PATIENT CAME WITH C/O LOWER BACK ACHE SINCE 3 WEEKS RADIATING TO LEFT LOWER LIMB

Case history and clinical findings:

 PATIENT CAME WITH C/O LOWER BACK ACHE SINCE 3 WEEKS RADIATING TO LEFT LOWER LIMB

HOPI:PATIENT WAS APPARENTLY ASYMPTOMATIOC 3 WEEKS BACK SINCE THEN, PATIENT COMPLAINTS OF LOWER BACK ACHE WHICH IS SUDDEN ONSET,NON PROGRESSIVE,AGRAVATES ON MOVEMENT RELEIVES ON REST H/O TRAUMA(SLIP AND FALL FROM STEPS) 3 WEEKS BACK ,WAS TAKEN TO OUTSIDE HOSPITAL FOUND TO HAVE L5 BURST FRACTURE ON CT PELVIS AND CAME HERE FOR FURTHER MANAGEMENT

NO H/O LIFTING OF HEAVY WEIGHTS,FEVER BURNING MICTURITION BOWEL AND BLADDER INCONTINENCE

PAST HISTORY OF RIGHT PROXIMAL FEMUR FRACTURE AND DONE IMILN 10 YEARS BACK

H/O PTCA DONE ONE AND HALF YEAR BACK AND IS ON REGULAR MEDICATION

K/C/O DM II SINCE 20 YEARS AND IS ON T. METFORMIN 500 MG + T. VOGLIBOSE 0.2 MG + T. GLIMIPERIDE 2 MG


GENERAL EXAMINATION:  

PATIENT IS CONSCIOUS,COHERENT AND CO OPERATIVE NO SIGNS OF PALLOR,ICTERUS,CLUBBING,CYANOSIS,EDEMA AND LYMPHADENOPATHY

VITALS: TEMP:AFEBRILE

 BP: 110/80MMHG

 PR:80BPM

 RR:18CPM 

SYSTEMIC EXAMINATION:

 CVS: S1,S2+; NO MURMURS

 CNS:NAD 

RS:NVBS + 

P/A : SOFT,NON TENDER 

B/L OF LS SPINE: 

SKIN: NORMAL 

SWELLING: ABSENT

 TENDERNESS: PRESENT AT LUMBAR REGION

TRACHEOSTOMY WAS DONE ON 6/9/23

 BLOOD TRANSFUSION WAS DONE ON 12/9/23


PULMONOLOGY REFERRAL WAS DONE ON 30/8/23 AND ADVISED FOR CT CHEST AND INDUCED SPUTUM FOR CBNAAT AND CULTURE SENSITIVITY 

NEPHROLOGY REFERRAL WAS DONE ON 2/9/23 AND ADVISED FOR HAEMODIALYSIS 

PULMONOLOGY REFERRAL WAS DONE ON 2/9/23 AND ADVISED FOR USG GUIDED TAP AND ICD PLACEMENT

 SURGERY REFERRAL WAS DONE 4/9/23 AND ADVISED FOR ASEPTIC DRESSINGS, CHANGE OF POSITION 4 HOURLY AND ALPHA BED SURGERY REFERRAL WAS DONE 6/9/23 AND ADVISED FOR ASEPTIC DRESSINGS, CHANGE OF POSITION 2 HOURLY AND ALPHA BED 


PROVISIONAL DIAGNOSIS:

 HEART FAILURE WITH MID RANGE EJECTION FRACTION( EF 44%) WITH RIGHT LOWER LOBE COLLAPSE WITH BRONCHIECTASIS WITH RIGHT MIDDLE LOBE PLEURAL EFUSION WITH CHRONIC PANCREATITIS WITH SEPSIS WITH GRADE 2 BED SORE WITH K/C/O DM II SINCE 20 YEARS WITH K/C/O CAD-S/P: PTCA DONE 2 YEARS AGO

