LABORATORY DATA: Sodium 126, potassium 3.8, chloride 94, CO2 is 26, glucose is 146, BUN 18, creatinine 1.0, anion gap is 14. CPK and troponin are negative. Chest x-ray, PA and lateral, no acute disease. White count 13.2, H and H 12.2 and 36.6, platelet count 236 with 90 segs, 2 lymphocytes. Urinalysis: Occasional budding yeast, white blood cell clumps many, bacteria many, moderate leukocyte esterase, positive nitrite, large blood, 10-20 reds, 10-20 whites. Cardiac enzymes, second set, negative.
LABORATORY AND DIAGNOSTIC STUDIES: He had an EKG for an indication of lightheadedness. This showed normal sinus rhythm, 68 beats per minute. PR 168, QRS of 86, QTc 396. He had a leftward axis, normal intervals. No ST elevation or depression. No T-wave inversions. He had some flattened Ts in lead III and with R-wave progression in his inferior leads, but it was no change from a previous EKG. He had labs drawn including a normal CBC, normal renal panel. Glucose is slightly elevated. He had 3 sets of cardiac enzymes over 3 hours, which were normal. UA was normal and a BNP was normal. He had a chest x-ray read by the radiologist as normal.
LABORATORY DATA: Initial laboratory studies are remarkable for glucose 750, osmolality 330, acetone was negative, white blood cell count 5.2, SGOT 26, SGPT 146, sodium was 134, INR 0.9. EEG was reviewed and found to demonstrate minimal diffuse slowing.
LABORATORY AND DIAGNOSTIC STUDIES: EKG showed a paced rhythm with an underlying rhythm, likely to be atrial fibrillation and premature complexes. There is some ST segment depression in lead II. The EKG is essentially nondiagnostic, otherwise. The patient had a chest x-ray, which revealed no acute abnormalities. Cardiac enzymes were negative. Digoxin level 1.6. AST, ALT, and alkaline phosphatase are all normal. INR is 2.2. Lipase 34. White blood count of 5, hemoglobin 12.8, platelets 170, sodium 139, potassium 3.2, chloride 108, bicarbonate 26, glucose 98. BUN 14 and creatinine 0.9.
LABORATORY DATA: A CBC was obtained, which revealed a white count of 5.8, H and H of 13.9 and 41.8 and platelet count of 326,000. She had 53% neutrophils, 38% lymphocytes and 8% monocytes. Renal panel revealed a sodium of 140, potassium of 3.8, chloride 108, total CO2 of 30, BUN of 18, creatinine 1.1 and glucose of 109. Coagulation times revealed PT of 13.6, INR of 1.1 and PTT of 28.2. A set of cardiac enzymes revealed CK-MB of 1.7 with troponin I of less than 0.05. A chest x-ray was unremarkable. EKG revealed a slightly prolonged QTc at 162 milliseconds, but was otherwise an unremarkable EKG. Urinalysis revealed specific gravity of 1.024, small bili, trace ketones, 30 of protein and urine hCG was negative.
LABORATORY AND DIAGNOSTIC STUDIES: EKG showed sinus bradycardia at 56 beats per minute, normal axis, normal intervals. No evidence for acute ischemia. Otherwise, normal EKG. There is no old EKG for comparison. Noncontrast head CT was unremarkable. Chest x-ray was unremarkable. Sodium 138, potassium 3.8, BUN and creatinine 17 and 1.2 respectively with a glucose of 86. White count 6.6 with an H and H of 14.6 and 43.8, platelets 246,000. Cardiac enzymes are negative and normal x2. An LP was performed. CSF findings came back consistent with viral meningitis with a glucose of 54 and protein of 44, which were both within normal limits. Tube 1: Somewhat of a traumatic tap with 3000 red blood cells, 104 whites with 87 lymphocytes and 12% monocytes. Tube 4: Showed 3 red blood cells, still 100 white blood cells with 82% lymphocytes, 16% monocytes, and 1% eosinophil. Given this pattern, this is most likely viral meningitis.
