LABORATORY DATA ON ADMISSION: Sodium of 133, chloride of 97, potassium of 4.2, bicarbonate of 25, BUN of 36, creatinine of 2.3, glucose of 93. White blood cell count 7400, hemoglobin 10.1, hematocrit 29.4, platelets 215,000, calcium 9.7, albumin 3.5, total protein 7.1, alkaline phosphatase 79, total bilirubin 1.3, AST 18, ALT 15, amylase 66, lipase 22. Urinalysis was negative.
Chest x-ray showed changes consistent with sarcoidosis with questionable infiltrate in the right upper lobe, as well as right middle lobe of the lung. Abdominal ultrasound showed absence of gallbladder. That is due to the fact that the patient had a cholecystectomy. It showed a dilated common bile duct measuring 7.1 to 8.4 mm. No stones in the duct. Splenomegaly measuring 15.9 cm. Hepatic/portal veins with normal flow.
DIAGNOSTIC TESTS: CT of the head demonstrated a right MCA distribution infarct with mild hemorrhagic conversion without midline shift or mass effect. Chest x-ray showed the presence of a dual lead pacemaker, otherwise unremarkable. LDL was 82, HDL was 25, and troponin was 8.8 on admission, 4.5 at discharge. CK-MB was 6.7 on admission and 3.7 at discharge. Echocardiogram showed moderate left ventricular systolic dysfunction with an estimated ejection fraction of 40% and apical akinesis, dilated aortic root, aortic sclerosis, and trivial aortic insufficiency, right atrial and right ventricular enlargement.
LAB DATA: Laboratory data on admission showed hemoglobin of 9.3 and hematocrit of 28% and 1950 white blood cells including 38 polys, 53 lymphs, 5 monos and 177,000 platelets. PT and PTT were within normal limits. CMP showed mildly increased SGOT of 56 with normal SGPT of 48 and a normal serum creatinine of 0.8.
LABORATORY FINDINGS ON ADMISSION: CBC showed WBC of 4950 per cubic mm, hemoglobin was 8.4 g/dL, hematocrit 25.4%, platelet count 168,000 per cubic mm. CMP showed glucose of 125 mg%, creatinine 4.1 mg%, potassium 5.4 mEq per liter, albumin was 3.1 g%, AST 10 units per liter, ALT 7 units per liter, serum amylase 62 units per liter, and lipase 78 units per liter.
LABORATORY ON ADMISSION: WBC 10.9, platelet count of 323,000, hemoglobin 13.5, hematocrit 39.2. Sodium 135, potassium 4.2, chloride 100, bicarbonate 29, BUN 10, creatinine 0.8, glucose 167. PT was 11, PTT 24, and INR 1.0. Cholesterol 303, triglycerides 120, HDL 34, and LDL calculated was 245.
LAB DATA: Sodium 133, potassium 3.2, chloride 95, blood sugar was only 35 mg%, BUN 15, creatinine 1.2, calcium 8.7, and magnesium 1.8. Troponin I was zero. White count was 13,900 with 73% segs, hemoglobin 14.5 gm%. Subsequent white count was 8780, hemoglobin 14.3 gm%. Sedimentation rate was 32 mm per hour. Urinalysis showed presence of sugar and protein, with no significant microscopic findings. Subsequent electrolytes improved; potassium 4.6, sodium 134, chloride 96, BUN 17, and creatinine 1.2. Blood sugars ranged from 150 to as high as 409 from the steroids. Prior to discharge, blood sugar was 188 mg%. Sputum culture did not grow any organism. Urine culture was also negative.
X-ray of the left foot showed degenerative changes with vascular calcification. No osteomyelitis. Chest x-ray showed chronic obstructive pulmonary disease with no definite acute infiltrate. CT scan of the brain showed atrophy without any acute findings. A 12-lead EKG showed normal sinus rhythm with left axis deviation and nonspecific T-wave changes.
LABORATORY EXAMINATION: Hemoglobin 13.8, hematocrit 40.2, white blood cell count 11,200, and platelet count of 203,000. Sodium was 134, potassium 4.8, chloride 94, CO2 of 32, BUN 34, creatinine 1.4, glucose of 236, calcium of 8.9, CK of 5, troponin of 0, triglycerides 65, cholesterol 168, HDL 63, LDL 92, T4 is 7.3, alkaline phosphatase is 94, ALT is 45, AST is 21, bilirubin 0.16, calcium 9.2, protein 7.3, albumin 4.1, and TSH is 0.74. Sputum culture showed no growth. Bronchial culture for AFB was negative. Bronchial culture for fungus was negative.
Chest x-ray showed no infiltrate. EKG showed normal sinus rhythm with no progressive ischemia.
