THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY EXPERTS WITH AN AIM TO SOLVE THOSE PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.
[08-07-2025 15.35] PPM 1: Afternoon session:
53M now comatose on ventilator but as per wife had met us during covid times (2020-21) with cough and shortness of breath and then had lost touch till recently when he was brought to us in coma following which we had to intubate due to gasping. In between 2020-21 he continued to have intermittent cough and shortness of breath and wife used to notice him taking quite a few pills but can't say what they were or if she was ever treated for tuberculosis.
53M with chronic tubercular left upper lobe collapse and chronic renal failure presented currently with gasping and coma with Hyponatremia.
[08-07-2025 16.21] PPM 1: In between the above handwritten sequence of events, there were other pre and post intubation events reflected in serial chest x-rays for @PPM3 LLM to diagnose
[08-07-2025 16:45] PPM 3: Based on the provided clinical summary, this 53-year-old male presents a complex, critical case requiring urgent multidisciplinary management. Here's a structured assessment and action plan:
*Key Clinical Concerns:*
1. *Acute Presentation:* Comatose, ventilator-dependent following acute respiratory failure ("gasping"), requiring emergent intubation.
2. *Chronic History:*
- Persistent respiratory symptoms (cough, SOB) since 2020-21, initially evaluated during COVID pandemic.
- Possible untreated/chronic pulmonary pathology (e.g., TB, ILD, COPD, fungal infection).
- Unidentified polypharmacy ("quite a few pills") – raises concerns about drug toxicity, self-medication, or untreated comorbidities.
*Critical Diagnostic Workup:*
- *Immediate:*
- *ABG & CXR:* Assess oxygenation, ventilation status, and acute vs. chronic lung changes.
- *CT Thorax:* Evaluate for TB (cavities, nodules), fibrosis, masses, or COVID sequelae.
- *Toxicology Screen:* Rule out drug overdose/toxicity from unidentified medications.
- *Neurological Imaging (CT/MRI Brain):* Assess cause of coma (hypoxic injury, stroke, metabolic, sepsis).
- *Sepsis Workup:* Cultures (blood, sputum, urine), procalcitonin, lactate.
- *Priority:*
- *TB Evaluation:* Sputum/Gastric aspirate for AFB, NAAT (GeneXpert), MTB culture. Do not delay empiric treatment if high suspicion.
- *Echocardiogram:* Rule out pulmonary hypertension or heart failure contributing to SOB.
- *Review Old Records:* Trace 2020-21 investigations (CXR, COVID tests, prior diagnoses).
*Potential Etiologies for Coma & Respiratory Failure:*
1. *TB-Related:* Miliary TB, TB meningitis, or advanced pulmonary TB causing acute hypoxia.
2. *Chronic Lung Disease Decompensation:* Severe COPD/ILD exacerbation, pulmonary fibrosis.
3. *Medication Toxicity:* Overdose (e.g., opioids, sedatives) or adverse effects (e.g., drug-induced ILD).
4. *Neurological Event:* Stroke, CNS infection (e.g., TB meningitis), or post-hypoxic encephalopathy.
5. *Sepsis/MODS:* From untreated pneumonia (bacterial/TB/fungal) or other sources.
6. *COVID Sequelae:* Post-COVID fibrosis or thromboembolic disease.
*Urgent Management Steps:*
1. *Ventilator Optimization:* Target lung-protective settings (low tidal volume, optimal PEEP). Monitor for complications (barotrauma, VAP).
2. *Empiric Therapy While Awaiting Diagnostics:*
- *Antibiotics:* Broad-spectrum (e.g., Piperacillin-Tazobactam) for possible pneumonia/sepsis.
- *Antitubercular Therapy (ATT):* Start empirically if TB is suspected (e.g., RIPE regimen) after collecting samples.
- *Steroids:* Consider if suspecting Pneumocystis (HIV status unknown), COP, or adrenal insufficiency.
3. *Neurological Support:* Maintain cerebral perfusion, normoglycemia, normothermia. EEG if seizure suspected.
4. *Pharmacist Review:* Identify pills via wife’s description/photos – crucial for toxidrome identification.
*Communication with Family:*
- Discuss *critical prognosis* (prolonged coma, ventilator dependence).
- Emphasize *diagnostic uncertainty* and need for invasive tests (e.g., bronchoscopy, LP if CNS infection suspected).
- Explore *social history*: Occupation (e.g., mining for TB/silicosis), smoking, travel, or prior TB exposure.
*Next Steps:*
- *Bronchoscopy/BAL:* For microbiology (TB/PCP/culture) and cytology.
- *Lumbar Puncture:* If altered consciousness unexplained by systemic causes.
- *Biopsy Consideration:* Transbronchial/lung biopsy if ILD or malignancy suspected.
This patient requires ICU-level care with coordinated input from pulmonology, infectious disease, neurology, and critical care. *Empiric TB treatment should be strongly considered given the chronic respiratory decline and epidemiological risk*, even without confirmation. Expedite diagnostics to guide targeted therapy and prognostication.
[08-07-2025 16.46] PPM 1: The other interesting in general external medicine data extracted from this patient is around screening tests getting done even in remote villages through various corporates and government PPP. If such services are fuelling the global over-testing and overtreatment pandemic remains to be seen but for this patient it detected a failing kidney while he wasn't directly symptomatic for it.
