LABORATORY DATA: Hemoglobin 9.3, hematocrit 27.4, white blood cell count 4090, and platelet count of 262,000. Urinalysis showed no nitrites, 15 mcg/dL of protein, and no blood. Stool for occult blood initially was positive, then converted to negative. Sodium 133, potassium 5.1, chloride 104, and CO2 of 18. Initial BUN was 60 and creatinine 5.3, repeat BUN was 29 and creatinine 2.7. Protein 5.5, albumin 2.8, and calcium 8.6. Bilirubin 0.3, AST 9, ALT 20, alkaline phosphatase 101. Magnesium 2.4. Triglyceride 214, cholesterol 190, HDL 25, and LDL 122. Stool for Clostridium difficile is positive. Stool for ova and parasites was negative. Stool for enteric pathogens was negative.
Renal scan showed poor glomerular function. No evidence of obstructions. Abdominal ultrasound showed calcification of the arcuate artery. Chest x-ray showed no infiltrate. KUB showed no free air. EKG showed normal sinus with nonspecific ST flattening.
LABORATORY DATA: On admission, white blood cell count is 6.9, hemoglobin 8.6, hematocrit 24.6, neutrophil percentage is 29.6, lymphocytes 54.9%, MCV was 94.2, reticulocytes 3.5%. Sodium 134, potassium 4.2, chloride 102, bicarbonate 24, BUN 18, creatinine 0.8, calcium 8.2. Total bilirubin is 1.5, direct is 0.3, AST 145, ALT 24, lactate dehydrogenase is 2852, total protein 6, alkaline phosphatase is 76, albumin 3.6, amylase 64, lipase 46. PT was 17, PTT 31.9, INR 1.3. UA on admission showed 1+ protein, 1+ blood, negative for leukocyte esterase, negative for nitrites, 2 to 5 white blood cells. EKG showed normal sinus rhythm. Chest x-ray showed no evidence of acute cardiopulmonary disease; although, on chest x-ray, there appeared to be some cardiomegaly.
LABORATORY DATA: Hemoglobin was 13.5, hematocrit 39.6, white blood cell 6090, and platelet count of 276,000. D-dimer was negative. Urinalysis did show 3+ bacteria, positive nitrites, and negative protein. Sodium 138, potassium 3.8, chloride 102, CO2 of 28, BUN 19, creatinine 0.9, glucose 136, protein 7.5, albumin 4.1, calcium 9.1. Bilirubin 0.44, AST 19, ALT 36, alkaline phosphatase 76, CK of 50, amylase 35, lipase 164. Triglycerides 209, cholesterol 194, HDL 38, LDL 118. Troponin 0.03. A pH of 7.5, PCO2 31, PO2 105, and bicarbonate of 24. Urine cultures showed no growth.
Electrocardiogram showed normal sinus rhythm with no progressive ischemia. Ventilation/perfusion scan was negative for pulmonary embolism. Chest x-ray showed no infiltrate. Electrocardiogram showed normal systolic function, trace mitral regurgitation, left ventricular diastolic dysfunction.
LABORATORY DATA: Hemoglobin 10.4, hematocrit 31.6, white blood cell count 6050, and platelet count 214,000. Urinalysis did show 1+ bacteria and no nitrites, 100 mcg/dL protein and 25 mcg/dL of blood. Sodium 142, potassium 2.9, chloride 105, CO2 of 25, BUN 60, creatinine 5.2, glucose 51, protein 6.5, albumin 3.1, calcium 8.2, and bilirubin 0.28. AST is 20, ALT is 24, alkaline phosphatase 136. CK 80, repeat CK 77 and 71. Triglyceride 99, cholesterol 115, HDL 46, LDL 51. Troponin 0.05. T3 of 124 and 24-hour urine for creatinine was 9. Urine cultures showed no growth.
Chest x-ray showed congestive heart failure with basilar consolidation and bilateral fluids. Echocardiogram showed ejection fraction of 35% with mitral regurgitation, dilated left ventricle and EKG showed normal sinus rhythm with intraventricular conduction delay.
