A 60 yr old female patient with shortness of breath and anasarca.

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Chief complaints:-

A  60 yr old patient came to the opd with chief complaints of..

 Pedal edema since 3 days.

Decreased urine output since 3 days.

H/o vomitings and loose stools 5 days ago lasted 3 days and subsided.

 History of present illness:- 

Patient was apparently asymptomatic 15 yrs back.. then she developed

She developed....

Shortness of breath;-

  since 15 years..  

10-15 episodes per year and she was taking medication during the episodes ..

 2 months back....

 pneumonitis with Type 1                   Respiratory Failite,

 ? Interstial lung disease, 

? Right heart failure .

 treated with .. 

1. Tab. Augmentin 625 mg ×7 days

2. Tab. Wysolone 40 mg ×10 days.

    30 mg × 10 days 

    20 mg ×10 days

    10 mg ×10 days.

3. Tab . Lasix 20 mg  × 1 month.

4. Pantop 

5. Montek FX   -- 1 month.

6.Oxygen inhalation.

 Presently her complaints are:-  

Pedal edema

since 3 days, which is pitting  type.. which gradually progressed to anasarca.

Decreased urine output..

since 3 days..

There is no h/o  burning micturition.

 

Vomitings

since 5  days , food as content and 2 episodes per day.

Loose motions

5 days ago 5 episodes lasted for 1 day.

There is no complaints of fever, cold and cough.

 In our hospital after admission-

Vitals;-

Bp;- 130/80

PR;-83bpm

RR;- 18

temp;- 97.5 F

Spo2 :- 85% on room air

Personal history:-

Diet:- mixed

Appetite :-normal

Bowel and bladder :-regular

Addictions:- none.

Fever chart:-

on examination:-

CVS:- S1, S 2 present

Respiratory system;- 

BAE  present

Right IMA , IAA  CREPTS .

Investigations:- On 04/06/2021. 

ultrasond abdomen:-

On 6/06/2021

SPO2  80% in oom air

 on 09 /06/2021 

SPO2 84% on room air

Treatment:-

1. IV fluids

2. Tab. Pan 40 mg po OD 

3. Inj. Lasix 80 mg IV BD

4. Thiamin 200 mg in 100 ml NS IV BD

5.Tab. Levocet 5 mg Po BD

6.Liquid paraffin for LIA

7.Grbs 6 th hrly

8.I/o charting, temp. Charting

UPDATES;-

 Investigations on  07 / 06/2021:-

HRCT ;

Investigations on 10/06/2021:-

On 16/062021

PH:- 7.39

Pco2 :-61

Po2 :-51

Hco3- 36.4

Serum creatinine:-3.1

 On 14/06/2021

PH:- 7.34

Pco2:-58

Po2:- 94.1

Hco3-:- 30.8

So2:- 96

Hb:- 10.5

TLC:- 17300

Platelets:- 1.5

Serum creatinine:- 3.9

Serum electrolytes:- Na+ 137, k+ 4.4, cl- 89.

On 15/06/2021.

Review  echo:-RVSP :58

RA/RV/IVC - dialated.

Hb:-  10

TLC:- 8000

Platelets :- 1.53.

On 16/062021

PH:- 7.39

Pco2 :-61

Po2 :-51

Hco3- 36.4

Serum creatinine:-3.1

Fbs:- 82

HbA1c :- 7.5

 

On 20/06/2021.

On 21/06/2021

PH:- 7.45

Pco2:- 39.8

Hco3- 27.3

Po2: 68.7

So2:- 92.7

CUE:- 

albumin + , 

pus cells :3-6, 

epithelial cells : 2-4

Sugar: nil

Spot urine protein: creatinine ratio:- 0.4

Spot protein:- 8

Spot creatinine :20

HbA1c :- 7.5

Fbs:-82

  pco2 trend:-

 Dialysis in our hospital:-

 On 06/06/2021 ,

 On 07/06/2021,

 On 09/06/2021,

On 11/06/2021.

