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 – Yellow, slightly turbid, pH 6.5 sp gr 1.005, albumin (-), sugar (-), RBC 0-2/hpf, pus cell 8-12/hpf and bacteria +++. Day 1 (01-26-10) • Chest X-ray was requested • Spot sputum AFB stain showed no acid fast bacilli • Ceftriaxone (2g/IV OD) and Paracetamol (500mg/tab, 1 tab q4h prn) were both started Day 2 (01-27-10) • Spot sputum AFB stain still showed no acid fast bacilli. • Urine and blood specimen were taken for urine GS/CS and Blood Culture. • 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. Day 2 (01-27-10) • Serum sodium and potassium levels were requested – Hyponatremia and hypokalemia • Kalium durule, 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. 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 • Ceftriaxone was 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. • Discharge Medications: – Cefixime 200mg/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. LABORATORY RESULTS CBC Date Hgb (NV: 120-170 g/dl) RBC (NV: 3.8-5.5x106/µL ) Hct (NV: 0.37-0.54) MCV (NV: 78-101 fL) MCH (NV: 27-31 pg) MCHC (NV: 32-36 g/dl) RDW (NV: 11.6-14.6) MPV (NV: 7.4-10.4 fL) Plt (NV: 150-450x109/L WBC (NV: 4.5-10x109/L Neutro (NV: 0.5-0.9) Bands (NV: 0-0.05) Segmenters (NV: 0.5-0.7) Lym (NV: 0.20-0.40) Mono (NV: 0-0.07) Eos (NV: 0-0.01) Baso (NV: 0-0.01) Jan 26 2010 127 4.41 0.37 84.3 28.9 34.3 12.6 5.5 320 35.5 0.92 0.09 0.83 0.08 - Jan 28 2010 113 3.98 0.33 83.7 28.3 33.8 12.9 5.3 298 11.8 0.63 0.63 0.34 0.02 0.01 - Abnormal Findings Hgb (NV: 120-170 g/dl) Hct (NV: 0.37-0.54) WBC (NV: 4.5-10x109/L) Neutro (NV: 0.5-0.9) Segmenters (NV: 0.5-0.7) Jan 26 2010 127 Jan 28 2010 113 0.37 35.5 0.33 11.8 0.92 0.83 0.63 0.63 Blood Chemistry Date Jan 27, 2010 (Day 2) Sodium (NV: 137-147 mmol/L) 133 Potassium (NV: 3.8-5 mmol/L) 3.3 FBS (NV: <100mg/dl) 87 Urinalysis Date Color Transparency pH Specific Gravity Albumin Sugar Hyaline casts RBC Pus cell Squamous cell Bacteria Jan 26 2010 Yellow Turbid 6.5 1.005 Negative Negative 0-2/coverslip 0-2/hpf 8-12/hpf ++ +++ Urine GS/CS • Urine culture showed no growth after 2 days of incubation • Urine gram stain showed no findings on centrifuged and on uncentrifuged urine. Blood Culture • Blood culture showed no growth after 5 days of incubation.