LABORATORY DATA: Hemoglobin 13.3, hematocrit 41.9, white blood cell count 8040, and platelet count 164,000. D-dimer was negative. INR of 1. Stool for occult blood negative. Sodium 138, potassium 4.5, chloride 102, and CO2 of 34. BUN 26 and creatinine 0.8. Glucose 139. Calcium 8.9. Phosphorus 4.4, CK 45, and magnesium 2.2. Triglycerides 97, cholesterol 167, HDL 72, and LDL 76. Troponin of 0. TSH of 0.66. Sputum culture did show Acinetobacter baumannii.
Chest x-ray showed no infiltrate. CT of the chest showed no infiltrates. Hiatal hernia was noted. EKG showed normal sinus rhythm with poor R-wave progression.
LABORATORY EXAMINATION: EPO was 302. Hemoglobin was 10.4 and hematocrit was 31.3. Sodium 138, potassium 4.5, chloride 104, and CO2 of 28. BUN 4 and creatinine 0.9. Glucose 115. Protein 5.1 and albumin 2.4. Calcium 8.7. Bilirubin 0.3. AST is 23, ALT is 27, alkaline phosphatase 77. CK 45, LDH 156, amylase 30, lipase 130. Magnesium 1.7 and beta hCG was negative. Iron was 1, TIBC 225. Troponin is 0. B12 of 574, folic acid 9.7, haptoglobin 2. TSH 4.6. Rheumatoid factor negative and ANA negative. Blood cultures showed Escherichia coli. Peritoneal culture showed Escherichia coli and urine culture showed Escherichia coli.
Abdominal ultrasound was normal. Pelvic ultrasound showed a 18 mm right cyst. CT of the abdomen was normal. Nuclear scan showed no evidence of pulmonary embolus. Chest x-ray was normal.
LABORATORY DATA: WBC 9.3, hemoglobin 14.2, hematocrit 40.6, and platelet count 186,000. APTT 28.4, PT 12.9, INR 0.95. D-dimer 0.33. Triglycerides 204, cholesterol 187, HDL 43, LDL 103. CPK 156, 117, and 127, CK-MB 2.7, 1.5. Potassium 3.3, magnesium 2.9. Troponin 0.02 and less than 0.02. TSH 0.896. Total T3 of 122, T4 of 6.4.
LABORATORY AND DIAGNOSTIC DATA: White count 10.6, hemoglobin 11.9, hematocrit 37.8 and platelets 279,000. Differential was adequate at the time of discharge. There was 1+ polychromasia, hypochromasia and anisocytosis. PT, INR, PTT normal. D-dimer elevated. Sodium 142, potassium 4.3, chloride 102, CO2 of 30, BUN 22, creatinine 0.9, glucose 162, B-natriuretic peptide 34, magnesium 2.7. Serial blood sugars obtained. Glucoses were excellent, occasional low and occasional high. Urine, positive nitrite, 1+ leukocyte esterase, 1+ bacteria. CDT screen was positive. Ova and parasites were negative. Stool, sputum and blood cultures were all negative. Chest x-ray had some left basilar atelectasis, questionable infiltrates. CT of the chest, study is limited due to suboptimal pulmonary artery opacification. No definite pulmonary embolus seen. Abdominal x-ray, some scattered air-fluid levels, probably a large bowel. Knee x-rays, osteopenia and mild narrowing of the medial joint space compartment bilaterally, vascular calcification.
LABORATORY DATA: White count 10.8, hemoglobin 15.8, hematocrit 47.6, platelets of 236,000. BMP: Sodium 138, potassium 4.4, chloride 102, carbon dioxide 28, BUN 22, creatinine 0.9 and glucose of 85. Serum ammonia level was 126. ESR was 13. Cardiac troponin 0, TSH 1.52, free T4 0.84. Urinalysis was normal. Urine drug screen was also negative. Blood culture showed no growth. Cocci serology, indeterminate IgM level and negative for IgG.