Course in the hospital :-

Patient was admitted with complaining of vomitings loose tools since 5 days followed by pedal Oedema decreased urine output since 3 days chronic history of seasonal SOB since 15 years using inhalers on and off whenever she had SOB 

she is a farmer by occupation and history of analgesic  abuse whenever she has generalised body pains after work she was admitted in government hospital with fever dry cough Two months ago where they have discharged her with diagnosis of ? viral pneumonia ? ILD with right heart failure patient was admitted and necessary investigations were sent patient was found to have Blood urea of 194 Serum creatinine 10.0 .

patient was managed conservatively for one day and the next day patient become irritable, confused so the patient has been taken for dialysis with suspiscion  of ?uremic encephalopathy Patient underwent 2-D Echo Found to have a right heart failure without any left heart failure as evident by her discharge summary two months ago patient is chronically hypoxic which causes Pulmonary vasoconstriction and right heart failure (cor pulmonale)

 HRCT chest was done showing pulmonary oedema after four sessions of haemodialysis her serum creatinine remained static at 3-3.5mg/dl (?analgesic nephropathy) but her hypoxia did not improve so the provisional diagnosis of ?ILD ?allergic hypersensitivity pneumonitis were made no further indication for haemodialysis was present so last date was done on 11 -06-2021 

patient eventually on day three of admission also became hypercapnia ?hyperventilation secondary to obesity so the patient was started on intermittent BiPAP or CPAP 4th hourly her PCO2 was fluctuating between 36-65 mmhg when the patient was on intermittent BiPAP/CPAP on the day of discharge her PCO2 was 48 mmhg patient has been advised for home oxygen support

Discharge summary:-

General Medicine
Unit: 5
Name of Treating Faculty
Dr. Praveen Naik (Associate)
Dr. Hareen (SR)
Dr. Vaishnavi (PGY2)
Dr. Chandana (PGY1)
Dr. Krupa (Intern)
Dr. Nikitha (Intern)
Dr. Tejaswini (Intern)
Dr. Sravani (Intern)

Diagnosis
AKI seconday to ? acute gastroenteritis
?acute gllomerulonephritis
right heart failure (cor pulmonale)
type 2 respiratory failure.

Case History and Clinical Findings

Chief complaints:-A 60 yr old patient came to the opd with chief complaints of..Pedal edema since 3
days.Decreased urine output since 3 days.H/o vomitings and loose stools 5 days ago lasted 3 days
and subsided.History of present illness:-Patient was apparently asymptomatic 15 yrs back.. then she
developedShortness of breath; since 15 years..10-15 episodes per year and she was taking
medication during the episodes ..2 months back....pneumonitis with Type 1 Respiratory Failite,?
Interstial lung disease,
? Right heart failure . 

Presently her complaints are:-Pedal edemasince 3 days, which is pitting type..
which gradually progressed to anasarca.Decreased urine output..since 3 days..There is no h/o
burning micturition.Vomitingssince 5 days , food as content and 2 episodes per day.Loose motions5
days ago 5 episodes lasted for 1 day.There is no complaints of fever, cold and cough.

Vitals;-

Bp;- 130/80

PR;-83bpm

RR;- 18

temp;- 97.5 F

Spo2 :- 85% on room air

Personalhistory:-

Diet:- mixed

Appetite :-normalBowel and bladder :-regular

Addictions:- none

on examination- patient is conscious, coherent and co operative

abdominal examination
- tenderness in right hypochondrium and epigastrium. No palpable mass.
CVSs1
s2 heard, no thrills, no murmurs
Respiratory system-
BAE present, nvbs
CNS - intact