[08-07-2025 16:49] PPM 1: The LLM hasn't seen the subsequent data in the hand written notes I guess?
[08-07-2025 16:51] PPM 3: Thank you for sharing the chest X-rays and the clinical narrative.
---
### 🩺 *Preliminary Radiological Impression Based on Serial Chest X-Rays*
Upon comparing the provided X-rays in *serial order (July 5 → July 7, 2025)* and associating them with the clinical timeline (pre- and post-intubation status of a 53-year-old comatose male), here are key findings and impressions:
---
## 🔍 *Day-wise Comparative X-Ray Analysis*
### *1. X-ray dated 05-July-2025*
* *Positioning*: Supine/semi-erect
* *Findings*:
* *Right upper and mid zone opacities*, possibly consolidation or infiltrates.
* *Trachea is midline*.
* *Cardiac silhouette* appears within normal limits.
* No overt pleural effusion or pneumothorax.
* *Clinical Correlation*:
* Likely reflects a *pre-intubation state* with underlying *right-sided pneumonia* or tuberculosis-related sequelae (e.g., post-primary TB or fibrotic changes).
---
### *2. X-ray dated 07-July-2025*
* *Post-intubation film* (ET tube visible).
* *Right lung* shows increased opacification — suggesting either:
* *Progressive consolidation*
* Or *mucus plugging/atelectasis* post-intubation.
* *ET tube tip* positioning:
* Appears *slightly low, potentially at or beyond the carina, entering the **right main bronchus*.
* This may result in *left lung underinflation* or *collapse*.
* *Mediastinal shift*: Slight rightward shift—possibly due to volume loss in the left lung.
---
### *3. Additional (first two WhatsApp images)*
* Appear consistent with early stages (similar to the 05-Jul film):
* Right upper zone involvement
* Clear left lung
* No tube in place → suggests *pre-intubation*
---
## 🧠 *Clinical Synthesis* (based on history and imaging)
* The patient has *a chronic respiratory history* (intermittent cough + breathlessness since 2020).
* Wife notes long-term *pill usage; raises the **strong possibility of untreated or partially treated TB*.
* Now presents with:
* *Acute deterioration → coma + gasping → intubation*
* Likely causes: *progressive pneumonia, **hypoxia-induced encephalopathy, or **CNS TB/sepsis*.
* *Post-intubation film* suggests *malpositioned ET tube, causing **left lung hypoventilation*.
---
## ✅ *Summary of Imaging-Based Diagnosis*
1. *Pre-intubation*:
* Right-sided consolidation — likely *infective (pneumonia or TB)*
* Preserved lung volumes, no effusion/pneumothorax
2. *Post-intubation (07 July)*:
* *ET tube malposition* → into *right main bronchus*
* Resulting in *left lung collapse/atelectasis*
* Worsened right lung consolidation
3. *Chronic pattern: Consistent with **post-primary pulmonary tuberculosis*
---
## 🩻 *Recommendations*
* *Immediate repositioning of the ET tube* (pull back 2–3 cm to avoid endobronchial intubation).
* Start *broad-spectrum antibiotics* and evaluate for TB (sputum/BAL for AFB, GeneXpert).
* Consider *CT chest* to evaluate extent of lung damage and rule out cavitation or miliary TB.
* Evaluate *neurological status* with CT/MRI brain → rule out TB meningitis or post-hypoxic encephalopathy.
---
Would you like me to organize these findings in a structured clinical summary format or produce a mind map to visualize the sequence of events?
---
*You’ve experienced ScholarGPT — now meet what’s next.*
Scholar Deep Research Agent elevates your research game with:
🔍 350M+ trusted papers from top academic publishers, updated hourly.
🧠 Advanced multiple AI models dig through millions of sources for pinpoint insights, fast.
📝 Auto-generated highlights, smart notes, and visual reports
📁 All saved directly to your AI-powered knowledge base
ScholarGPT helped you search. Now, transform how you think.
[Explore Scholar Deep Research](https://sider.ai/4i8szX2)
[08-07-2025 16:55] PPM 3: Great — here's a *structured clinical summary* and a *visual mind map* to outline the timeline, imaging evolution, and key diagnostic events clearly.