 D9-S/P: TRACHEOSTOMY


Investigation 

RFT 29-08-2023 01:11:PM

UREA 77 mg/dl 42-12 mg/dl

 CREATININE 1.1 mg/dl 1.3-0.9 mg/dl 

URIC ACID 2.9 mg/dl 7.2-3.5 mg/dl 

CALCIUM 8.8 mg/dl 10.2-8.6 mg/dl 

PHOSPHOROUS4.8 mg/dl 4.5-2.5 mg/dl 

SODIUM 121 mEq/L 145-136 mEq/L 

POTASSIUM 4.6 mEq/L 5.1-3.5 mEq/L 

CHLORIDE 95 mEq/L 98-107 mEq/L 

LIVER FUNCTION TEST (LFT) 29-08-2023 01:11:PM

Total Bilurubin 0.76 mg/dl 1-0 mg/dl 

Direct Bilurubin 0.19 mg/dl 0.2-0.0 mg/dl 

SGOT(AST) 11 IU/L 35-0 IU/L 

SGPT(ALT) 13 IU/L 45-0 IU/L 

ALKALINE PHOSPHATE 321 IU/L 128-53 IU/L

 TOTAL PROTEINS 5.0 gm/dl 8.3-6.4 gm/dl 

ALBUMIN 2.59 gm/dl 5.2-3.5 gm/dl 

A/G RATIO 1.02 

HBsAg-RAPID29-08-2023 01:11:PM

Negative Anti HCV Antibodies - RAPID29-08-2023 01:11:PM

 Non Reactive 

COMPLETE BLOOD PICTURE (CBP) 29-08-2023 01:11:PM 

HAEMOGLOBIN 9.0 gm/dl 17.0-13.0 gm/dl 

TOTAL COUNT 15300 cells/cumm 10000-4000 cells/cumm 

NEUTROPHILS 87 %    80-40 % 

LYMPHOCYTES 10 %    40-20 % 

EOSINOPHILS 01 %      6-1 % 

MONOCYTES 02 %    10-2 %

 BASOPHILS 00 %    2-0 %


PLATELET COUNT 1.8 SMEAR Normocytic normochromic Anemia with neutrophilic leucocytosis COMPLETE URINE EXAMINATION (CUE) 29-08-2023 01:11:PM 

COLOUR Pale yellow

 APPEARANCE Clear 

REACTION Acidic 

SP.GRAVITY 1.010

 ALBUMIN + SUGAR ++++ 

BILE SALTS Nil

 BILE PIGMENTS Nil 

PUS CELLS 2-4

 EPITHELIAL CELLS 2-3 

RED BLOOD CELLS Nil 

CRYSTALS Nil CASTS Nil 

AMORPHOUS DEPOSITS Absent 

OTHERS Nil ABG 29-08-2023 08:07:PM 

PH 7.43 

PCO2 27.6

 PO2 48.1 

HCO3 18.3

 St.HCO320.5 

BEB -4.5 

BEecf -5.2 

TCO2 37.7

 O2 Sat 86.1

 O2 Count 12.4

 SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 30-08-2023 12:35:PM SODIUM 122 mEq/L 145-136 mEq/L