CT scan of the head showed multiple subcutaneous metallic foreign bodies posteriorly. No intracranial abnormalities were seen. CT scan of the chest showed no pulmonary emboli. There was a prior gunshot wound primarily at the left side of the chest. EKG: Sinus bradycardia with nonspecific ST-T wave abnormalities.
LABORATORY DATA: CBC: White blood cell count 6800 with 54% neutrophils, 31% lymphocytes. Hemoglobin and hematocrit 13.9 and 41.8 respectively with low MCV of 81.6, normal MCH of 27.2, and MCHC of 33.3. Platelet count was 229,000. Coagulation profile: PT 13.1, PTT 28.2. Chemistry profile: Sodium 141, potassium 4.1, chloride 104, CO2 of 27, calcium 8.3, and hemoglobin A1c 5.9. Lipid profile: Cholesterol 136, triglycerides 122, HDL low at 35, LDL 78, cholesterol/HDL ratio is 3.9. Hepatic profile was completely within normal limits. Urinalysis: Specific gravity 1.020, pH 6 with trace blood, otherwise normal. TSH 2.23. Arterial blood gas: A pH of 7.39, pCO2 of 42, pO2 of 87, base excess 0, bicarbonate 25.1, and saturation 96%.
A chest x-ray was normal. EKG demonstrated normal sinus rhythm with leftward axis and prolonged QT interval. Colon screening: Hemoccult cards were negative x3. A 2-hour oral glucose tolerance test included fasting glucose of 106, which was mildly elevated and a significantly elevated 2-hour glucose of 212.
LABORATORY DATA: BMP: Glucose 272, BUN 13, creatinine 0.9. GFR greater than 60. Sodium 134, potassium 4.4, chloride 94, CO2 of 26, anion gap 18, calcium 9.8. CBC: WBC 20,400, neutrophils 90%, no bands, no eosinophils, no basophils. Hemoglobin 14.2, hematocrit 42.4. MCV 91.8, platelets 330,000. ESR 94. Urine: Yellow, slightly hazy, specific gravity 1.024, pH 5.6, protein 100, glucose greater than 1000. Urobilinogen 0.2, negative bile pigment, small blood. Leukocyte esterase and nitrite were negative. Microscopic reports 2-5 red blood cells. Gram stain of the wound reported 1+ wbc and 1+ gram positive cocci. Serum ketone is greater than 100. MRSA screening is pending. Liver function test: SGOT 66, SGPT 55, alkaline phosphatase 156, total bilirubin 1.4, direct bilirubin 0.3, indirect bilirubin 1.1, total protein 9.7, and albumin is 3.4.
LABORATORY/DIAGNOSTIC DATA: WBC of 16.6, hemoglobin of 12.4, hematocrit of 36.2, platelets of 297,000. Sodium of 131, potassium of 6.5, chloride of 98, CO2 of 23, BUN of 26, creatinine of 1.2. Blood sugar 116, ionized calcium of 1.18. He has lipase of 42, AST of 72, ALT of 58, alkaline phosphatase of 152, total bilirubin of 5.5, direct bilirubin of 1.4, total protein of 6.9, albumin of 2.4. Troponin I of 0.13. BNP of 168. Lactate of 1.3. CK-MB of 4.5.
EKG revealed 96 beats per minute, normal sinus rhythm. Q-wave is slightly prolonged at 446 msec. There are no specific ST-T changes consistent with coronary event. His arterial blood gases showed pH of 7.42, pCO2 of 34, pO2 of 76. Oxygen saturation of 95% on room air. Chest x-ray shows bilateral lower lobe infiltrates, questionable for effusion. CT scan of the abdomen without contrast showed abdominal mass in the prevertebral area around T10 level. There is no free air or free fluid in his CT scan of the abdomen.