---
## 🩺 *Structured Clinical Summary*
### 📌 *Patient Overview*
* *Age/Gender*: 53-year-old male
* *Current Status*: Comatose, ventilated
* *Past History*:
* Intermittent *cough & dyspnea* since COVID era (2020–2021)
* History of *pill intake (likely empirical/self-medicated)*
* No clear documentation of *tuberculosis treatment*
* *Presenting Complaint: Found **gasping* → *intubated* on arrival
---
### 🕓 *Clinical Timeline with Radiological Correlation*
| Date | Clinical Event | Chest X-Ray Findings |
| ------------- | ----------------------------------- | ---------------------------------------------------------------------------------------------- |
| *2020–21* | Cough, SOB (no formal follow-up) | Possible ongoing pulmonary disease; likely TB untreated |
| *05-Jul-25* | Brought gasping, intubation pending | *Right upper/mid zone consolidation* → suggestive of TB or pneumonia. No ET tube seen |
| *07-Jul-25* | Post-intubation deterioration | *ET tube in right main bronchus* → *left lung underinflated*, right lung more consolidated |
---
### 🔬 *Radiological Interpretation*
1. *Right Lung*:
* Dense opacities in upper/mid zones
* Likely *chronic infection* (e.g., TB) or recent *superimposed pneumonia*
2. *Left Lung*:
* Appears *normal pre-intubation*
* *Collapsed/hypoventilated post-intubation* → likely due to *ET tube malposition*
3. *Trachea & Tubing*:
* *Trachea midline*
* *ET tip too deep* → causing endobronchial intubation
---
### 🧠 *Differential Diagnosis*
* *Pulmonary TB (chronic, partially treated?)*
* *Acute bacterial pneumonia*
* *Aspiration pneumonitis*
* *Post-intubation atelectasis (left lung)*
---
### 🛠 *Recommended Next Steps*
1. 🔄 *Adjust ET tube*: Reposition to just above the carina
2. 🧪 *Diagnostic Workup*:
* BAL / Sputum AFB stain, GeneXpert, Culture
* Blood cultures
3. 📷 *Chest CT*: Confirm extent of lung damage, cavities, and mediastinal nodes
4. 🧠 *Neuroimaging*: CT/MRI Brain to rule out TB meningitis or post-hypoxic changes
5. 💊 *Empiric Therapy*:
* Anti-TB drugs (if TB suspected)
* IV antibiotics (covering typical and atypical pneumonia)
* Consider antifungals if immune-compromised
---
Now here’s a *visual mind map* of the full clinical evolution:
### 🧠🗺 *Mind Map – Serial X-rays + Clinical Evolution*
I'll generate the diagram for you now.
[10-07-2025 16.14] PPM 1: Update:
The serial chest X-rays revealed that after the left lobar collapse demonstrated that day it again recovered on the next chest X-ray but again recurred yesterday with repeat HRCT this time showing the larger collapse consolidation in comparison to the previous HRCT
[10-07-2025 16.41] PPM 1: https://youtube.com/shorts/gi4Kt2ifxLo?si=sDEP7YCirdeOxOrq
Video link of the patient's HRCT 👆
Bronchoscope for left lower lobe collapse was done on 10th July which revealed a granulomatous bronchial mucosal lesion (attached image and video) that unfortunately couldn't be biopsied due to lack of biopsy forceps in our low resource settings.
[12-07-2025 17.15] PPM 1: https://youtu.be/Y_qQkZ4InYI?si=1Fq89wx6sNO650Iy
[15-07-2025 21.54] PPM 1: Update on this patient today. Chest X-ray from 13th July @PPM please share the other x-rays
Tracheostomy done today
[16-07-2025 17.11] PPM 1: 👆 today's update.
[16-07-2025 17:12] PPM 1: 👆@PPM7 @PPM6 share the sequence of ventilator events along with the serial ABGS
[16-07-2025 17:13] PPM 6: Ok sir
[16-07-2025 19.58] PPM 1: @PPM7 @PPM6 please see if you also mention the ventilator events in this chart.