LAB DATA: Hemoglobin 10.6, hematocrit 31.4, white blood cell count 8200, and platelet count of 305,000, INR of 1.9, PTT of 42.6. Urinalysis showed no nitrites, no protein, and no blood. Sodium 144, potassium 3.8, chloride 107, CO2 of 26, BUN 18, creatinine 2.6, glucose 112, protein 5.2, albumin 2.1, calcium 8.3, and bilirubin 0.26. AST is 24, ALT is 22, alkaline phosphatase 213, amylase 88, lipase of 152, magnesium 1.4, digoxin 0.62, vancomycin 15.9, pH of 7.290, PCO2 51, PO2 76, and bicarbonate of 37.
A CT of the chest showed bilateral effusions with basilar pneumonia. Nuclear scan was indeterminate for pulmonary embolus. KUB showed distension of the bowel. Venous Doppler of the left upper extremity showed normal flow pattern. EKG showed normal sinus rhythm, right axis deviation, anterior T-wave inversions.
LABORATORY DATA: Cardiac biomarkers were not done. CBC: Hemoglobin 13.3, hematocrit 38.8, MCV 93.3, WBC 19.4, neutrophils 88, no bands, lymphocytes 3%, monocytes 9%, platelets 276,000. BMP: Glucose 141, BUN 28, creatinine 1.6, GFR 42, sodium 136, potassium 4.1, chloride 104, calcium 8.6, CO2 of 26, amylase 142, lipase 56, SGOT 66, SGPT 38, ALT 94, total bilirubin 2.9, direct bilirubin 0.9, indirect bilirubin 2, total protein 7.2, albumin 3.4, lactic acid 1.2. PT 31.4, INR 3. Urine: Yellow, clear. Specific gravity 1.025. Protein 100 mg/dL, negative for glucose, ketones, nitrite and leukocyte esterase. Microscopic appeared to be 5-20 red blood cells with occult bacteria, no white cells.
LAB DATA: White count of 13,300 with 73% segs and hemoglobin 13.2 gm%. Her admission electrolytes showed hypokalemia with potassium of 3.3, chloride of 97, BUN of 35, and creatinine 1.6 consistent with renal insufficiency. Magnesium was only 1, which improved to 1.9. Followup potassium was 4.8. Her blood sugar on admission was 122 mg%. Subsequent blood sugar went up as high as 370 mg%. Subsequent BUN and creatinine stayed mildly elevated. Upon discharge, BUN was 32 with a creatinine of 1.4 and potassium of 3.6. Digoxin level was elevated at 2.98 on admission, repeat of 3.40. Arterial blood gases showed pH of 7.42, PCO2 39, and PO2 76. The sputum culture grew Candida albicans.
Serial 12-lead EKG showed atrial fibrillation with poor progression of R waves in the precordial leads and occasional aberrancy. Chest x-ray showed no acute infiltrate initially. A repeat chest x-ray showed a vague density in the left apex suggestive of granuloma.
LABORATORY EXAMINATION: Hemoglobin 13.4, hematocrit 38.5, white blood cell count 13,900, and platelet count 152,000. Sodium 137, potassium 3.7, chloride 98, and CO2 of 27. BUN 23 and creatinine 1.1. Glucose 172. Protein 6.4 and albumin 3.2. Calcium 8.7. Bilirubin 0.4, AST is 26, ALT is 29, GGT 36, alkaline phosphatase 96, CK is 78, amylase 26, and lipase 162. Triglycerides 157, cholesterol 224, HDL 37, and LDL 158. PSA of 46.8. Troponin 0.3.
Abdominal ultrasound showed a cholelithiasis. Nuclear scan showed no excretion into the small bowel. Chest x-ray showed recurrent aspiration pneumonia. CT of the chest showed question aspiration pneumonia. Thoracic spine showed degenerative changes. CT of the abdomen showed a 4.5 cm abdominal aortic aneurysm, diverticulosis with question of a metastatic lesion of L1. Sigmoid diverticulosis was noted as well. Bone scan showed question of metastatic lesion of L1. EKG showed sinus tachycardia with a right bundle branch block.
LABORATORY EXAMINATION: Hemoglobin 12.4, hematocrit 35.7, white blood cell count 12,500, and platelet count 169,000. Urinalysis showed 3+ bacteria, no nitrites, positive protein. Sodium 142, potassium 4.2, chloride 104, and CO2 of 30. BUN 42 and creatinine 1.2. Glucose 75. Protein 5.1 and albumin 2.1. Calcium 8.7. Bilirubin is 0.39, AST is 18, ALT is 24, alkaline phosphatase is 66. Magnesium is 1.9. TSH is 0.07. Amylase of 27 and lipase of 97. Triglycerides 90, cholesterol 185, HDL 57, LDL 110. B12 768, folic acid greater than 24. CEA 2.7. Digoxin of 1.36. Blood cultures x4 showed no growth. Sputum culture showed Candida.
Chest x-ray showed no infiltrate. CT of the pelvis showed diverticulosis. Bilateral venous lower extremity Dopplers were negative and EKG shows atrial fibrillation.
