LAB 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 81.9, normal MCH of 27.2, and MCHC of 33.2. Platelet count was 229,000. Coagulation profile: PT 13.3, PTT 28.2. Chemistry profile: Sodium 141, potassium 4.2, chloride 104, CO2 of 26, calcium 8.6, and hemoglobin A1c 5.9. Lipid profile: Cholesterol 137, 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 2.24. Arterial blood gas: pH 7.38, PaCO2 41, pO2 87, base excess 0, bicarbonate 25.3, and saturation 97%.
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: White count 7400, hemoglobin 9.8, hematocrit 28.4, BUN 33, creatinine 3.2, potassium 4.2, CO2 of 24, calcium 8.2, glucose 106. Albumin was low at 1.8. Liver function tests normal. Lipase normal at 26. Urinalysis: pH of 6.0, protein 300 mg/dL, large blood, negative leukocyte esterase, positive nitrite. Microscopic exam showed many epithelial cells, 2 to 5 white cells, 20 to 50 red cells, and many bacteria. Urine culture was sent and to date is growing greater than 100,000 multiple non-predominating organisms. Blood cultures are negative to date. Renal ultrasound showed normal-sized kidneys with diffusely increased echogenic parenchyma. No obstruction. Intake and output yesterday was 1800 in and 1500 out. A CAT scan of the abdomen and pelvis was done and showed a 1 mm nonobstructing calculus at the lower pole of the right kidney. No obstruction. There were post cholecystectomy changes in the right upper quadrant.
LAB DATA: Chemistry: Sodium 146, potassium 3.9, chloride 88, bicarbonate 37, BUN 27, creatinine 7.5, and blood sugar 198. CBC shows WBC 17.2 with 4% bandemia and 78 segs. Hemoglobin 11.8, hematocrit 34.4, and platelets 298. Coagulation: PT is 16, INR 1.3, PTT 36.8. Liver functions: Total protein 7.3, albumin 3.7, AST 18, ALT 14, alkaline phosphatase 66, total bilirubin 1.3, direct bilirubin 0.4, indirect bilirubin 0.9, lipase 19. Ionized calcium 0.92. ABG showed pH 7.6, PCO2 of 41, PO2 of 49. CK total 169. Imaging: CT of the abdomen with contrast showed polycystic kidney disease, normal appendix. Chest x-ray showed increased pulmonary vasculature and cardiomegaly. Abdominal x-ray showed mild nonspecific small bowel dilatation on the left side but no obstruction. EKG showed normal sinus rhythm, rate of 94, PR interval 209 msec, T-wave inversion in V5 and V6.
LABORATORY DATA: BUN and creatinine upon transfer were 14.2 and 0.7. Sodium 141, potassium 3.4, CK-MB 5.1, CK-MB index 3.9, troponin 0.06, BNP 96. White blood cell count was 16, had improved to 6.2 at the time of transfer. Hemoglobin and hematocrit on transfer were 11.4 and 33.6. Platelets were 260 and declined subsequently to 145. D-dimer was 0.82. ABG; pH 7.34, pCO2 of 43, pO2 of 50, base excess -1, bicarbonate 23, O2 saturation 83% on non-rebreather mask. AFB smear from bronchoscopy was negative for acid-fast bacilli. Sputum culture from bronchoscopy showed reduced growth of upper respiratory tract flora. MRSA culture screen was negative for MRSA. Blood cultures showed no growth.
X-ray of the chest showed complete opacification of the left hemithorax, residual opacities throughout the left lung and the right lower lung. Chest x-ray subsequently showed improvement in left hemithorax infiltrate as well as the right base infiltrate.
Echocardiogram showed vigorous left ventricular systolic function with an EF of 65-70%, mild LV diastolic dysfunction, grade 1/4 mild to moderate tricuspid regurgitation, trace pulmonic regurgitation, severe pulmonary artery systolic hypertension.