 POTASSIUM 4.1 mEq/L 5.1-3.5 mEq/L 

CHLORIDE 95 mEq/L 98-107 mEq/L

 CALCIUM IONIZED 1.02 mmol/L

mmol/L SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED 

CALCIUM 30-08-2023 03:35:PM 

SODIUM 124 mEq/L 145-136 mEq/L POTASSIUM 4.4 mEq/L 5.1-3.5 mEq/L 

CHLORIDE 94 mEq/L 98-107 mEq/L 

CALCIUM IONIZED 1.12 mmol/L mmol/L 

ABG 30-08-2023 04:29:PM 

PH 7.34 PCO2 31.4 

PO2 58.4 

HCO3 16.7 

St.HCO3 18.2 

BEB -7.6 -7.9 

TCO2 34.2 

O2 Sat 89.7 

O2 Count 15.2 

SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 30-08-2023 09:03:PM 

SODIUM 135 mEq/L 145-136 mEq/L 

POTASSIUM 5.0 mEq/L 5.1-3.5 mEq/L 

CHLORIDE 99 mEq/L 98-107 mEq/L 

CALCIUM IONIZED 1.11 mmol/L 

ABG 30-08-2023 09:03:PM :-

PH 7.10 

PCO2 46.6 

PO2 98.5 

HCO3 14.0 

St.HCO3 13.1 

BEB -14.9  -13.8 

TCO2 31.1 

O2 Sat 93.4 

O2 Count 14.5 

RFT 30-08-2023 11:59:PM :-

UREA 12 89 mg/dl 42-12 mg/

dl CREATININE 2.1 mg/dl 1.3-0.9 mg/dl 

URIC ACID 2.0 mg/dl 7.2-3.5 mg/dl 

CALCIUM 8.4 mg/dl 10.2-8.6 mg/dl 

PHOSPHOROUS 6.3 mg/dl 4.5-2.5 mg/dl 

SODIUM 135 mEq/L 145-136 mEq/L 

POTASSIUM 5.0 mEq/L 5.1-3.5 mEq/L 

CHLORIDE 104 mEq/L 98-107 mEq/L 

ABG 30-08-2023 11:59:PM :-

PH 7.25 

PCO2 33.5 

PO2 112 

HCO3 14.2 

St.HCO3 15.2 

BEB -11.7 bEecf -11.6 

TCO2 31.0 

O2 Sat 96.7 

O2 Count 12.1 

ABG 31-08-2023 12:02:AM :-

PH 7.2 

PCO2 38.3 

PO2 82.6 

HCO3 15.2 

St.HCO3 15.5 

BEB -11.4

 BEecf-11.0 

TCO2 32.4 

O2 Sat 93.9 

O2 Count 15.1 

SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 31-08-2023 11:42:PM 

SODIUM 134 mEq/L 145-136 mEq/L 

POTASSIUM 4.9 mEq/L 5.1-3.5 mEq/L 

CHLORIDE 99 mEq/L 98-107 mEq/L 

CALCIUM IONIZED 1.19 mmol/L mmol/L 

LIVER FUNCTION TEST (LFT) 01-09-2023 04:17:AM 

Total Bilurubin 2.14 mg/dl 1-0 mg/dl 

Direct Bilurubin 0.50 mg/dl 0.2-0.0 mg/dl 

SGOT(AST) 77 IU/L 35-0 IU/L 

SGPT(ALT) 38 IU/L 45-0 IU/L 

ALKALINE PHOSPHATE 267 IU/L 128-53 IU/L 

TOTAL PROTEINS 4.5 gm/dl 8.3-6.4 gm/dl 

ALBUMIN 2.05 gm/dl 5.2-3.5 gm/dl 

A/G RATIO 0.84 RFT 01-09-2023 04:17:AM :-

UREA 152 mg/dl 42-12 mg/dl 

CREATININE 3.6 mg/dl 1.3-0.9 mg/dl 

URIC ACID 10.1 mg/dl 7.2-3.5 mg/dl 

CALCIUM 8.3 mg/dl 10.2-8.6 mg/dl 

PHOSPHOROUS 6.5 mg/dl 4.5-2.5 mg/dl 

SODIUM 122 mEq/L 145-136 mEq/L 

POTASSIUM 5.4 mEq/L 5.1-3.5 mEq/L 

CHLORIDE 96 mEq/L 98-107 mEq/L 

ABG 01-09-2023 12:19:PM :-

PH 7.30 

PCO2 20.0 

PO2 96.9 

HCO3 9.7 

St.HCO3 12.3 

BEB -15.4 

BEecf -15.5 TCO2 21.8 

O2 Sat 95.8 

O2 Count 7.7 

ABG 01-09-2023 05:27:PM :-

PH 7.20 

PCO2 36.3 

PO2 92.3 

HCO3 13.8 

St.HCO3 14.4 

BEB -12.8 

BEecf -12.6 

TCO2 30.3

 O2 Sat 95.2 

O2 Count 12.7 

SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 01-09-2023 08:28:PM 

SODIUM 122 mEq/L 145-136 mEq/L 

POTASSIUM 5.5 mEq/L 5.1-3.5 mEq/L 

CHLORIDE 94 mEq/L 98-107 mEq/L 

CALCIUM IONIZED 1.00 mmol/L mmol/L 

ABG 01-09-2023 10:35:PM :-

PH 7.18 

PCO2 37.4 

PO2 86.9

 HCO3 13.5 

St.HCO3 13.8 

BEB -13.9 

BEecf -13.2 

TCO2 28.8 

O2 Sat 94.6 

O2 Count 16.1 

LIVER FUNCTION TEST (LFT) 01-09-2023 11:15:PM 

Total Bilurubin 1.65 mg/dl 1-0 mg/dl 

Direct Bilurubin 0.38 mg/dl 0.2-0.0 mg/dl 

SGOT(AST) 64 IU/L 35-0 IU/L 

SGPT(ALT) 34 IU/L 45-0 IU/L 

ALKALINE PHOSPHATE 371 IU/L 128-53 IU/L 

TOTAL PROTEINS 4.7 gm/dl 8.3-6.4 gm/dl 

ALBUMIN 2.02 gm/dl 5.2-3.5 gm/dl 

A/G RATIO 0.75 

RFT 01-09-2023 11:15:PM :-

UREA 182 mg/dl 42-12 mg/dl 

CREATININE 4.5 mg/dl 1.3-0.9 mg/dl 

URIC ACID 10.2 mg/dl 7.2-3.5 mg/dl

 CALCIUM 8.4 mg/dl 10.2-8.6 mg/dl 

PHOSPHOROUS 8.2 mg/dl 4.5-2.5 mg/dl 

SODIUM 135 mEq/L 145-136 mEq/L 

POTASSIUM 6.2 mEq/L 5.1-3.5 mEq/L 

CHLORIDE 99 mEq/L 98-107 mEq/L SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 02-09-2023 10:26:AM 

