Case #3:
Discharge Summary
Discharge Information
Discharge Summary Information
Admitted 8/14/2005.
Discharged 8/21/2005.
Admitting diagnosis: hyponatremia.
Discharge diagnosis: Discharge diagnosis:
All Problems
hyponatremia.
Physical Examination
Narrative
Gen: NAD, A&Ox3
HEENT: OP clear and moist
neck: no thyroid nodules, no JVD
Heart :RRR, no murmurs, gallops
Lungs: CTAB
Abd: soft, ntnd, +bs
extr: no le edema, good dp pulses b/l
neuro: 5/5 strenght b/l, gait is normal. .
Results Review
General results
Today's results : ALL RESULT SECTIONS(Date Range: 08/20/05 00:00 - 08/27/05 00:00)
08/21/05 04:00
White Cell Count
11.1 K/UL High
Red Cell Count
3.33 M/UL LOW
Hemoglobin
10.5 GM/DL LOW
Hematocrit
29.4 % LOW
MCV
88 FL
MCH
31.6 pg
MCHC
35.8 % High
RDW
18.7
High
Platelet Count
478 K/UL High
Differential Type
AUTO
Neutrophils
69 %
Eosinophils
1 %
Basophils
0 %
Lymphocytes
22 %
Monocytes
8 %
Absolute Neutrophils
7.7 K/UL
Absolute Eosinophils
0.1 K/UL
Absolute Basophils
0.0 K/UL
Absolute Lymphocytes
2.4 K/UL
Absolute Monocytes
0.9 K/UL
Sodium
127 mEq/L LOW
Potassium
3.0 mEq/L LOW
Chloride
99 mEq/L
Bicarbonate
18 mEq/L LOW
Blood Urea Nitrogen
36 mg/dL High
Creatinine
1.6 mg/dL
GFR (non-African Amer)
37
LOW
GFR (African American)
45
LOW
Glucose Level
81 mg/dL
Calcium
8.2 mg/dL LOW
Magnesium
1.8 mg/dL
Phosphorus
5.3 mg/dL High
Hospital Course
Hospital Course
Pt was admitted originally for hyponatremia workup. Pt originally came to ER with abd pain, severe n/v, fever,
concerned for SBO, admitted for hyponatremia and confusion. Na on admission was 109. Pt was started on
IVF at 75 cc/hr and her Na improved, along with BUN/Cr. when she was transferred to the floor, her Na
was 127. The pt was then fluid restricted since her Una > 20 and FeNa was 3%, serum osm were low,
Uosm>100. The pt's hyponatremia began to worsen again. She was also noted to be losing HCO3 and Cr
began to rise again. The pt was also noted to be "craving" baking soda without a clear reason. Na
worsened to 112, HCO3 to 11, Cr to 1.6. Urine lytes still appeared to be SIADH picture. On further
questioning, the pt was noted to have SPK transplant, where her pancreas was connected to her bladder.
On repeat UA, her urine pH was 9.0, UAG was +60's. It was concluded that she was losing HCO3 through
her urine. She was started on fluids and renal was called for help managing her fluid resuscitation. With
fluid & HCO3 repletion, the pt's Na returned to normal. During the admission, the pt was noted to have a
CDiff infection. 3 day course of flagyl started. Pt was discharged to follow up with her PMD.
Discharge Plan
Discharge Summary Plan
Discharge Status: improved.
Discharge Disposition: discharge to home.
Prescriptions: Prednisone 5 mg qD
Dilaudid 0.5 mg IV q3hrs PRN
Prevacid 30 qD
Fentanyl patch
Haldol 5 q6 PRN
Nicotine patch
Ativan 2 mg q4hrs pRN
Prograff 2 AM, 1 PM
Remeron 30 mg qHS
Ritalin 10 mg q6hrs
Cardizem 180 mg qD
Lovenox 40 mg SC qd
Cozaar 100 mg qD
Cellcept 750 mg BID
PO baking soda daily
Flagyl 500 tid. .
Patient Instruction: please f/u with PMD at west suburban.
please f/u with transplant surgeons.