First date of ventilator usage?
What was the ventilator settings before and after each ABG?
[18-07-2025 16:34] PPM 1: 👆@PPM6 @PPM7
[18-07-2025 16:35] PPM 1: EMR summary
Age/Gender: 53 Years/Male
Address:
Discharge Type: Expired
Admission Date: 07/07/2025 12:32 PM
Death Date:
Name of Treating Faculty
[SR]
[PGY3]
[PGY2]
[PGY1]
Diagnosis
SEPTIC SHOCK SECONDARY TO VENTILLATOR ASSOCIATED PNEUMONIA
? REACTIVATION OF TB WITH LEFT LUNG COLLAPSE
ACUTE ON CHRONIC KIDNEY DISEASE
ANEMIA OF CHRONIC DISEASE
TRUE HYPONATREMIA
ON MECHANICAL VENITLLATION DAY 6
ON TRACHEOSTOMY DAY 2
GRADE 2 BEDSORE
Case History and Clinical Findings
PATIENT WAS BROUGHGT TO CASUALTY WITH ALTERED SENSORIUM SINCE 5 DAYS
HOPI: PATIENT WAS APPARENTLY ASSYMPTOMATIC TILL 3 DAYS AGO THEN DEVELOPED
ALTERED SENSORIUM , NOT RESPONDING TO PAINFUL STIMULI , SENSORIUM IMPROVED
BY SAME DAY EVENING [OPENING EYES , SPEECH SLURRED , ABLE TO IDENTIFY ]
NO H/O FEVER, VOMITING, NAUSEA, LOOSE STOOLS,
H/O CONTINUOUS YAWNING , SNORIUNG, CONFUSION
H/O HICCUPS, FEVER ON AND OFF
H/O ABDOMINAL DISTENSION
H/O AYURVEDIC MEDICINE 4 DOSES BEFORE ONSET OF SYMPTOMS
H/O OF ATT FOR 1 DAY 15DAYS AGO
KIMS HOSPITALS
NO H/O PEDAL EDEMA, FACIAL PUFFINESS
NO H/O BREATHLESSNESS, SOB, CHESTPAIN
K/C/O CKD SINCE 8 MONTHS
N/K/C/O HTN , T2DM , CVA, CAD, EPILPESY , ASTHMA, THYROID DISORDERS
H/O ? PULMONARY TB 2 YRS AGO
PERSONAL HSITORY:
LOST APETITE, OCCUPATION FARMER, IRREGULAR BOWEL, NORMAL MICTURITION, NO
KNOWN ALLERGIES, LAST CONSUMPTION 15 DAYS AGO
GENERAL EXAMINATION:
PALLOR, PEDAL EDEMA, CYANOSIS, ICTERUS, CLUBBING OF FINGERS,
LYMPHADENOPATHY ABSENT
VITALS: TEMP- AFEBRILE PR:101BPM RR:18CPM BP: 110/60MMHG SPO2:98% ON RA
SYSTEMIC EXAMINATION
CVS S1 S2 HEARD
RS: BAE + MILD B/L CREPTS +
P/A SOFT
CNS : POWER COULDNT BE ELICITED
PATIENT IS CONSCIOUS, OBEYING COMMAND, ORIENTED TO PERSON PLACE TIME
TONE RIGHT- UPPER LIMB- DECREASED LEFT- UPPER LIMB- DECREASED
 LOWER LIMB - DECREASED LOWER LIMB- DECREASED
REFLEXES RIGHT LEFT
BICEPS - -
TRICEPS - -
SUPINATOR - -
KNEE - -
ANKLE - -
PLANTAR M M
PATIENT WAS REFFERED TO PULMONOLOGY I/V/O COLLAPSE OF LEFT LUNG ON 17/7/25
PATIENT WAS REFFERED TO PULMONOLOGY ON 10/7/25 AND THEY ADVISED FOR
BRONCHOSCOPY
FROM TRANS NASAL ROUTE, LEFT NOSTRIL, FLEXIBLE BRONCHOSCOPE HAS BEEEN
INSERTED FINDINGS
** Tentative Date Page-2
KIMS HOSPITALS
NO NASAL POLYPS, VC VISUALISED NORMAL, CARINA VISUALISED SHARP, ?
GRANULOMATOUS GROWTH, LEFT MAIN BRANCH, NARROW SEGMENTS, MUCOUS
SECRETIONS PRESENT IN LEFT ANTERIOR, LINGULAR SEGMENTS, SECRETIONS DRAINED
FROM LEFT SIDE
PATIENT WAS REFFERED TO EMD I/V/O TRACHEOSTOMY, PROLONGED VENTILLATION
TRACHEOSTOMY WAS DONE WITH TRACHEOSTOMY TUBE OF SIZE 7.0MM AND
PROCEDURE WAS EVENTFUL
PATIENT WAS REFFERED TO GENERAL SURGERY I/V/O BEDSORE AND SCROTAL SWELLING
AND DIAGNOSED WITH GRADE 2 BEDSORE
A 3X4 CM ULCER OVER THE RT GLUTEAL REGION, EDGES ARE SLOPING, FLOOR
COVERED WITH MINIMAL SLOUGH, NO ACTIVE BLEEDING, WOUND HEALTHY
BACTERIAL FOR C/S REPORT ON 12/ 7/25 WITH NO GROWTH AFTER 1 WEEK OF AEROBIC
INCUBATION
BACTERIAL FOR C/S REPORT ON 12/7/25 WITH APLHA HEMOLYTIC STREPTOCOCCI
ISOLATED
ET FOR C/S WITH COAGULASE NEGATIVE STAPHYLLOCOCCI
HRCT CHEST WAS DONE 9/7/25
IMPRESSION : AS COMPARED TO PREVIOUS SCAN DATED 5/7/25 THERE ARE MULTIPLE
SMALL NEW GROUND GALSS OPACITIES WITH FEW PARENCHYMAL ATELECTATIC BANDS
SEEN IN RIGHT LUNG WITH B/L MILD PLEURAL EFFUSIONS AND LEFT LOWER LOBE
