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Blood Chemistry * BUN (29.4 mg/dL) - ↑ Creatinine (1.8 mg/dL) - ↑ Hyponatremia (134 meq/L)

Lots of inconcistencies on dates. Best to check for consistency when the whole presentation has been compiled. Ward Management (1 st hospitalization day):. Blood Chemistry * BUN (29.4 mg/dL) - ↑ Creatinine (1.8 mg/dL) - ↑ Hyponatremia (134 meq/L) Hypokalemia (3.3 meq/L)

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Blood Chemistry * BUN (29.4 mg/dL) - ↑ Creatinine (1.8 mg/dL) - ↑ Hyponatremia (134 meq/L)

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  1. Lots of inconcistencies on dates. Best to check for consistency when the whole presentation has been compiled.

  2. Ward Management (1st hospitalization day): • Blood Chemistry* • BUN (29.4 mg/dL) - ↑ • Creatinine (1.8 mg/dL) - ↑ • Hyponatremia (134 meq/L) • Hypokalemia (3.3 meq/L) • Hypocalcemia (1.06 anong units ito? pero siguradong hypo siya kahit ano pa units) • Normal nga ba ang PT at aPTT niya noong September 18, 2009? (See tables at end of this section.) • CXR*: subsegmental atelectasis of the left lobe. *For all items with an asterisk: state why this test is indicated in this case. Kung routine yung test, sabihin ang findings expected kung leptospirosis. **For all items with two asterisks (subsequent slides), state why this treatment is indicated in this case. ↑↓

  3. Ward Management (1st hospitalization day): • IV Fluids**: pNSS • Antibiotics • Ceftriaxone IV antibiotic, 2 g, IV OD • (bakit ceftriaxone? ano na ba ang working diagnosis at this point?) • Analgesics • Paracetamol 500 mg/tab q4h • Tramadol HCl 37.5 mg + Paracetamol 325 mg (Dolcet) tablet TID as needed  pwede ba to • Diet** • Renal diet with 35 kcal/kg/day, 60% HBV what’s this divided into 3 meals & 2 snacks • MAT  what’s this • Confirmed leptospirosis • Ceftriaxone replaced with penicillin G 1.5 M u q6h

  4. Ward Management (1st hospitalization day): Behavioral Changes Uremic Encephalopathy? Not suggestive of Uremic Encephalopathy Nephrology Referral: Dialysis TCVS Referral for IJC insertion: 12 Lead ECG BUN, Creatinine, PT, aPTT Aseptic Meningitis? Neurology Referral: Acute Confusional State Sinus rhythm with left axis deviation and non-specific ST-T wave Changes Continue Ward Management

  5. Ward Management (2nd hospitalization day): • Clinical • No more behavioral abnormalities • Neurologic exam unremarkable • no meningeal or increased ICP signs • No signs of uremia • Laboratory • Creatinine improving (1.6) – but still ↑ • Medications • For laboratory abnormalities found on the 1st day of admission • CaCO3 500 mg tab, 1 tab between meals • Kalium durule, 1 durule TID x 2 days

  6. Ward Management (4th hospitalization day): • Clinical • Afebrile • No behavioral changes • Laboratory • BUN (21.3) – normal • Creatinine improved further – but still slightly ↑ (1.3) • Normonatremia (142) • Normokalemia (4.7) • Medications: • Penicillin G was then shifted to Amoxicillin 500 mg/cap 1 cap QID.

  7. CBC, Differential count and Anti HAV IgM(9/16/09)

  8. Urinalysis

  9. Blood Chemistry Panel

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