LABORATORY EXAMINATION: Hemoglobin 11.4, hematocrit 34.3, white blood cell count 5020, and platelet count 294,000. INR of 1.4. Urinalysis shows positive esterase, negative nitrites, and negative protein. Sodium 144, potassium 4.5, chloride 106, and CO2 of 26. BUN 35 and creatinine 1.4. Glucose of 95. Protein 5.5 and albumin 3.4. Calcium 8.7. Bilirubin 0.7. AST 21, ALT 39, and alkaline phosphatase 86. CK 35. Magnesium 2.2. Troponin of 0.72, although troponin did initially show positive at 1.88. Triglyceride 106, cholesterol 136, HDL 24, and LDL 92. B12 of 812 and folic acid 24. T4 of 1.2 and TSH of 1.29. CEA was 2.2. ANA negative. Hepatitis A negative. Hepatitis B surface antigen negative. Hepatitis B core IgM negative. Hepatitis C negative. The pH is 7.4, PCO2 of 25, PO2 of 79, and bicarbonate of 81. Urine culture showed no growth.
Chest x-ray showed cardiomegaly, right effusion. CT of the chest shows moderate right effusion with no mass. EKG shows atrial fibrillation, poor R-wave progression.
LABORATORY DATA: Gastrin level 56. Hemoglobin 12.2, hematocrit 35.6, white blood cell count 9060, and platelet count 306,000. Sodium 143, potassium 3.6, chloride 107, and CO2 of 24. BUN 11.2 and creatinine 0.9. Glucose 95. Protein 5.7 and albumin 3.2. Calcium 7.9. Bilirubin is 0.65. AST 20, ALT 29, alkaline phosphatase 35. Amylase 79 and lipase 210. Triglycerides 125, cholesterol 226, HDL 90, and LDL 108. CLOtest is negative.
Small bowel series showed rapid transit. No fixed strictures or stenosis. Mild thickening of the distal ileum. Abdominal ultrasound was negative. CT of the abdomen showed inflammatory changes in the mid small bowel. KUB showed no free air. EKG showed normal sinus rhythm with no progressive ischemia.
LABORATORY STUDIES: Hemoglobin was 9.9, hematocrit 29.1, white blood cell count 2055, and platelet count 98,000. INR was 1.4. UA showed 1+ bacteria but no nitrites and 30 mcg/dL of protein. Sodium 143, potassium 3.6, chloride 107, CO2 of 28, BUN 12, creatinine 1.1, glucose 105, protein 6.6, albumin 3.3, and calcium 8.7. Bilirubin was 0.84, AST 69, ALT 57, GGT 48, and alkaline phosphatase 106. Amylase 32 and lipase 177. Magnesium 1.9. Triglycerides 68, cholesterol 126, HDL 39, and LDL 75. T4 of 14 and TSH 0.39. CEA 2.2, CA19-9 of 61, CA125 of 20, and AFP 5.3. Stool culture showed no growth. Urine culture showed no growth.
Gastrografin enema showed severe diverticulosis with spasm. CT of the abdomen showed a left renal cyst and mild splenomegaly. CT of the pelvis was normal. Chest x-ray showed no infiltrate. KUB showed no free air. EKG showed normal sinus rhythm with no acute ischemia.
LABORATORY EXAMINATION: Hemoglobin 12.8, hematocrit 38.5, white blood cell count 5065, and platelet count 183,000. Sedimentation rate of 3. Sodium 134, potassium 4.6, chloride 99, CO2 of 29, BUN 5, creatinine 0.8, and glucose 99. Protein is 6.7, albumin is 3.9, and calcium is 8.6. Bilirubin 0.25, AST 19, ALT 38, and alkaline phosphatase 116. Amylase 42 and lipase 259. Triglycerides 135, cholesterol 232, HDL 72, and LDL 134. T4 of 7.1 and TSH of 0.75. Dilantin level 2.3. Phenobarbital level 5.4.
CT of the chest showed chronic obstructive pulmonary disease with no mass noted, small pericardial effusion was noted. CT of the abdomen showed no evidence of a mass. CT of the pelvis showed no evidence of a mass. EKG showed normal sinus rhythm with no acute ischemia.