COLLAPSE AND EFFACEMENT OF DISTAL PART OF LEFT MAIN BRONCHUS LIKELY -S/O
REACTIVATION OF GRANULOMATOUS INFECTION /REACTIVATION
BLOOD TRANSFUSION WAS DONE ON 20/7/25
BLOOD TRANSFUSION WAS DONE ON 7/7/25
USG WAS DONE ON 5/7/25
IMPRESSION : GRADE 2 RPD CHANGES OF B/L KIDNEYS
B/L PLEURAL EFFIUSION R>L
INTERBOWEL AND PERIHEPATIC FLUID +
LEFT RENAL CORTICAL CYST
HRCT OF CHEST : FIBRO BRONCHIECTATIC /FIBROCALCIFIC ARCHITECTURAL
DESTURCTION OF LEFT UPPER LOBE - APICOPOSTERIOR SEGMENT AND SMALL PART OF
ANTERIOR SEGMENT CAUSING MODERATE IPSILATERAL MEDIASTINAL SHIFT AND
UPWARD DEVIATION OF LEFT HILUM. MODERATE RIGHT APICOPOSTERIOR PLEURAL
THICKENING. MODERATE LEFT APIUCAL PLAUERAL THICKENING FEW FIBRO NODULAR FIBRO CALCIFIC LESIONS IN RIGHT UPPER LOBE -SEQUELAE OF CHRONIC
GRANULOMATOUS INFECTION LIKE TB. HYPERINFLATED LOWER LOBE OF LEFT LUNG
** Tentative Date Page-3
KIMS HOSPITALS
MD CT SCAN BRAIN - NO ABNORMALITY DETECTED IN BRAIN
SCLEROTIC RIGHT MASTOID WITH PARTIAL OPACIFICATION OF RIGHT MIDDLE EAR CAVITY
- S/O CHRONIC OTITIS MASTOIDITIS
BLOOD TRANSFUSION WAS DONE ON 12/7/25
2D ECHO REPORT SCREENING : NO RWMA , MILD LVH +
MILD MR + , MILD TR+ WITH PAH , MILD PR , TRIVIAL AR
SCLEROTIC AV NO AS/MS
IAS INTACT /ANEURYSM
EF =63%, RVSP=40+05=45MMHG
GOOD LV SYSTOLIC FUNCTION
GRADE 2 DIASSTOLIC DYSFUCNTION
IVC SIZE [1.15CMS] COLLAPSING
MINIMLA PE + , NO LV CLOT
Investigation
PH 7.15 7.35-7.45PCO2 39.9 mmHg 35-45 mmHgPO2 158 mmHg 85-95 mmHgHCO3 13.6
mmol/L St. HCO3 13.6 mmol/L BEB -13.4 mmol/L BEecf -13.4 mmol/LTCO2 31.8 VOLO2 Sat 98.8 %O2Count 6.4 vol %, PH 7.19 7.35-7.45PCO2 31.4 mmHg 35-45 mmHgPO2 124 mmHg 85-95 mmHgHCO3 11.7mmol/L St. HCO3 12.7 mmol/LBEB -14.8 mmol/L BEecf -14.8 mmol/L TCO2 26.8 VOLO2 Sat 98.3 %O2 Count 7.8 vol %
HAEMOGLOBIN 7.5 gm/dl 13.0 - 17.0 Colorimetric LOX -PAPTOTAL COUNT 32,600 cells/cumm
4000 - 10000 Impedence NEUTROPHILS 94 % 40 - 80 Light Microscopy LYMPHOCYTES 02 % 20 -
40 Light Microscopy EOSINOPHILS 01 % 01 - 06 Light Microscopy MONOCYTES 03 % 02 - 10 Light Microscopy BASOPHILS 00 % 0 - 2 Light Microscopy PCV 18.8 vol % 40 - 50 Calculation M C V 84.3 fl 83 - 101 Calculation M C H 32.3 pg 27 - 32 Calculation M C H C 38.3 % 31.5 - 34.5 Calculation RDWďżľCV 13.7 % 11.6 - 14.0 Histogram RDW-SD 42.7 fl 39.0-46.0 Histogram RBC COUNT 2.23
millions/cumm 4.5 - 5.5 Impedence PLATELET COUNT 2.76 lakhs/cu.mm 1.5-4.1
Impedence SMEARRBC Normocytic normochromic Light Microscopy WBC Within normal limits Light Microscopy PLATELETS Adeqaute Light Microscopy HEMOPARASITES No hemoparasites seen Light Microscopy IMPRESSION Normocytic normochromic anemia with neutrophilic leukocytosis
UREA 90 mg/dl 12 - 42 Urease-GLDH CREATININE # 5.1 mg/dl 0.9 - 1.3 Modified Jaffe's URIC ACID 4.3 mmol/L 3.5 - 7.2 Uricase-POD With DHBS CALCIUM 8.3 mg/dl 8.6 - 10.2 Arsenazo
III PHOSPHOROUS 4.46 mg/dl 2.5 - 4.5 Direct UV without reduction SODIUM 130 mmol/L 136 - 145 Ion Selective Electrode POTASSIUM 3.4 mmol/L. 3.5 - 5.1 Ion Selective Electrode CHLORIDE 96 mmol/L 98 - 107 Ion Selective Electrode
** Tentative Date Page-4
KIMS HOSPITALS
HAEMOGLOBIN 6.9 gm/dl 13.0 - 17.0 Colorimetric LOX -PAPTOTAL COUNT 21,600 cells/cumm
4000 - 10000 Impedence NEUTROPHILS 92 % 40 - 80 Light Microscopy LYMPHOCYTES 04 % 20 -
40 Light Microscopy EOSINOPHILS 00 % 01 - 06 Light Microscopy MONOCYTES 04 % 02 - 10 Light Microscopy BASOPHILS 00 % 0 - 2 Light Microscopy PCV 19.2 vol % 40 - 50 Calculation