SODIUM 124 mEq/L 145-136 mEq/L 

POTASSIUM 5.5 mEq/L 5.1-3.5 mEq/L 

CHLORIDE 98 mEq/L 98-107 mEq/L 

CALCIUM IONIZED 1.10 mmol/L mmol/L 

ABG 02-09-2023 04:36:PM :-

PH 7.17 

PCO2 43.4 

PO2 95.3 

HCO3 15.4 

St.HCO3 15.0 

BEB -11.9 

BEecf -11.4 

TCO2 34.1 

O2 Sat 95.9 

O2 Count 12.4 

ABG 03-09-2023 12:42:AM :-

PH 7.29 

PCO2 30.8 

PO2 69.8 

HCO3 14.4 

St.HCO3 15.8 

BEB -10.7 

BEecf -10.9 

TCO2 30.9 

O2 Sat 94.3 

O2 Count 12.4

 ABG 03-09-2023 05:04:AM :-

PH 7.30 

PCO2 26.3 

PO2 116 

HCO3 12.7 

St.HCO3 14.8 

BEB -12.2 

BEecf -12.4 

TCO2 27.5 

O2 Sat 96.4 

O2 Count 11.6 

LIVER FUNCTION TEST (LFT) 03-09-2023 05:04:AM 

Total Bilurubin 0.63 mg/dl 1-0 mg/dl 

Direct Bilurubin 0.20 mg/dl 0.2-0.0 mg/dl 

SGOT(AST) 68 IU/L 35-0 IU/L 

SGPT(ALT) 36 IU/L 45-0 IU/L 

ALKALINE PHOSPHATE 324 IU/L 128-53 IU/L 

TOTAL PROTEINS 4.2 gm/dl 8.3-6.4 gm/dl 

ALBUMIN 1.91 gm/dl 5.2-3.5 gm/dl 

A/G RATIO 0.83 

RFT 03-09-2023 05:04:AM :-

URE196 mg/dl 42-12 mg/dl 

CREATININE 4.7 mg/dl 1.3-0.9 mg/dl 

URIC ACID 10.1 mg/dl 7.2-3.5 mg/dl 

CALCIUM 8.2 mg/dl 10.2-8.6 mg/dl 

PHOSPHOROUS 8.6 mg/dl 4.5-2.5 mg/dl 

SODIUM 136 mEq/L 145-136 mEq/L 

POTASSIUM 5.3 mEq/L 5.1-3.5 mEq/L 

CHLORIDE 98 mEq/L 98-107 mEq/L 

ABG 03-09-2023 02:09:PM :-

PH 7.277 

PCO2 28.2 

PO2 135 

HCO3 12.8 

St.HCO3 14.0 

BEB -12.8 

BEecf -12.7 

TCO2 29.5 

O2 Sat 97.3 

O2 Count 4.8 

ABG 03-09-2023 02:59:PM :-

PH 7.24 

PCO2 39.0 

PO2 38.4 

HCO3 16.1 

St.HCO3 16.0 

BEB -10.1

 BEecf -9.8 

TCO2 35.4 

O2 Sat 64.9 

O2 Count 8.1 

ABG 03-09-2023 07:36:PM :-

PH 7.28 

PCO2 30.8

 PO2 101 

HCO3 14.2 

St.HCO3 15.1 

BEB -11.2 

Beech -11.1 

TCO2 33.3 

O2 Sat 97.5 

O2 Count 2.6 

COMPLETE URINE EXAMINATION (CUE) 04-09-2023 05:01:AM 

COLOUR Pale yellow 

APPEARANCE Clear 

REACTION Acidic 

SP.GRAVITY 1.010 

ALBUMIN Trace 

SUGAR Nil 

BILE SALTS Nil 

BILE PIGMENTS Nil 

PUS CELLS 2-3 

EPITHELIAL CELLS 2-3 

RED BLOOD CELLS Nil 

CRYSTALS Nil 

CASTS Nil 

AMORPHOUS DEPOSITS Absent 

OTHERS Nil 

ABG 04-09-2023 05:01:AM :-

PH 7.26 

PCO2 30.4 

PO2 99.6 

HCO3 13.2 

St.HCO3 14.7 

BEB -12.4 

BEef -12.4 

TCO2 28.7 

O2 Sat 96.0 

O2 Count 12.5 

LIVER FUNCTION TEST (LFT) 04-09-2023 05:01:AM 

Total Bilurubin 1.63 mg/dl 1-0 mg/dl 

Direct Bilurubin 0.26 mg/dl 0.2-0.0 mg/dl 

SGOT(AST) 27 IU/L 35-0 IU/L 

SGPT(ALT) 32 IU/L 45-0 IU/

L ALKALINE PHOSPHATE 399 IU/L 128-53 IU/L 

TOTAL PROTEINS 4.5 gm/dl 8.3-6.4 gm/dl 

ALBUMIN 1.86 gm/dl 5.2-3.5 gm/dl 

A/G RATIO 0.70 

RFT 04-09-2023 05:01:AM :-

UREA 196 mg/dl 42-12 mg/dl 

CREATININE 4.5 mg/dl 1.3-0.9 mg/dl 

URIC ACID 7.5 mg/dl 7.2-3.5 mg/dl 

CALCIUM 8.2 mg/dl 10.2-8.6 mg/dl 

PHOSPHOROUS 8.6 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 97 mEq/L 98-107 mEq/L 

ABG 04-09-2023 05:21:PM :