Name Value Range Name Value Range
COMPLETE URINE EXAMINATION (CUE) 04-06-2021 03:55:PM
COLOUR Pale yellow
APPEARANCE Clear
REACTION Acidic
SP.GRAVITY 1.010
ALBUMIN ++
SUGAR Nil
BILE SALTS Nil
BILE PIGMENTS Nil
PUS CELLS 4-5
EPITHELIAL CELLS 2-3
RED BLOOD CELLS 3-4
CRYSTALS Nil
CASTS Nil
AMORPHOUS
DEPOSITS
Absent
OTHERS Nil
BLOOD UREA 04-
06-2021 03:55:PM
194 mg/dl 42-12 mg/dl
SERUM
CREATININE 04-06-
2021 03:55:PM
10.0 mg/dl 1.1-0.6 mg/dl SERUM ELECTROLYTES (Na, K, C l) 04-06-2021 03:55:PM
SODIUM 135 mEq/L 145-136 mEq/L
POTASSIUM 4.3 mEq/L 5.1-3.5 mEq/L
CHLORIDE 84 mEq/L 98-107 mEq/L
Anti HCV Antibodies
- RAPID 04-06-2021
04:01:PM
Non Reactive Kit
Name:Life Band
HBsAg-RAPID 04-
06-2021 04:01:PM
Negative Kit Name:
Abon
LIVER FUNCTION TEST (LFT) 04-06-2021 04:01:PM
Total Bilurubin 1.21 mg/dl 1-0 mg/dl
Direct Bilurubin 0.57 mg/dl 0.2-0.0 mg/dl
SGOT(AST) 48 IU/L 31-0 IU/L
SGPT(ALT) 561 IU/L 34-0 IU/L
ALKALINE
PHOSPHATE
130 IU/L 141-53 IU/L
TOTAL PROTEINS 5.6 gm/dl 8.3-6.4 gm/dl
ALBUMIN 3.4 gm/dl 4.6-3.2 gm/dl
A/G RATIO 1.57
ABG 04-06-2021 06:06:PM
PH 7.26
PCO2 34.8
PO2 79.6
HCO3 15.1
St.HCO3 16.0
BEB -10.7
BEecf -10.5
TCO2 31.2
O2 Sat 90.7
O2 Count 17.0
BLOOD UREA 05-
06-2021 07:48:AM
197 mg/dl 42-12 mg/dl SERUM
CREATININE 05-06-
2021 07:48:AM
10.3 mg/dl 1.1-0.6 mg/dl
 
SARS-COV-2
Qualitative PCR 05-
06-2021 10:50:AM
Negative ABG 06-06-2021 05:57:AM
PH 7.26
PCO2 47.9
PO2 254
HCO3 21.1
St.HCO3 20.0
BEB -5.4
BEecf -4.7
TCO2 43.8
O2 Sat 98.2
O2 Count 17.9
RFT 06-06-2021 05:57:AM
UREA 136 mg/dl 42-12 mg/dl
CREATININE 8.2 mg/dl 1.1-0.6 mg/dl
URIC ACID 11.0 mg/dl 6-2.6 mg/dl
CALCIUM 8.0 mg/dl 10.2-8.6 mg/dl
PHOSPHOROUS 10.3 mg/dl 4.5-2.5 mg/dl
SODIUM 138 mEq/L 145-136 mEq/L
POTASSIUM 4.4 mEq/L 5.1-3.5 mEq/L
CHLORIDE 90 mEq/L 98-107 mEq/L
COMPLETE BLOOD PICTURE (CBP) 06-06-2021 05:57:AM
HAEMOGLOBIN 12.4 gm/dl 15.0-12.0 gm/dl
TOTAL COUNT 10200 cells/cumm 10000-4000
cells/cumm
NEUTROPHILS 87 % 80-40 %
LYMPHOCYTES 06 % 40-20 %
EOSINOPHILS 03 % 6-1 %
MONOCYTES 04 % 10-2 %
BASOPHILS 00 % 2-0 %
PLATELET COUNT 1.10
SMEAR Normocytic
normochromic with
neutrophilia and
thrambocytopenia
COMPLETE BLOOD PICTURE (CBP) 06-06-2021 11:49:PM
HAEMOGLOBIN 12.8 gm/dl 15.0-12.0 gm/dl
TOTAL COUNT 9300 cells/cumm 10000-4000
cells/cumm
NEUTROPHILS 68 % 80-40 %
LYMPHOCYTES 22 % 40-20 %
EOSINOPHILS 03 % 6-1 %
MONOCYTES 07 % 10-2 %
BASOPHILS 00 % 2-0 %
PLATELET COUNT 1.40
SMEAR Normocytic
normochromic mild
thrombocytopenia
ABG 06-06-2021 11:49:PM
PH 7.38
PCO2 34.3
PO2 132
HCO3 19.9
St.HCO3 21.2
BEB -3.9
BEecf -4.3
TCO2 39.0
O2 Sat 97.6
O2 Count 20.2
  

