LABORATORY DATA: CBC revealed a white count of 12.2, hemoglobin of 12.8, hematocrit of 40.8, MCV of 82 and platelet count of 226,000. Chemistry revealed sodium of 135, potassium of 4.6, chloride of 102, CO2 of 22, BUN of 19, creatinine of 1.1, glucose of 117, AST of 34, ALT of 18, alkaline phosphatase of 74, total bilirubin of 0.9, calcium of 8.7, albumin of 3.4, total protein of 6.8, globulin of 3.4 and BNP of 304. Cardiac enzymes were negative x1 set. Blood gases demonstrated a pH of 7.34, pCO2 of 33, PaO2 of 81 and bicarbonate of 18.
DIAGNOSTIC STUDIES: Twelve-lead EKG demonstrated the patient to be in atrial fibrillation with no evidence of acute ischemia. Chest x-ray demonstrated bilateral pulmonary edema, questionable infiltrate at the base.
LABORATORY DATA: WBC 7.2, hemoglobin 17.2, hematocrit 51.2, platelets 286,000. Sedimentation rate 7. Sodium 140, potassium 3.6, chloride 102, CO2 of 26, creatinine 1.2, BUN 14, glucose 96. SGOT 26, SGPT 39, total bilirubin 0.4. Cholesterol 198, triglyceride 104, HDL 64, LDL 112. TSH 3.16. Urine drug screen negative. Acetaminophen and salicylate negligible. Blood alcohol 336.
LABORATORY DATA: The patient has seen a rheumatologist who performed a rheumatology workup which was proved to be negative with negative cryoglobulins, negative C-ANCA and P-ANCA, Smith antibody, anti-ribonucleoprotein, normal creatine kinase of 32 with normal 0-190. Laboratory workup consisted of a sed rate which is 32, C1 esterase inhibitor which is normal at 34, normal white count of 5.4, 0% eosinophils, no evidence of antithyroid antibodies, negative RAST testing to extensive foods including meats, shellfish, nuts and other seafood. The patient has had a normal Chem-20 with no evidence of elevated liver enzymes. The patient did have an ANA which was 1:100 speckled pattern. The patient has had a negative rheumatoid factor. Normal total complement levels and negative hepatitis B surface antibody. The patient does have a positive CD203 Fc epsilon basophil degranulation assay at 20.9% with normal reference range at 0 to 2%.
LABORATORY DATA: Hematology: WBC 6.6, hemoglobin 11.2, platelets 266. Chemistry: Sodium 134, potassium 4.8, chloride 104, CO2 of 22, BUN 48, creatinine 3.1, glucose 218. Liver functions normal. GFR 14, calcium 10.2, albumin 3.3, total protein 6.6, globulin 3. A/G ratio 1.1. Anion gap 12. BUN/creatinine ratio of 15.48. CK 57, magnesium 2.1. Cardiac enzymes first set negative. Urine examination: Yellow, hazy, specific gravity 1.008, pH 5.6, protein positive, glucose trace, ketone negative, bilirubin negative, blood small, nitrite negative, leukocytes negative, wbc’s occasional, rbc’s occasional. EKG: First-degree AV block, inverted T-waves in lead II and III; otherwise, there are no acute ST elevation myocardial infarction changes.
LABORATORY DATA AND STUDIES: White count 3.8, hemoglobin 12.4, platelet count 198. Serum sodium 141, potassium 4.1, chloride 104, bicarbonate 26, BUN 10, creatinine 0.7 and glucose 120. Total protein 7.2. Albumin 4.1. Total bilirubin 0.6. AST 16, ALT 9 and alkaline phosphatase 46. Lipase 27. Troponin less than 0.01. Electrocardiogram demonstrates normal sinus rhythm, left axis deviation and right bundle branch block. There are no ischemic changes. Electrocardiogram is unchanged from last EKG. Did have an ultrasound that demonstrated multiple gallstones. No evidence of acute cholecystitis. Does have an ill-defined hypoechoic focus along the pancreatic neck region. INR is 1.1. PTT is 35.
LABORATORY DATA: WBC was 18.9 and the repeat was down to 9.8. The differential was normal. Glucose was 108. Creatinine was 2. BUN was 22. Serum magnesium was 1.6 and 1.5. Liver function tests were normal. Cardiac enzymes were normal. Hemoglobin A1c was 6.5. Rheumatoid factor was positive. Rheumatoid factor titer was 81. Antinuclear antibody index was 0.67. Antinuclear antibody was negative. Urine examination was reported as follows: Cloudy, leukocyte esterase 3+, rbc’s 0-4, wbc’s greater than 50 and bacteria 3+. Repeat of the urine examination 3 days later was reported as yellow, hazy, leukocyte esterase 2+, bacteria 1+, wbc’s 0-4, coarse granular casts 5-10. Urine culture and sensitivity showed E. coli.