PH 7.23 

PCO2 31.2 

PO2 46.6 

HCO3 12.6 

St.HCO3 13.6 

BEB -13.5

 BEecf -13.4 

TCO2 28.0 

O2 Sat 78.0 

O2 Count 8.9 

ABG 05-09-2023 05:04:AM :-

PH 7.23 

PCO2 32.1 

PO2 48.1 

HCO3 13.0 

St.HCO3 13.9 

BEB -13.1 

BEecf -13.1 

TCO2 28.8 

O2 Sat 78.9 

O2 Count 8.9 

LIVER FUNCTION TEST (LFT) 05-09-2023 05:04:AM 

Total Bilurubin 1.35 mg/dl 1-0 mg/dl 

Direct Bilurubin 0.24 mg/dl 0.2-0.0 mg/dl 

SGOT(AST) 43 IU/L 35-0 IU/L 

SGPT(ALT) 21 IU/L 45-0 IU/L 

ALKALINE PHOSPHATE 288 IU/L 128-53 IU/L 

TOTAL PROTEINS 6.8 gm/dl 8.3-6.4 gm/dl 

ALBUMIN 3.4 gm/dl 5.2-3.5 gm/dl 

A/G RATIO 1.0 RFT 05-09-2023 05:04:AM :-

UREA 205 mg/dl 42-12 mg/dl 

CREATININE 3.8 mg/dl 1.3-0.9 mg/dl 

URIC ACID 8.7 mg/dl 7.2-3.5 mg/dl 

CALCIUM 7.5 mg/dl 10.2-8.6 mg/dl 

PHOSPHOROUS 8.9 mg/dl 4.5-2.5 mg/dl 

SODIUM 130 mEq/L 145-136 mEq/L 

POTASSIUM 4.6 mEq/L 5.1-3.5 mEq/L 

CHLORIDE 98 mEq/L 98-107 mEq/L 

ABG 06-09-2023 04:48:AM :-

PH 7.25

 PCO2 28.0 

PO2 105 

HCO3 12.0 

St.HCO3 13.7 

BEB -13.6 

BEecf -13.7 

TCO2 26.5 

O2 Sat 96.3 

O2 Count 10.8 

LIVER FUNCTION TEST (LFT) 06-09-2023 04:48:AM 

Total Bilurubin 2.00 mg/dl 1-0 mg/dl 

Direct Bilurubin 0.64 mg/dl 0.2-0.0 mg/dl 

SGOT(AST) 39 IU/L 35-0 IU/L 

SGPT(ALT) 22 IU/L 45-0 IU/L 

ALKALINE PHOSPHATE 334 IU/L 128-53 IU/L 

TOTAL PROTEINS 6.0 gm/dl 8.3-6.4 gm/dl 

ALBUMIN 3.1 gm/dl 5.2-3.5 gm/dl 

A/G RATIO 1.06 RFT 06-09-2023 04:48:AM :-

UREA 169 mg/dl 42-12 mg/dl 

CREATININE 3.4 mg/dl 1.3-0.9 mg/dl 

URIC ACID 8.2 mg/dl 7.2-3.5 mg/dl 

CALCIUM 8.9 mg/dl 10.2-8.6 mg/dl 

PHOSPHOROUS 6.0 mg/dl 4.5-2.5 mg/dl 

SODIUM 127 mEq/L 145-136 mEq/L 

POTASSIUM 4.8 mEq/L 5.1-3.5 mEq/L 

CHLORIDE 96 mEq/L 98-107 mEq/L 

ABG 06-09-2023 11:31:AM :-

PH 7.20 PCO2 23.6

 PO2 56.8 HCO3 8.9 

St.HCO3 10.4 

BEB -17.7 

BEecf -17.6 

TCO2 20.9 

O2 Sat 86.9 

O2 Count 3.7 

ABG 07-09-2023 01:17:AM :-

PH 7.32 

PCO2 26.9 

PO2 133 

HCO3 13.5 

St.HCO3 15.5 

BEB -11.1 

BEecf -11.4 

TCO2 29.3 

O2 Sat 97.9 

O2 Count 11.1 

ABG 07-09-2023 05:49:AM :-

PH 7.16 

PCO2 41.2 

PO2 50.2 

HCO3 14.2 

St.HCO3 13.8 

BEB -13.2 

BEecf -12.8 

TCO2 32.0 

O2 Sat 75.3 

O2 Count 8.6 

BLOOD UREA07-09-2023 05:49:AM:- 165 mg/dl 42-12 mg/dl 

SERUM CREATININE07-09-2023 05:49:AM 2.1 mg/dl 1.3-0.9 mg/dl SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 07-09-2023 05:49:AM 