RFT 06-06-2021 11:49:PM
UREA 146 mg/dl 42-12 mg/dl
CREATININE 8.7 mg/dl 1.1-0.6 mg/dl
URIC ACID 11.5 mg/dl 6-2.6 mg/dl
CALCIUM 8.7 mg/dl 10.2-8.6 mg/dl
PHOSPHOROUS 9.7 mg/dl 4.5-2.5 mg/dl
SODIUM 135 mEq/L 145-136 mEq/L
POTASSIUM 4.2 mEq/L 5.1-3.5 mEq/L
CHLORIDE 84 mEq/L 98-107 mEq/L
ABG 07-06-2021 06:14:PM
PH 7.33
PCO2 50.1
PO2 77.8
HCO3 25.8
St.HCO3 24.3
BEB -0.0
BEecf 0.6
TCO2 53.2
O2 Sat 91.9
O2 Count 15.5
RFT 07-06-2021 06:14:PM
UREA 58 mg/dl 42-12 mg/dl
CREATININE 4.2 mg/dl 1.1-0.6 mg/dl
URIC ACID 4.8 mg/dl 6-2.6 mg/dl
CALCIUM 9.1 mg/dl 10.2-8.6 mg/dl
PHOSPHOROUS 5.2 mg/dl 4.5-2.5 mg/dl
SODIUM 141 mEq/L 145-136 mEq/L
POTASSIUM 4.3 mEq/L 5.1-3.5 mEq/L
CHLORIDE 90 mEq/L 98-107 mEq/L
COMPLETE BLOOD PICTURE (CBP) 08-06-2021 06:30:AM
HAEMOGLOBIN 12.1 gm/dl 15.0-12.0 gm/dl
TOTAL COUNT 7600 cells/cumm 10000-4000
cells/cumm
NEUTROPHILS 60 % 80-40 %
LYMPHOCYTES 33 % 40-20 %
EOSINOPHILS 03 % 6-1 %
MONOCYTES 04 % 10-2 %
BASOPHILS 00 % 2-0 %
PLATELET COUNT 1.65 Lakhs/cu.mm
SMEAR NORMOCYTIC/NORM
OCHROMIC
RFT 08-06-2021 06:30:AM
UREA 67 mg/dl 42-12 mg/dl
CREATININE 5.1 mg/dl 1.1-0.6 mg/dl
URIC ACID 6.2 mg/dl 6-2.6 mg/dl
CALCIUM 8.7 mg/dl 10.2-8.6 mg/dl
PHOSPHOROUS 4.6 mg/dl 4.5-2.5 mg/dl
SODIUM 135 mEq/L 145-136 mEq/L
POTASSIUM 4.0 mEq/L 5.1-3.5 mEq/L
CHLORIDE 99 mEq/L 98-107 mEq/L
ABG 08-06-2021 05:33:PM
PH 7.28
PCO2 60.7
PO2 136
HCO3 28.1
St.HCO3 25.1
BEB 0.9
BEecf 2.1
TCO2 58.6
O2 Sat 96.8
O2 Count 16.1
ABG 08-06-2021 09:26:PM
PH 7.28
PCO2 61.4
PO2 127
HCO3 27.9
St.HCO3 25.0
BEB 0.7
BEecf 1.8
TCO2 58.9
O2 Sat 97.3
O2 Count 15.1
ABG 09-06-2021 02:20:PM
PH 7.33
PCO2 52.5
PO2 73.5
HCO3 27.1
St.HCO3 25.4
BEB 1.2
BEecf 1.8
TCO2 57.0
O2 Sat 92.4
O2 Count 13.