LABORATORY AND DIAGNOSTIC STUDIES: CBC: White count 11.6, hemoglobin 17.2, hematocrit 51.4, platelets 139. Renal: Sodium 134, potassium 3.8, chloride 102, bicarbonate 26, BUN 11, creatinine 1.4, glucose is 186. CK MB is 1.3. Troponin 0.06 and BNP is 37.2. Second set of cardiac enzymes, CK MB was 1.2, troponin was less than 0.05. AST was 362, ALT was 354, total bilirubin 7.9, direct bilirubin 2.9, protein 6.8, albumin 4.2, lipase is 8. Alkaline phosphatase 126. Protime 18.2, INR 1.6 and PTT is 33.8. Urinalysis showed 100 protein, 40 ketones, 100 bacteria, 100 sugar, moderate bacteria, 3-5 white blood cells, small blood, urobilinogen 8.1, large bilirubin and 3-5 white blood cells, 5-10 reds. EKG was done, which showed a normal sinus rhythm, heart rate is 66. No ST elevation or depression noted. No acute ischemic changes noted, normal axis. There is no old EKG to compare to at this time. Also did a CT scan of the abdomen and pelvis, which did show gallstones and acute cholecystitis.
LABORATORY AND DIAGNOSTIC STUDIES: CBC: White count 4.7, hemoglobin 15.2, hematocrit 45.6, platelets 236. Renal: Sodium 140, potassium 4.1, chloride 108, bicarbonate 28, BUN 10, creatinine 0.9, glucose is 108. CK-MB is less than 1, troponin is less than 0.05. AST is 22, ALT is 14, total bilirubin 0.6, direct bilirubin 0.1, protein 6.8, albumin 4.4, lipase is 14, alkaline phosphatase 74 and BNP was 19.8. A second set of cardiac enzymes was also negative. A chest x-ray showed mild hyperinflation; otherwise, no acute disease. EKG showed a normal sinus rhythm, heart rate of 74 with no ST elevation or depression noted. No acute ischemic changes were noted.
LABORATORY AND DIAGNOSTIC DATA: CBC: White count 11.6, hemoglobin 10.2, hematocrit 30.6, platelets 344. Renal panel showed sodium of 140, potassium 5.1, chloride 111, BUN 46, creatinine 1.9, which is up from her baseline of 1.2. She had a glucose of 120. Cardiac enzymes showed a CK-MB of 9.2 and a troponin of less than 0.05. She did have a total CK of 882. The patient had a BNP, which was 260 and protime and INR which were within normal limits. She had a chest x-ray which showed AICD, otherwise no acute process. She had an EKG which showed sinus tachycardia with a rate of 106, normal axis, normal intervals. She did have Q-waves in the inferior leads indicating an old MI. She also had LVH. She also had T waves in leads V4 through V6. There was no ST elevation or depression, no evidence of any acute ischemia.
LABORATORY AND DIAGNOSTIC DATA: CBC: White count 12.2, hemoglobin 11.4, hematocrit 33.6, platelets were 228. Initial renal panel showed sodium of 131, potassium 3.2, chloride 102, BUN 32, creatinine 1.3. Glucose was 98. She had LFTs and lipase, which were within normal limits. Urinalysis showed 30 protein and was otherwise negative. She was typed and screened, which showed A positive with a negative antibody screen. She had acute abdominal series, which showed indeterminate for small bowel obstruction. Repeat renal panel showed a BUN of 28 and creatinine of 1.1. Her potassium also improved to 3.6. The patient did have a CT of abdomen and pelvis with IV and p.o. contrast with no acute abnormalities noted. EKG showed normal sinus rhythm with a rate of 88. She had a left bundle branch block, normal intervals. She did have one set of cardiac enzymes, which were negative.