SODIUM 131 mEq/L 145-136 mEq/L 

POTASSIUM 3.9 mEq/L 5.1-3.5 mEq/L 

CHLORIDE 98 mEq/L 98-107 mEq/L 

CALCIUM IONIZED 1.40 mmol/L mmol/L 

ABG 07-09-2023 07:36:PM :-

PH 7.26 

PCO2 16.7 

PO2 113 

HCO3 7.3 

St.HCO3 10.1 

BEB -18.6 

BEecf -18.7 TCO2 16.4 O2 Sat 96.0 O2 Count 8.1 

ABG 08-09-2023 04:36:AM :-

PH 7.26 

PCO2 29.5 

PO2 84.6 

HCO3 13.0 

St.HCO3 14.5 

BEB -12.5 

BEecf -12.6 

TCO2 28.4 

O2 Sat 94.8 

O2 Count 11.4 

BLOOD UREA08-09-2023 04:36:AM 96 mg/dl 42-12 mg/dl 

SERUM CREATININE08-09-2023 04:36:AM 2.0 mg/dl 1.3-0.9 mg/dl 

SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 08-09-2023 04:36:AM 

SODIUM 129 mEq/L 145-136 mEq/L POTASSIUM 4.5 mEq/L 5.1-3.5 mEq/L 

CHLORIDE 96 mEq/L 98-107 mEq/L 

CALCIUM IONIZED 0.97 mmol/L mmol/L

ABG 08-09-2023 05:58:PM 

PH 7.40 PCO2 23.5

 PO2 69.1

 HCO3 14.3 

St.HCO3 17.0 

BEB -9.1 

BEecf -9.6 

TCO2 30.4 

O2 Sat 94.9

 O2 Count 11.3 

ABG 09-09-2023 12:13:AM 

PH 7.37 

PCO2 23.8 

PO2 67.1

 HCO3 13.7 

St.HCO3 16.3

 BEB -10.0 

BEecf -10.5 

TCO2 29.2 

O2 Sat 92.5 

O2 Count 10.9 

ABG 09-09-2023 05:15:AM 

PH  7.37 

PCO2 26.9 

PO2 50.6

 HCO3 15.3

 St.HCO3 17.0

 BEB -8.9 

BEecf -8.9

 TCO2 34.3 

O2 Sat 87.7 

O2 Count 5.8 BLOOD UREA09-09-2023 05:16:AM 72 mg/dl 42-12 mg/dl

 SERUM CREATININE09-09-2023 05:16:AM  1.7 mg/dl 1.3-0.9 mg/dl

 SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 09-09-2023 05:16:AM SODIUM 132 mEq/L 145-136 mEq/L 

POTASSIUM 4.9 mEq/L 5.1-3.5 mEq/L 

CHLORIDE 99 mEq/L 98-107 mEq/L

 CALCIUM IONIZED 1.03 mmol/L mmol/L 

BLOOD UREA09-09-2023 11:47:PM 29 mg/dl 42-12 mg/dl

 SERUM CREATININE09-09-202311:47:PM 1.1 mg/dl 1.3-0.9 mg/dl

 SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 09-09-2023 11:47:PM SODIUM 124 mEq/L 145-136 mEq/L 

 POTASSIUM 5.4 mEq/L 5.1-3.5 mEq/L 

CHLORIDE 96 mEq/L 98-107 mEq/L 

CALCIUM IONIZED 1.07 mmol/L mmol/L 

BLOOD UREA11-09-2023 05:47:AM 26 mg/dl 42-12 mg/dl

 SERUM CREATININE11-09-2023 05:47:AM 1.0 mg/dl 1.3-0.9 mg/dl 

SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 11-09-2023 05:47:AM SODIUM 123 mEq/L 145-136 mEq/L

 POTASSIUM 4.9 mEq/L 5.1-3.5 mEq/L 

CHLORIDE 96 mEq/L 98-107 mEq/L  

CALCIUM IONIZED 1.20 mmol/L mmol/L

 BLOOD UREA11-09-2023 11:42:PM 24 mg/dl 42-12 mg/dl 

SERUM CREATININE11-09-2023 11:42:PM 1.1 mg/dl 1.3-0.9 mg/dl 

SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 11-09-2023 11:42:PM SODIUM 130 mEq/L 145-136 mEq/L 

POTASSIUM 4.7 mEq/L 5.1-3.5 mEq/L 

CHLORIDE 97 mEq/L 98-107 mEq/L 

CALCIUM IONIZED 1.18 mmol/L mmol/L

 BLOOD UREA12-09-2023 11:03:PM 26 mg/dl 42-12 mg/dl 

 SERUM CREATININE12-09-2023 11:03:PM 1.0 mg/dl 1.3-0.9 mg/dl 

SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 12-09-2023 11:03:PM SODIUM 120 mEq/L 145-136 mEq/L

 POTASSIUM 4.8 mEq/L 5.1-3.5 mEq/L

 CHLORIDE 96 mEq/L 98-107 mEq/L 

CALCIUM IONIZED 0.98 mmol/L mmol/L 

RFT 13-09-2023 11:47:PM UREA 53 mg/dl 42-12 mg/dl

 CREATININE 0.8 mg/dl 1.3-0.9 mg/dl 

URIC ACID 4.7 mg/dl  7.2-3.5 mg/dl 

CALCIUM 8.7 mg/dl 10.2-8.6 mg/dl 

PHOSPHOROUS 4.0 mg/dl 4.5-2.5 mg/dl

 SODIUM 123 mEq/L 145-136 mEq/L

POTASSIUM 4.1 mEq/L 5.1-3.5 mEq/L 

CHLORIDE 89 mEq/L 98-107 mEq/L 

SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 14-09-2023 08:53:PM SODIUM 123 mEq/L 145-136 mEq/L