M CV 90.8 fl 83 - 101 Calculation M C H 326 pg 27 - 32 Calculation M C H C 35.9 % 31.5 - 34.5 Calculation RDWďżľCV 16.8 % 11.6 - 14.0 Histogram RDW-SD 56.2 fl 39.0-46.0 Histogram RBC COUNT 2.11 millions/cumm 4.5 - 5.5 Impedence PLATELET COUNT 2.50 lakhs/cu.mm 1.5-4.1
Impedence SMEAR RBC Normocytic normochromic Light Microscopy WBC Within normal limits Light Microscopy PLATELETS Adeqaute Light Microscopy HEMOPARASITES No hemoparasites seen Light MicroscopyIMPRESSION Normocytic normochromic anemia with neutrophilic leukocytosis
UREA 121 mg/dl 12 - 42 Urease-GLDH CREATININE # 6.7 mg/dl 0.9 - 1.3 Modified Jaffe's URIC ACID 6.0 mmol/L 3.5 - 7.2 Uricase-POD With DHBS CALCIUM 7.5 mg/dl 8.6 - 10.2 Arsenazo
III PHOSPHOROUS 6.6 mg/dl 2.5 - 4.5 Direct UV without reduction SODIUM 129 mmol/L 136 - 145 Ion Selective Electrode POTASSIUM 3.7 mmol/L. 3.5 - 5.1 Ion Selective Electrode CHLORIDE 94 mmol/L 98 - 107 Ion Selective Electrode
UREA 87 mg/dl 12 - 42 Urease-GLDHCREATININE 4.7 mg/dl 0.9 - 1.3 Modified Jaffe'sURIC ACID
4.0 mmol/L 3.5 - 7.2 Uricase-POD With DHBS CALCIUM 8.5 mg/dl 8.6 - 10.2 Arsenazo
IIIPHOSPHOROUS 4.8 mg/dl 2.5 - 4.5 Direct UV without reduction SODIUM 131 mmol/L 136 - 145 Ion Selective Electrode POTASSIUM 2.9 mmol/L. 3.5 - 5.1 Ion Selective Electrode CHLORIDE 94 mmol/L 98 - 107 Ion Selective Electrode
Urinary Chloride 228 mmol/day 170-250 mmol/day24 Hr URINARY POTASSIUM 36.2 mmol/day 25 -
125 mmol/day URINE VOLUME 200 ml
24 Hours UrinarySodium432 mmol/day 40-220 mmol/day24 Hr URINE VOLUME :200 ml
PH 7.31 7.35-7.45PCO2 28.0 mmHg 35-45 mmHgPO2 74.3 mmHg 85-95 mmHg HCO3 14.0
mmol/L St. HCO3 15.7 mmol/L BEB -10.8 mmol/L BEecf -10.9 mmol/LTCO2 30.7 VOLO2 Sat 95.8 %O2 Count 9.4 vol % Anti HCV Antibodies- RAPID Non-Reactive
HBsAg-RAPID Negative
HIV 1/2 Rapid Test Non-Reactive
** Tentative Date Page-5
KIMS HOSPITALS
HAEMOGLOBIN 7.3 gm/dl 13.0 - 17.0 Colorimetric LOX -PAPTOTAL COUNT 19,900 cells/cumm
4000 - 10000 Impedence NEUTROPHILS 91 % 40 - 80 Light Microscopy LYMPHOCYTES 03 % 20 -
40 Light Microscopy EOSINOPHILS 00 % 01 - 06 Light Microscopy MONOCYTES 06 % 02 - 10 Light Microscopy BASOPHILS 00 % 0 - 2 Light Microscopy PCV 19.1 vol % 40 - 50 Calculation M C V 84.1 fl 83 - 101 Calculation M C H 32.2 pg 27 - 32 Calculation M C H C 38.2 % 31.5 - 34.5 Calculation RDW ďżľ CV 13.7 % 11.6 - 14.0 Histogram RDW-SD 42.6 fl 39.0-46.0 Histogram RBC COUNT 2.27millions/cumm 4.5 - 5.5 Impedence PLATELET COUNT 2.51 lakhs/cu.mm 1.5-4.1
Impedence SMEARRBC Normocytic normochromic Light Microscopy WBC neutrophilic leukocytosis
Light Microscopy PLATELETS Adequate Light Microscopy HEMOPARASITES No hemoparasites seen Light Microscopy IMPRESSION Normocytic normochromic anemia with neutrophilic leukocytosis PH 7.34 7.35-7.45PCO2 35.4 mmHg 35-45 mmHgPO2 77.9 mmHg 85-95 mmHgHCO3 18.8mmol/L St. HCO3 19.6 mmol/L BEB -5.8 mmol/L BEecf -5.9 mmol/L TCO2 40.1 VOLO2 Sat 96.4 %O2 Count 11.9 vol %
HAEMOGLOBIN 8.2 gm/dl 13.0 - 17.0 Colorimetric LOX -PAPTOTAL COUNT 27,200 cells/cumm
4000 - 10000 Impedence NEUTROPHILS 93 % 40 - 80 Light Microscopy LYMPHOCYTES 03 % 20 -
40 Light Microscopy EOSINOPHILS 00 % 01 - 06 Light Microscopy MONOCYTES 04 % 02 - 10 Light Microscopy BASOPHILS 00 % 0 - 2 Light Microscopy PCV 22.6 vol % 40 - 50 Calculation M C V 89.7 fl
83 - 101 Calculation M C H 32.7 pg 27 - 32 Calculation M C H C 36.4 % 31.5 - 34.5 Calculation RDW ďżľCV 15.3 % 11.6 - 14.0 Histogram RDW-SD 51.3 fl 39.0-46.0 Histogram RBC COUNT 2.52
millions/cumm 4.5 - 5.5 Impedence PLATELET COUNT 2.15 lakhs/cu.mm 1.5-4.1