ABG 09-06-2021 03:02:PM
PH 7.28
PCO2 61.4
PO2 60
HCO3 27.9
St.HCO3 25.0
BEB 0.7
BEecf 1.8
TCO2 58.9
O2 Sat 70
O2 Count 15.1
COMPLETE BLOOD PICTURE (CBP) 10-06-2021 05:38:AM
HAEMOGLOBIN 10.8 gm/dl 15.0-12.0 gm/dl
TOTAL COUNT 6900 cells/cumm 10000-4000
cells/cumm
NEUTROPHILS 61 % 80-40 %
LYMPHOCYTES 30 % 40-20 %
EOSINOPHILS 05 % 6-1 %
MONOCYTES 04 % 10-2 %
BASOPHILS 00 % 2-0 %
PLATELET COUNT 1.57
SMEAR microcytic
hypochromic
ABG 10-06-2021 05:38:AM
PH 7.25
PCO2 60.4
PO2 136
HCO3 26.2
St.HCO3 23.6
BEB -1.0
BEecf -0.1
TCO2 56.5
O2 Sat 97.3
O2 Count 13.2
RFT 10-06-2021 05:38:AM
UREA 55 mg/dl 42-12 mg/dl
CREATININE 4.8 mg/dl 1.1-0.6 mg/dl
URIC ACID 6.3 mg/dl 6-2.6 mg/dl
CALCIUM 8.9 mg/dl 10.2-8.6 mg/dl
PHOSPHOROUS 5.8 mg/dl 4.5-2.5 mg/dl
SODIUM 133 mEq/L 145-136 mEq/L
POTASSIUM 4.4 mEq/L 5.1-3.5 mEq/L
CHLORIDE 92 mEq/L 98-107 mEq/L
COMPLETE URINE EXAMINATION (CUE) 10-06-2021 07:34:PM
COLOUR Pale yellow
APPEARANCE Clear
REACTION Acidic
SP.GRAVITY 1.010
ALBUMIN ++
SUGAR Nil
BILE SALTS Nil
BILE PIGMENTS Nil
PUS CELLS 4-5
EPITHELIAL CELLS 2-3
RED BLOOD CELLS Nil
CRYSTALS Nil
CASTS Nil
AMORPHOUS
DEPOSITS
Absent
OTHERS Nil
ABG 11-06-2021 05:35:AM
PH 7.29
PCO2 65.3
PO2 93.3
HCO3 31.0
St.HCO3 27.7
BEB 3.7
BEecf 5.0
TCO2 65.4
O2 Sat 95.7
O2 Count 14

RFT 11-06-2021 05:35:AM
UREA 67 mg/dl 42-12 mg/dl
CREATININE 5.5 mg/dl 1.1-0.6 mg/dl
URIC ACID 7.0 mg/dl 6-2.6 mg/dl
CALCIUM 9.1 mg/dl 10.2-8.6 mg/dl
PHOSPHOROUS 5.7 mg/dl 4.5-2.5 mg/dl
SODIUM 136 mEq/L 145-136 mEq/L
POTASSIUM 3.9 mEq/L 5.1-3.5 mEq/L
CHLORIDE 92 mEq/L 98-107 mEq/L
ABG 12-06-2021 05:49:AM
PH 7.32
PCO2 29.9
PO2 82.8
HCO3 30.4
St.HCO3 27.9
BEB 3.9
BEecf 4.7
TCO2 64.7
O2 Sat 96.0
O2 Count 12.6
BLOOD UREA 12-
06-2021 05:49:AM
55 mg/dl 42-12 mg/dl SERUM
CREATININE 12-06-
2021 05:49:AM
4.0 mg/dl 1.1-0.6 mg/dl
SERUM ELECTROLYTES (Na, K, C l) 12-06-2021 05:49:AM
SODIUM 134 mEq/L 145-136 mEq/L
POTASSIUM 4.2 mEq/L 5.1-3.5 mEq/L
CHLORIDE 92 mEq/L 98-107 mEq/L
BLOOD UREA 13-
06-2021 06:41:AM
64 mg/dl 42-12 mg/dl
SERUM
CREATININE 13-06-
2021 06:41:AM
3.9 mg/dl 1.1-0.6 mg/dl SERUM ELECTROLYTES (Na, K, C l) 13-06-2021 06:41:AM
SODIUM 136 mEq/L 145-136 mEq/L
POTASSIUM 3.8 mEq/L 5.1-3.5 mEq/L
CHLORIDE 91 mEq/L 98-107 mEq/L
ABG 14-06-2021 07:01:AM
PH 7.34
PCO2 58.0
PO2 94.1
HCO3 30.8
St.HCO3 28.6
BEB 4.7
BEecf 5.4
TCO2 65.2
O2 Sat 96.9
O2 Count 13.1
BLOOD UREA 14-
06-2021 07:01:AM
90 mg/dl 42-12 mg/dl
SERUM
CREATININE 14-06-
2021 07:01:AM
3.9 mg/dl 1.1-0.6 mg/dl SERUM ELECTROLYTES (Na, K, C l) 14-06-2021 07:01:AM
SODIUM 137 mEq/L 145-136 mEq/L
POTASSIUM 4.4 mEq/L 5.1-3.5 mEq/L
CHLORIDE 89 mEq/L 98-107 mEq/L