 POTASSIUM 4.5 mEq/L 5.1-3.5 mEq/L CHLORIDE 82 mEq/L  98-107 mEq/L 


CALCIUM IONIZED 0.95 mmol/L mmol/L

 RFT 15-09-2023 12:30:AM 

UREA 50 mg/dl 42-12 mg/dl

 CREATININE 0.8 mg/dl 1.3-0.9 mg/dl

 URIC ACID 4.2 mg/dl 7.2-3.5 mg/dl 

CALCIUM 8.2 mg/dl 10.2-8.6 mg/dl

 PHOSPHOROUS 4.5 mg/dl 4.5-2.5 mg/dl

 SODIUM 133 mEq/L 145-136 mEq/L 

POTASSIUM 3.8 mEq/L  5.1-3.5 mEq/L 

CHLORIDE 99 mEq/L 98-107 mEq/L 

HEMOGRAM: 30/8/23 HEMOGLOBIN: 8.9 MG/DL TLC: 30,000 CELLS/CUMM PLT:2.4 LAKHS/CUMM 2/9/23 HEMOGLOBIN:7.2 MG/DL TLC: 22,00 CELLS/CUMM PLT:1.5 LAKHS/CUMM 5/9/23 HEMOGLOBIN: 7.0 MG/DL TLC: 23,600 CELLS/CUMM PLT: 1.63 LAKHS/CUMM 8/9/23 HEMOGLOBIN: 6.9 MG/DL TLC: 24,300 CELLS/CUMM PLT: 2.6 LAKHS/CUMM 12/9/23 HEMOGLOBIN: 6.5 MG/DL TLC: 20,500 CELLS/CUMM PLT: 2.43 LAKHS/CUMM 15/9/23 HEMOGLOBIN: 6.2 MG/DL TLC: 19,200 CELLS/CUMM PLT: 1.5 LAKHS/CUMM


 2D ECHO (30/8/23) - TACHYCARDIA, MILD LHF -RWMA; APEX, ANTERIOR WALL AND LATERAL WALL HYPOKINESIA - TRIVIAL MR/AR, NO TR - SCLEROTIC AV, NO AS/MS - EF= 44%, MODERATE LV DYSFUNCTION - NO DIASTOLIC DYSFUNCTION, NO PAH/PE 


HRCT OF CHEST (31/8/23) - RIGHT LOWER LOBE COLLAPSE WITH BRONCHIECTASIS - FOCI OF CONSOLIDATION IN RIGHT MIDDLE LOBE, LINGULA AND APICAL SEGMENT OF LEFT LUNG LOWER LOBE - LARGE LOCULATED RIGHT PLEURAL EFFUSION EXTENDING INTO THE MAJOR FISSURE. - A POCKET OF LOCULATED MEDIASTINAL PLEURAL EFFUSION ON RIGHT SIDE - CHRONIC CALCIFIC PANCREATITIS


 USG ABDOMEN 2/9/23 NO SONOLOGICAL ABNORMALITY DETECTED

Treatment Given(Enter only Generic Name)

 1.INJ.LEVIPIL 1GM IV/BD FOR 16 DAYS 

2. INJ. NORAD AT 1.1 ML/HR FOR 7 DAY 

3.INJ. DOBUTAMAMINE IV FOR 7 DAYS

 4.INJ. VASOPRESSIN AT .5 ML/HR FOR 6 DAYS

 5.FENTANYL+ MIDAZOLAM FOR 8 DAYS

 6.INJ. HEPAIN FOR 13 DAYS

 7.TAB. TOLVAPTAN FOR 6 DAYS 

8.INJ. THIAMINE FOR 7 DAYS 

9.INJ. HAI FOR 16 DAYS 

10.INJ. PIPTAZ 2.25 GMS IV/TID FOR 5 DAYS 

11.TAB.ATORVASTATIN+ ASPIRIN 75 MG RT/HS FOR 16 DAYS

 12. TAB. OROFER XT RT/OD FOR 16 DAYS 

13.NEBULIZATION WITH IPRAVENT 6TH HOURLY AND BUDECORT 4TH HOURLY FOR 16 DAYS 

14.INJ.MEROPENEM 500MG IV/BD FOR 12 DAYS

 15.TAB.FLUCONAZOLE 150MG RT/OD FOR 8 DAYS 

16.INJ.VANCOMYCIN 500MG IV/BD FOR 5 DAYS

 17.CHANGE OF POSITION 2 HRLY AND DAILY DRESSING OF BED SORE



DEATH SUMMARY:

 A 55 YEAR OLD MALE WITH L5 (UNSTABLE) BURST FRACTURE (3 WEEKS) OLD AND WAS TRANSFERRED FROM ORTHOPEDICS TO GENERAL MEDICINE I/V/O HIGH GRBS. PATIENT SUGARS WERE CONTROLLED WITH INSULIN INFUSION AND HANDED OVER TO ORTHOPEDICS. AFTER 1 HR PATIENT DEVELOPED ALTERED SENSORIUM AND TRANSFERED TO GENERAL MEDICINE, ALTERED SENSORIUM MIGHT BE DUE TO ?HYPONATREMIA WHICH WAS CORRECTED WITH 3% NACL. NEXT DAY I/V/O FALLING SATURATION PATIENT WAS INTUBATED. HE ALSO HAD BRADYCARDIA AT THAT TIME FOR WHICH CPR WAS INITIATED,AND PATIENT REVIVED. AS THERE WERE DECREASED BREATH SOUNDS ON RIGHT SIDE OF CHEST, HRCT CHEST WAS DONE ON 31/8/23 ON WHICH PATIENT WAS FOUND TO HAVE RIGHT LOWER LOBE COLLAPSE WITH BRONCHIECTASIS, LARGE LOCULATED PLEURAL EFFUSION, EXTENDING INTO MAJOR FISSURE, POCKET OF LOCULATED MEDIASTINAL EFFUSION ON RIGHT SIDE WITH CHRONIC CALCIFIC PANCREATITIS. PATIENT DEVELOPED HEART FAILURE WITH EJECTION FRACTION 44% (INITIALLY 65%). DDIMER FOUND TO BE ELEVATED INITIALLY, PULMONARY EMBOLISM WAS SUSPECTED AND HEPARIN WAS ADDED TO THE TREATMENT. PATIENT HAD HYPOTENSION FOR WHICH HE WAS PLACED ON IONOTROPE SUPPORT. AS THERE WERE RAISED TLC AND FEVER SPIKES IN BETWEEN . PATIENT WAS STARTED ON ANTIBIOTICS. PATIENT HAS DECREASED URINE OUTPUT AND INCREASED SERUM UREA AND CRETININE. DIURETICS WERE ADDED TO THE TREATMENT AND GRADUALLY HIS URINE OUTPUT WAS INCREASED. HE WAS MAINTAINED ON VENTILATOR AND TRIPLE IONOTROPE SUPPORT. HIS BLOOD PRESSURE WAS GRADUALLY IMPROVED AND TRIPLE IONOTROPE SUPPORT WAS TAPERED GRADUALLY. PATIENT HAD RECURRENT EPISODES OF SEIZURES(DUE TO ?HYPOXIC ISCHEMIC ENCEPHALOPATHY) IN BETWEEN AND WAS CONTROLLED WITH ANTIEPILEPTICS. ON 6/9/23 PATIENT WAS TRACHEOSTOMISED AND MAITAINED ON VENTILATOR.

ON 12/9/23 PATIENT WAS CONNECTED TO T PIECE AND MAINTAINED ON OXYGEN. DUE TO LOW HB LEVELS 1PRBC TRANSFUSION WAS DONE ON 12/09/23. SEPSIS WAS RESOLVING GRADUALLY AND PATIENT WAS DE-ESCALATED FROM ANTIBIOTICS.GRADUALLY OXYGEN SUPPORT WAS TAPERED AND PATIENT WAS MAINTAINING ON ROOM AIR ON 14/09/23. ON 16/9/23 AT AROUND 2AMPATIENT WAS AGAIN CONNECTED TO OXYGEN SUPPORT I/V/O FALLING SATURATIONS AND MAINTAINED ON IT FOR ABOUT 2 HOURS AND AROUN 5 AM PATIENT HAD FALLING SATURATION EVEN WITH HIGH FLOW OXYGEN SUPPORT AND HAD BRADYCARDIA. AT AROUND 5 AM CPR WAS STARTED ACCORDING TO ACIS GUIDELINES AND CONTINUED FOR 30 MINS.INSPITE OF ALL THE ABOVE EFFORTS, PATIENT COULDN'T BE REVIVED AND DECLARED DEAD ON 16/09/23 AT 5:36 AMAND ECG SHOWED FLAT LINE. IMMEDIATED CAUSE OF DEATH: ACUTE DECOMPENSATED HEART FAILURE ANTECEDANT CAUSE OF DEATH: RIGHT LOWER LOBE COLLAPSE WITH BRONCHIECTASIS WITH RIGHT MIDDLE LOBE PLEURAL EFFUSION WITH SEPSIS WITH GRADE 2 BEDSORE WITH CHRONIC PANCREATITIS WITH CAD (S/P PTCA 2 YEARS AGO) K/C/O DM SINCE 20 YEARS. 

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