LABORATORY DATA: CBC: WBC is elevated at 13.6, hemoglobin is low at 8.2, low MCV of 71. Platelet count is 402 which is elevated. There is a left shift. Chemistry: Sodium 136, potassium is low at 2.8, chloride 102, CO2 of 26, BUN 18, creatinine 0.7, glucose is elevated at 102. AST is mildly elevated at 44, ALT 32, alkaline phosphatase 86, total bilirubin 0.6. Calculated GFR is greater than 60. Calcium is low at 8.2. Albumin low at 1.8. Total protein 5.7. N-peptide is elevated at 3850. Cardiac enzymes showed an elevated CK of 406 and CK-MB of 8.4. Troponin is within normal limits at 0.20. Urinalysis shows cloudy appearance, 30 protein and moderate blood. Otherwise, negative for urinary tract infection. ABG is significant for an elevated pH of 7.54, pCO2 of 30 and pO2 of 54 as well as oxygen saturation of 91% on room air. Bicarbonate is within normal limits at 26.
LABORATORY DATA: HCG was 3820. Hemoglobin was 11.6. Clean-catch urinalysis showed moderate leukocyte esterase, too numerous to count white blood cells and few bacteria. Transvaginal ultrasound showed no adnexal masses, no free fluid in the cul-de-sac, 1.3 cm fluid collection in the endometrial cavity with no yolk sac or a fetal pole. This collection could represent an early intrauterine pregnancy but cannot definitely exclude ectopic pregnancy, although no masses were seen in the adnexa.
LABORATORY DATA: The patient’s CBC was normal. Creatinine was normal. Chem profile was normal. The patient had an ANA that was negative with multiple ANAs negative including Scl-70, Jo-1 antibody, Sm, RNP and Ro and La all negative and normal as well as an anti-DNA. Complements were normal. Urinalysis was normal. There was no evidence for a connective tissue disease. Rheumatoid factors showed a rheumatoid factor by nephelometer to be elevated at 64 but anti-CCP antibody and slide agglutination rheumatoid factor were both negative.
LABORATORY DATA: Initial labs showed an ESR of 31 with serum sodium of 124, BUN of 11, and creatinine of 1.3. Hemoglobin 9.8 and hematocrit 29. Laboratory tests during this hospitalization showed the patient to have, as stated before, low sodium with sodium of 124. This low sodium was noted to resolve and the number did improve throughout the hospitalization. The patient had normal BUN with creatinine between 1.1 and 1.2. The patient had total cholesterol of 240 with HDL of 138 and an LDL of 88. Cardiac enzymes were negative for myocardial infarction. B-type natriuretic peptide was slightly elevated at 120 with normal being between 0 and 100. CK-MB fractions were negative. Amylase as well as lipase were both within normal limits. Iron was 60. Urine sodium was low at 22. CA-125 was normal at 21.2. Alpha-fetoprotein was normal at 7.5. TSH was normal at 3.7. CEA was normal at 0.6. Folic acid was normal at 7.4. Vitamin B12 level was normal at 528. Hepatitis viral profile was negative for hepatitis B, hepatitis A, and hepatitis C. Urine osmolality was low at 148 with blood osmolality normal at 263. Urinalysis was negative for finding of urinary tract infection. Hemoglobin was ranging between 9.7 and 8.7, with the lowest being 8.7 on MM/DD/YYYY. This number did improve throughout the hospitalization. Hemoglobin electrophoresis was normal with no hemoglobin variation. The patient had an MRI of the brain performed, which showed no acute ischemia identified. There is mild age-related chronic small vessel ischemic disease. Noncontrast CAT scan of the head showed no evidence of acute infarct. There was no mass effect or midline shift. Chest x-ray showed eventration of the right hemidiaphragm, otherwise unremarkable. Abdominal ultrasound showed fatty liver changes and normal gallbladder. CAT scan of the abdomen performed showed liver, gallbladder, biliary tree, and pancreas was unremarkable. The spleen was normal in size. There were no adrenal lesions. The kidneys were normal in size. There was no renal calcification seen. There was no hydronephrosis. There was no evidence of any retroperitoneal bleeding. The CAT scan of the pelvis performed showed what appeared to be routine IUD in place. There was right colonic diverticuli. Echocardiogram performed showed preserved left ventricular systolic function with evidence of possible diastolic compliance changes. There was trivial valvular flow abnormality. There was no gross mural thrombi or vegetations.
LABORATORY DATA: White blood cell count 8000, hemoglobin 11, hematocrit 34.9, MCV 89.8, and platelets 201,000. BUN 21 and creatinine 1.4. Glucose 115. Sodium 136, potassium 3.8, chloride 101, bicarbonate 29, and calcium 10.5.
LABORATORY DATA: The patient was found to have a low white blood cell count of 3.4 upon admission. The patient was also found to be anemic with hemoglobin of 10.2 upon admission. The patient’s sed rate was 49. The patient’s PT was 28.4 with an INR of 2.8 upon admission. Culture of the discharge from the knee revealed methicillin-resistant Staphylococcus aureus or MRSA and Staphylococcus epidermidis or Staph epi.
