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Course in the ward

Course in the ward. Day 1 (01-26-10). Patient was hydrated and placed under diet 1800 kcal/day, 270g CHO, 15g CHON, 25g fats divided into 3 meals and 2 snacks. CBC with platelet count: WBC of 35.5 predominantly neutrophils . Urinalysis

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Course in the ward

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  1. Course in the ward

  2. Day 1 (01-26-10) • Patient was hydrated and placed under diet • 1800 kcal/day, 270g CHO, 15g CHON, 25g fats divided into 3 meals and 2 snacks. • CBC with platelet count: • WBC of 35.5 predominantly neutrophils. • Urinalysis • Yellow, slightly turbid, pH 6.5 sp gr 1.005, albumin (-), sugar (-), RBC 0-2/hpf, pus cell 8-12/hpf and bacteria +++.

  3. Day 1 (01-26-10) • Chest X-ray showed that there is confluent density over the L paracardiac area, which in lateral view is posterior in location and may represent a pulmonary mass to rule out a pneumonic consolidation, with ill-defined densities over the RUL with bleb formation.   • Spot sputum AFB stain showed no acid fast bacilli • Urine GS/CS and Blood C/S were also requested • Ceftriaxone (2g/IV OD) and Paracetamol (500mg/tab, 1 tab q4h prn) were both started

  4. Day 2 (01-27-10) • Spot sputum AFB stain still showed no acid fast bacilli. • Urine culture showed no growth after 2 days incubation. • There were still episodes of fever and cough, with no dysuria • Crackles were heard bilaterally on both lung fields • Ceftriaxone was continued and Erdosteine(300mg/cap, 1 cap BID) was started.

  5. Day 2 (01-27-10) • Serum sodium and potassium levels were requested • Hyponatremia and hypokalemia • Kaliumdurule, 2 durules TID x 6 doses was given and hydration with PNSS was continued. • A repeat CBC showed WBC of 11.80. (35.5 in Day 1) • FBS was also requested showing normal value.

  6. Day 3 (01-28-10) • Spot sputum AFB stain still showed no acid fast bacilli. • Patient was referred to DOTS for further evaluation and management. • Patient was afebrile, with stable vital signs, no dysuria but still has cough and (+) bilateral crackles • Ceftriaxonewas shifted to Cefixime 200mg/cap, 1 cap BID for 5 days (until Feb 1, 2010) • Patient had stable vital signs. The rest of the hospital stay was unremarkable. Patient was then discharged improved and stable.

  7. Discharge Medications: • Cefixime200mg/cap, 1 cap BID for 5 days (until Feb 1, 2010) • Special Instructions • Refer back to DOTS with X-ray and sputum AFB results as outpatient, increase oral fluid intake • Follow-up or Transfer Instruction • To come back at Med OPD on Feb 11, 2010 (Thurs, 8am) with DOTS referral.

  8. Laboratory Results

  9. CBC

  10. Abnormal Findings

  11. Blood Chemistry

  12. Urinalysis

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