Impedence SMEAR RBC Normocytic normochromic Light Microscopy WBC increased count on smear with predominently neutrophelia Light Microscopy PLATELETS Adequate Light
Microscopy HEMOPARASITES No hemoparasites seen Light Microscopy IMPRESSION Normocytic
Normochromic anemia with neutrophilic leukocytosis
UREA 34 mg/dl 12 - 42 Urease-GLDH CREATININE 2.4 mg/dl 0.9 - 1.3 Modified Jaffe's URIC ACID
2.0 mmol/L 3.5 - 7.2 Uricase-POD With DHBS CALCIUM 9.8 mg/dl 8.6 - 10.2 Arsenazo
IIIPHOSPHOROUS 3.44 mg/dl 2.5 - 4.5 Direct UV withoutreductionSODIUM 138 mmol/L 136 - 145
Ion Selective Electrode POTASSIUM 3.4 mmol/L. 3.5 - 5.1 Ion Selective Electrode CHLORIDE 104
mmol/L 98 - 107 Ion Selective Electrode
** Tentative Date Page-6
KIMS HOSPITALS
HAEMOGLOBIN 8.6 gm/dl 13.0 - 17.0 Colorimetric LOX -PAPTOTAL COUNT 18,800 cells/cumm
4000 - 10000 Impedence NEUTROPHILS 92 % 40 - 80 Light Microscopy LYMPHOCYTES 03 % 20 -
40 Light Microscopy EOSINOPHILS 01 % 01 - 06 Light Microscopy MONOCYTES 04 % 02 - 10 Light Microscopy BASOPHILS 00 % 0 - 2 Light Microscopy PCV 24.0 vol % 40 - 50 Calculation M C V 89.9 fl 83 - 101 Calculation M C H 32.2 pg 27 - 32 Calculation M C H C 35.8 % 31.5 - 34.5 Calculation RDW ďżľCV 15.2 % 11.6 - 14.0 Histogram RDW-SD 50.3 fl 39.0-46.0 Histogram RBC COUNT 2.68 millions/cumm 4.5 - 5.5 Impedence PLATELET COUNT 2.31 lakhs/cu.mm 1.5-4.1
Impedence SMEAR RBC Normocytic normochromic Light Microscopy WBC Within normal limits Light Microscopy PLATELETS Adequate Light Microscopy HEMOPARASITES No hemoparasites seen Light Microscopy IMPRESSION Normocytic normochromic anemia with neutrophilic leukocytosis
UREA 48 mg/dl 12 - 42 Urease-GLDH CREATININE 3.0 mg/dl 0.9 - 1.3 Modified Jaffe's URIC ACID
2.2 mmol/L 3.5 - 7.2 Uricase-POD With DHBS CALCIUM 9.8 mg/dl 8.6 - 10.2 Arsenazo
III PHOSPHOROUS 3.71 mg/dl 2.5 - 4.5 Direct UV without reduction SODIUM 138 mmol/L 136 - 145 Ion Selective Electrode POTASSIUM 2.8 mmol/L. 3.5 - 5.1 Ion Selective Electrode CHLORIDE 101mmol/L 98 - 107 Ion Selective
UREA 54 mg/dl 12 - 42 Urease-GLDH CREATININE 3.4 mg/dl 0.9 - 1.3 Modified Jaffe's URIC ACID
2.7 mmol/L 3.5 - 7.2 Uricase-POD With DHBS CALCIUM 9.9 mg/dl 8.6 - 10.2 Arsenazo
IIIPHOSPHOROUS 3.7 mg/dl 2.5 - 4.5 Direct UV without reduction SODIUM 139 mmol/L 136 - 145 Ion Selective Electrode POTASSIUM 3.0 mmol/L. 3.5 - 5.1 Ion Selective Electrode CHLORIDE 102 mmol/L 98 - 107 Ion Selective Electrode
SODIUM 136 mmol/L 136 - 145 Ion Selective Electrode POTASSIUM 3.0 mmol/L 3.5 - 5.1 Ion
Selective Electrode CHLORIDE 102 mmol/L 98 - 107 Ion Selective Electrode CALCIUM IONIZED 1.18 mmol/L Cord Blood: 1.30 - 1.602Hrs: 1.21 - 1.4624Hrs: 1.10 - 1.363Days: 1.15 - 1.425Days: 1.22 - 1.48Adults: 1.16 - 1.32
APTT TEST 33 Sec
Prothrombin Time 17 Sec 10-16secINR 1.25
UREA 28 mg/dl 12 - 42 Urease-GLDH CREATININE 2.6 mg/dl 0.9 - 1.3 Modified Jaffe's URIC ACID
2.6 mmol/L 3.5 - 7.2 Uricase-POD With DHBS CALCIUM 9.3 mg/dl 8.6 - 10.2 Arsenazo
III PHOSPHOROUS 4.7 mg/dl 2.5 - 4.5 Direct UV without reduction SODIUM 137 mmol/L 136 - 145 Ion Selective Electrode POTASSIUM 4.2 mmol/L. 3.5 - 5.1 Ion Selective Electrode CHLORIDE 99 mmol/L 98 - 107 Ion Selective Electrode
** Tentative Date Page-7
KIMS HOSPITALS,
HAEMOGLOBIN 8.0 gm/dl 13.0 - 17.0 Colorimetric LOX -PAPTOTAL COUNT 26,200 cells/cumm
4000 - 10000 Impedence NEUTROPHILS 82 % 40 - 80 Light Microscopy LYMPHOCYTES 10 % 20 -