COMPLETE BLOOD PICTURE (CBP) 14-06-2021 07:01:AM
HAEMOGLOBIN 10.5 gm/dl 15.0-12.0 gm/dl
TOTAL COUNT 17300 cells/cumm 10000-4000
cells/cumm
NEUTROPHILS 78 % 80-40 %
LYMPHOCYTES 12 % 40-20 %
EOSINOPHILS 03 % 6-1 %
MONOCYTES 07 % 10-2 %
BASOPHILS 00 % 2-0 %
PLATELET COUNT 1.50 Lakhs/cu.mm
SMEAR NORMOCYTIC/NORM
OCHROMIC WITH
LEUCOCYTOSIS.
COMPLETE BLOOD PICTURE (CBP) 14-06-2021 09:23:PM
HAEMOGLOBIN 10.0 gm/dl 15.0-12.0 gm/dl
TOTAL COUNT 8000 cells/cumm 10000-4000
cells/cumm
NEUTROPHILS 58 % 80-40 %
LYMPHOCYTES 32 % 40-20 %
EOSINOPHILS 05 % 6-1 %
MONOCYTES 05 % 10-2 %
BASOPHILS 00 % 2-0 %
PLATELET COUNT 1.53
SMEAR Normocytic
normochromic anemia
ABG 14-06-2021 09:23:PM
PH 7.29
PCO2 59.2
PO2 104
HCO3 27.6
St.HCO3 25.3
BEB 1.0
BEecf 1.6
TCO2 59.9
O2 Sat 96.2
O2 Count 11.3
RFT 14-06-2021 09:23:PM
UREA 51 mg/dl 42-12 mg/dl
CREATININE 3.6 mg/dl 1.1-0.6 mg/dl
SODIUM 137 mEq/L 145-136 mEq/L
POTASSIUM 4.3 mEq/L 5.1-3.5 mEq/L
CHLORIDE 95 mEq/L 98-107 mEq/L
ABG 15-06-2021 04:19:PM
PH 7.38
PCO2 66.3
PO2 57.2
HCO3 39.0
St.HCO3 35.4
BEB 11.9
BEecf 13.4
TCO2 80.1
O2 Sat 83.0
O2 Count 13.4
BLOOD UREA 15-
06-2021 04:19:PM
67 mg/dl 42-12 mg/dl
SERUM
CREATININE 15-06-
2021 04:19:PM
3.4 mg/dl 1.1-0.6 mg/dl SERUM ELECTROLYTES (Na, K, C l) 15-06-2021 04:19:PM
SODIUM 137 mEq/L 145-136 mEq/L
POTASSIUM 4.4 mEq/L 5.1-3.5 mEq/L
CHLORIDE 92 mEq/L 98-107 mEq/L
 

COMPLETE URINE EXAMINATION (CUE) 15-06-2021 04:19:PM
COLOUR Pale yellow
APPEARANCE Clear
REACTION Acidic
SP.GRAVITY 1.010
ALBUMIN +
SUGAR Nil
BILE SALTS Nil
BILE PIGMENTS Nil
PUS CELLS 3-6
EPITHELIAL CELLS 2-4
RED BLOOD CELLS Nil
CRYSTALS Nil
CASTS Nil
AMORPHOUS
DEPOSITS
Absent
OTHERS Nil
ABG 17-06-2021 05:50:AM
PH 7.21
PCO2 68.4
PO2 79.7
HCO3 26.8
St.HCO3 23.1
BEB -1.5
BEecf -0.1
TCO2 58.0
O2 Sat 93.7
O2 Count 13.6
BLOOD UREA 17-06-2021 05:50:AM
Blood Urea 70 mg/dl 42-12 mg/dl
Blood Urea 70 mg/dl 42-12 mg/dl
Blood Urea 70 mg/dl 42-12 mg/dl
SERUM
CREATININE 17-06-
2021 05:50:AM
3.7 mg/dl 1.1-0.6 mg/dl
SERUM ELECTROLYTES (Na, K, C l) 17-06-2021 05:50:AM
SODIUM 139 mEq/L 145-136 mEq/L
POTASSIUM 4.4 mEq/L 5.1-3.5 mEq/L
CHLORIDE 92 mEq/L 98-107 mEq/L
ABG 18-06-2021 06:50:AM
PH 7.39
PCO2 61.0
PO2 51.2
HCO3 36.4
St.HCO3 33.3
BEB 9.8
BEecf 11.1
TCO2 74.0
O2 Sat 85.7
O2 Count 14.5
BLOOD UREA 18-
06-2021 06:50:AM
71 mg/dl 42-12 mg/dl SERUM
CREATININE 18-06-
2021 06:50:AM
3.1 mg/dl 1.1-0.6 mg/dl
SERUM ELECTROLYTES (Na, K, C l) 18-06-2021 06:50:AM
SODIUM 140 mEq/L 145-136 mEq/L
POTASSIUM 4.4 mEq/L 5.1-3.5 mEq/L
CHLORIDE 91 mEq/L 98-107 mEq/L
POST LUNCH
BLOOD SUGAR 18-
06-2021 03:45:PM
113 mg/dl 140-0 mg/dl

