hemoglobin 13.1. Sodium 138, potassium 3.6, chloride 98, bicarbonate 26. CK initially was elevated to 914, then 640, and normalized to 70. CPK and MB fraction negative. Triglycerides 84, cholesterol 156, LDL 102, and HDL 39. Albumin 3.4. Dilantin level on the day of admission was 3.6, subsequently raised up to 4.2, and when the dose was increased, to 11.1, 13.9, and 16.1 on the day of discharge.
LAB AND DIAGNOSTIC STUDIES: White count was 12.3, hemoglobin 10.6, platelets 196. Sodium 132, potassium 5.2, chloride 98, bicarb 28. BUN and creatinine 24 and 1.8. Alkaline phosphatase 154, total protein 5.2. BNP 540. Troponins were positive at 0.9 and CPK is 48.
EKG showed no acute changes. The patient was in sinus rhythm. A chest x-ray showed underlying chronic interstitial fibrosis, stable in appearance, slightly improved aeration, left base. No evidence of development or recurrence of consolidation or new infiltrate. On the CAT scan of her chest, the patient had pulmonary fibrotic changes and central lobar emphysema, hazy, ground glass opacities within the mid lung zone, perihilar region, bilaterally. Essentially unchanged in appearance from the prior study. There was no evidence of bronchiectasis or new focal consolidation or atelectasis. There was no pleural effusion. A 14 mm nodule in the left costophrenic angle, previously described mildly enlarged anteromedial mediastinal nodes were stable.
LABORATORY STUDIES: Showed hemoglobin 7.8, hematocrit 23.6, which remained stable during this hospitalization. White count of 6.4, 5.2, 7.2. Normal platelets from 286,000 to 350,000. There was no symptom of acute decompensation. Anemia was asymptomatic. His INR initially was 9.2 and then he received vitamin K x3 and subsequently INR came to 9.7, 7.5, 5.1 and 2.1. Microbiology data showed urine cultures with contamination as well as wound culture was VRE, which was sensitive to ampicillin, ceftriaxone, cefepime, imipenem, Levaquin as well as tobramycin. VRE was sensitive to ampicillin, but the patient has allergy to penicillin as well as cephalosporin, but most exclusively to Keflex.
LABORATORY STUDIES: White count 8.4, hemoglobin 12.2, hematocrit 36.2, platelet count 266,000. On admission, white count was 9.2 with a peak of 11. The patient's hemoglobin on admission was 15.2. The patient's sodium was 135, potassium 3.8, chloride 100, carbon dioxide 28, BUN 20, creatinine 1.1, glucose 120, calcium 8.6. Magnesium level pending. Total bilirubin 12.8, was 14.2 on admission, peaking at 15.8 two days after ERCP. Direct bilirubin 7.3, down from 8.6 on admission. Indirect bilirubin 5.4, down from peak of 6.8 after ERCP. AST 41, down from 142 on admission. ALT 48, down from 204 on admission. Total protein 4.6, albumin 2.2, alkaline phosphatase 274, down from 360 on admission. Amylase 34, lipase 22. CA 19-9 antigen 534, which was markedly elevated. The patient's sodium on admission was 131. PT 13.6, INR 1.1, PTT 24. D-dimer 0.74. The patient's urine was amber in appearance, 25 mg estimated protein, large amount of bilirubin, negative leukocyte esterase, 2-4 white cells, 10-14 granular casts, and 3-4 white cell casts.
LABORATORY DATA: WBC 6.6, hemoglobin 11.6, hematocrit at 32.8, MCV 86.6, and platelet count 109,000. PT 11.2. INR 1.0. Sodium 134, potassium 3.6, chloride 104, carbon dioxide 22, glucose 108, calcium 8.2, total protein 5.8, albumin 2.9, and alkaline phosphatase 64. SGPT 52, SGOT 56, total bilirubin 1.0. BUN 48 and creatinine 1.6.
LABORATORY STUDIES: Urine culture was positive for Proteus mirabilis and Pseudomonas aeruginosa. UA with large amount of leukocyte esterase, positive for nitrite, trace amount of blood, protein 25, over 50 wbc's, 1-2 rbc's, many bacteria. PT of 14, INR 1.1, PTT 25. WBC 11.8, hemoglobin 13.2, hematocrit 39.8, platelets 314,000. Bedside glucose ranged from 122 up to 320. Sodium 142, potassium 4.8, chloride 106, carbon dioxide 26, BUN 68, down to 28 by discharge, creatinine 2.1, down to 1.3 by discharge, glucose 184, calcium 9.6. Magnesium 1.4 and 1.7, day of discharge was 1.4. Amylase 58, lipase 18, alkaline phosphatase 58, total bilirubin 0.6, AST 16, ALT 15, total protein 5.4, albumin 2.4.
LABORATORY DATA: Includes a white count of 10.6, hemoglobin 12.4, hematocrit 37.2, and a platelet count 190,000. Chemistries include a sodium 134, potassium 4.2, chloride 104, CO2 of 28. BUN 78 and creatinine 3.6; the initial creatinine was 4.2. Glucose 176. CPK 2024 today and it was 1880 yesterday with MB of 1.3 and a troponin of less than 0.06 and a troponin yesterday 0.6. The CPK from his prior admission was reportedly 312. Protime 11.2, INR 1.0, and PTT 24. Arterial blood gas shows a pH 7.38, PCO2 of 44, and a PO2 of 46 with an oxygen saturation of 79. It is unclear whether that was a venous stick as it does not seem to correlate with his clinical status. The patient had a CAT scan of the brain, which showed chronic periventricular ischemic white matter changes with no acute abnormalities seen. The chest x-ray from his prior admission showed no evidence of congestive heart failure and again today it shows no congestive heart failure, but evidence of cardiomegaly with a pacemaker defibrillator noted. A lung scan was done on the prior admission for similar problems and was low probability for pulmonary emboli.
LABORATORY STUDIES: Still pending are anti-Sjogren's antibody, anti-neutrophil cytoplasmic Ab, anti-single-stranded DNA Ab, anti-double-stranded DNA Ab, angiotensin converting enzyme, rheumatoid factor, Lyme titer, ANA. RPR nonreactive. Rheumatoid factor negative. WBC 8.8, hemoglobin 14.2, hematocrit 42.4, and platelets 234,000. ESR 5. Sodium 141, potassium 3.6, chloride 110, carbon dioxide 26, BUN 16, creatinine 1.1, glucose 88, calcium 9.4. Liver function tests within normal limits. Vitamin B12 of 440, folate 15.6. TSH 0.68.
LABORATORY DATA: Chemistry showed sodium 131, potassium 3.6, chloride 96, CO2 of 29, glucose 134, calcium 9.4, albumin 2, bilirubin 0.3, alkaline phosphatase 144, SGPT 32, SGOT 23, BUN 36, creatinine 1.4, PT 11.4, INR 1.05, and PTT 31. CBC: WBC 14.8, hemoglobin 8.2, hematocrit 24.6, and platelet count 178,000. CT of the brain without contrast was reviewed and shows mild brain atrophy and white matter disease. Carotid ultrasound showed no stenosis.