LABORATORY DATA: Chest x-ray done in the ER showed a right lower lobe infiltrate, questionable infiltrate in left lower lobe. CMP showed sodium 138, potassium 3.7, chloride 100, bicarbonate 21, BUN 10, creatinine 0.7, and blood glucose of 242. Her CBC showed white blood cell count of 13,900, hemoglobin 13.1, hematocrit of 39.6, and platelets of 235,000. The poly count was 90.5% and the lymphocytes were 6.4. Also, the patient’s amylase was 75 and lipase 28. Albumin 4.3. Calcium 9.3. AST, ALT, and alkaline phosphatase were within normal limits.
LABORATORY EXAMINATION: Revealed WBC of 6500, hemoglobin of 12.8, MCV of 98.9. PT/PTT were within normal limits. BMP revealed sodium of 134 and creatinine of 1.9. Urinalysis revealed 3+ protein. MUGA scan revealed left ventricular ejection fraction of 71% with a right ventricular ejection fraction of 24%.
LABORATORIES AND STUDIES: WBC 6.2, hemoglobin 10.6, hematocrit 32.8 and platelets 190,000. Sodium 141, potassium 3.8, BUN 7, creatinine 0.7, glucose 204. UA negative. Cholesterol 90, triglycerides 60, HDL 32, LDL 46, VLDL 12. A1c 5.5. Procalcitonin less than 0.5. TSH 1.10. Cardiac enzymes have all been negative. CTA of the circle of Willis showed an ulcerated plaque in the proximal right internal carotid artery with no significant stenosis, occlusion of the cavernous portion of the right internal carotid artery, a severe stenosis of the cavernous portion of the left internal carotid artery. Chest x-ray showed satisfactory PICC placement, hazy infiltrate, left upper lobe, may represent pneumonia in appropriate clinical setting. MRI of the head without contrast and MRA showed distal left anterior cerebral artery territory infarct, old lacunar changes in the brain and brainstem, very abnormal circle of Willis. Carotid ultrasound showed atherosclerosis without hemodynamically significant carotid artery stenosis, retrograde flow in the right vertebral artery. Echocardiogram showed a mild diffuse hypokinesis in the left ventricle. The left ventricular ejection fraction is mildly reduced, 45-50%. There is severe grade 3 to 4 diastolic dysfunction, reversible restrictive pattern of mitral inflow. There is mild to moderate regurgitation, 1 to 2+. There is moderate concentric left ventricular hypertrophy. Estimation of right ventricular systolic pressure is not possible. There is a small pericardial effusion without echocardiographic evidence of tamponade.
LABORATORY DATA: His CBC was normal except for a white cell count of 3.8 and hemoglobin of 10.3, MCV of 80, platelets of 123,000. He had a pancytopenia. Chemistries essentially normal except for sodium of 116. Note that his sodium was 199 at his doctor’s office yesterday. His chloride is 87 and his AST is slightly elevated at 38. Calcium is a little low at 8.3. His serum osmolality was down to 246.
DIAGNOSTIC AND LABORATORY DATA: Head CT showed the pituitary mass which is unchanged from prior exams. X-ray of the chest done showed nothing acute. X-ray of the knees showed no acute changes. No fracture. No dislocation. Did have patellar osteophytes but no large joint effusion. X-rays of the hips did not show any fractures. EKG showed normal sinus rhythm, 80 beats per minute, baseline artifact. He had normal electrical axis. Had Q waves in V1 and V2 suggestive of an old septal infarct but no acute ST or T wave abnormalities to suggest any acute ischemia.
DIAGNOSTIC STUDIES: CT head shows no acute disease with chronic tiny lacunar basal ganglia infarcts and small vessel white matter ischemic disease. Chest x-ray is clear with old right rib fractures noted. Urinalysis: Too numerous to count wbc’s, too numerous to count bacteria, positive nitrites, largely positive leukocytes, specific gravity of 1.016 and a protein of 30 mg. CBC shows white count 8.2, hemoglobin 10.8, platelet count 166,000 with normochromic normocytic indices. Differential 80.6, 9.9% lymphocytes, 9.3% monocytes, 0.1% eosinophils and 0.1% basophils. Admission coagulations are ordered and pending. Has hyponatremia with sodium of 126, potassium 4.6, chloride 98, CO2 of 22, BUN 38, creatinine 1.6, glucose 148, calcium 9.6 and albumin 2.8. Liver enzymes normal. Blood cultures have been obtained and urine culture has been obtained.
LABORATORY DATA: WBC 6.4, hemoglobin 11.8, hematocrit 34, platelet count of 94,000, absolute neutrophil count of 3.99, absolute lymphocyte count of 1.5, reticulocyte count is 2.3. PSA was elevated at 40.19. Electrolytes are normal. Glucose 105, BUN 18, creatinine 1.01, total protein 6.8, albumin 3.4, total bilirubin 1, alkaline phosphatase 221, AST is 66, ALT is 38.