ABG 19-06-2021 07:43:AM
PH 7.45
PCO2 39.8
PO2 68.7
HCO3 27.3
St.HCO3 27.5
BEB 3.6
BEecf 3.5
TCO2 54.7
O2 Sat 92.7
O2 Count 16.0
BLOOD UREA 19-
06-2021 07:43:AM
82 mg/dl 42-12 mg/dl
SERUM
CREATININE 19-06-
2021 07:43:AM
3.1 mg/dl 1.1-0.6 mg/dl SERUM ELECTROLYTES (Na, K, C l) 19-06-2021 07:43:AM
SODIUM 137 mEq/L 145-136 mEq/L
POTASSIUM 4.3 mEq/L 5.1-3.5 mEq/L
CHLORIDE 95 mEq/L 98-107 mEq/L
ABG 19-06-2021 08:21:PM
PH 7.34
PCO2 47.4
PO2 96.2
HCO3 31.2
St.HCO3 30.1
BEB 6.3
BEecf 6.8
TCO2 61.9
O2 Sat 95.1
O2 Count 17.4
ABG 21-06-2021 08:02:AM
PH 7.41
PCO2 44.4
PO2 40.6
HCO3 27.9
St.HCO3 26.9
BEB 3.3
BEecf 3.6
TCO2 57.7
O2 Sat 71.8
O2 Count 10.7
ABG 22-06-2021 06:58:AM
PH 7.42
PCO2 49.2
PO2 57.7
HCO3 32.0
St.HCO3 30.0
BEB 6.5
BEecf 7.5
TCO2 60.6
O2 Sat 86.3
O2 Count 19.9

Treatment Given(Enter only Generic Name)
1) oral fluids upto 2L /day
2) IV fluids NS(10) RL(10) @100ML/HR
3) Inj. PAN 40mg iv OD
4) Inj. Lasix iv bd 80mg
5) Intermittent BIPAP 4th hrly
6) Nebulisation with duolin- 8 hrly, budecort 
7) tab. fluconazole 150mg po od
8) tab. Ultracet 1/2 tab qid
9) Inj. thiamine 200mg iv bd
10) syp. cremaffin 15ml po
11) inj. ceftriaxone 1gm po bd
12) tab. dolo 650 mg po sos
13) tab. levocet 5mg po bd
14) Oint. thrombophobe f
15) GRBS 8 hrly
16) 4 sessions of hemodialysis
1. on 05/06/2021
2.07/06/2021
3. 99/06/2021
4.11/06/2021
Advice at Discharge
1) Oral fluids upto 2L
2) TAB. PAN 40MG po od
3) tab. lasix 80mg bd
4) home oxygen support
When to Obtain Urgent Care
IN CASE OF ANY EMERGENCY IMMEDIATELY CONTACT YOUR CONSULTANT DOCTOR OR
ATTEND EMERGENCY DEPARTMENT.
Preventive Care
AVOID SELF MEDICATION WITHOUT DOCTORS ADVICE,DONOT MISS MEDICATIONS. In case
of Emergency or to speak to your treating FACULTY or For Appointments, Please Contact:
08682279999 For Treatment Enquiries Patient/Attendent Declaration : - The medicines prescribed
and the advice regarding preventive aspects of care ,when and how to obtain urgent care have been
explained to me in my own language.
SIGNATURE OF PATIENT /ATTENDER
SIGNATURE OF PG/INTERNEE
SIGNATURE OF ADMINISTRATOR
SIGNATURE OF