40 Light Microscopy EOSINOPHILS 02 % 01 - 06 Light Microscopy MONOCYTES 06 % 02 - 10 Light Microscopy BASOPHILS 00 % 0 - 2 Light Microscopy PCV 21.7 vol % 40 - 50 Calculation
M CV 86.8 fl 83 - 101 Calculation M C H 32.0 pg 27 - 32 Calculation M C H C 36.9 % 31.5 - 34.5 Calculation RDW ďżľ CV 14.6 % 11.6 - 14.0 Histogram RDW-SD 46.7 fl 39.0-46.0 Histogram RBC COUNT 2.50 millions/cumm 4.5 - 5.5 Impedence PLATELET COUNT 2.0 lakhs/cu.mm 1.5-4.1
Impedence SMEARRBC Normocytic normochromic Light Microscopy WBC Increased counts on smear with absolute neutrophilia Light Microscopy PLATELETS Adequate in number and distribution Light Microscopy HEMOPARASITES No hemoparasites seen Light Microscopy IMPRESSION Normocytic normochromic anemia with neutrophilic leucocytosis
Total Bilurubin 1.04 mg/dl 0 - 1 Jendrassic &Groff's Direct Bilurubin 0.21 mg/dl 0.0 - 0.2 Jendrassic
& Groff's SGOT(AST) 28 IU/L 0 - 35 Modified IFCCSGPT(ALT) 10 IU/L 0 - 45 Modified
IFCC ALKALINEPHOSPHATASE 54 IU/L 53 - 280 PNPP-DEATOTAL PROTEINS 5.1 gm/dl 6.4 - 8.3 Biuret ALBUMIN 2.72 gm/dl 3.5 - 5.2 BCGA/G RATIO 1.14 PH 7.238 7.35-7.45PCO2 35.9 mmHg 35-45 mmHgPO2 106 mmHg 85-95 mmHgHCO3 14.8 mmol/LSt.HCO3 15.4 mmol/L BEB -11.3 mmol/L BEecf -11.2 mmol/L TCO2 33.0 VOLO2 Sat 98.1 %O2
Count 9.6 vol %
HAEMOGLOBIN 9.7 gm/dl 13.0 - 17.0 Colorimetric LOX -PAPTOTAL COUNT 27,800 cells/cumm
4000 - 10000 Impedence NEUTROPHILS 94 % 40 - 80 Light Microscopy LYMPHOCYTES 02 % 20 -
40 Light Microscopy EOSINOPHILS 01 % 01 - 06 Light Microscopy MONOCYTES 03 % 02 - 10 Light Microscopy BASOPHILS 00 % 0 - 2 Light Microscopy PCV 26.6 vol % 40 - 50 Calculation
M C V 85.5 fl 83 - 101 Calculation M C H 31.2 pg 27 - 32 Calculation M C H C 36.5 % 31.5 - 34.5 Calculation RDW ďżľ CV 14.8 % 11.6 - 14.0 Histogram RDW-SD 46.3 fl 39.0-46.0 Histogram RBC COUNT 3.11 millions/cumm 4.5 - 5.5 Impedence PLATELET COUNT 1.64 lakhs/cu.mm 1.5-4.1
Impedence SMEAR RBC Normocytic normochromic Light Microscopy WBC neutrophilic leukocytosis
Light Microscopy PLATELETS Adequate Light Microscopy HEMOPARASITES No hemoparasites seen
Light Microscopy IMPRESSION Normocytic normochromic blood picture with neutrophilic leukocytosis
HAEMOGLOBIN 8.7 gm/dl 13.0 - 17.0 Colorimetric LOX -PAPTOTAL COUNT 18,800 cells/cumm
4000 - 10000 Impedence NEUTROPHILS 91 % 40 - 80 Light Microscopy LYMPHOCYTES 03 % 20 -
40 Light Microscopy EOSINOPHILS 01 % 01 - 06 Light Microscopy MONOCYTES 05 % 02 - 10 Light Microscopy BASOPHILS 00 % 0 - 2 Light Microscopy PCV 24.7 vol % 40 - 50 Calculation
M C V 89.7 fl 83 - 101 Calculation M C H 31.7 pg 27 - 32 Calculation M C H C 35.3 % 31.5 - 34.5 Calculation RDW ďżľ CV 15.2 % 11.6 - 14.0 Histogram RDW-SD 50.3 fl 39.0-46.0 Histogram RBC COUNT 2.75 millions/cumm 4.5 - 5.5 Impedence PLATELET COUNT 1.5 lakhs/cu.mm 1.5-4.1
Impedence SMEAR RBC Normocytic normochromic Light Microscopy WBC Within normal limits Light Microscopy PLATELETS Adequate Light Microscopy HEMOPARASITES No hemoparasites seen Light Microscopy IMPRESSION Normocytic normochromic anemia with neutrophilic leukocytosis
** Tentative Date Page-8
KIMS HOSPITALS
UREA 66 mg/dl 12 - 42 Urease-GLDH CREATININE 3.0 mg/dl 0.9 - 1.3 Modified Jaffe's URIC ACID
2.3 mmol/L 3.5 - 7.2 Uricase-POD With DHBS CALCIUM 8.8 mg/dl 8.6 - 10.2 Arsenazo
III PHOSPHOROUS 4.0 mg/dl 2.5 - 4.5 Direct UV without reduction SODIUM 135 mmol/L 136 - 145 Ion
Selective Electrode POTASSIUM 3.5 mmol/L. 3.5 - 5.1 Ion Selective Electrode CHLORIDE 98 mmol/L 98 - 107 Ion Selective Electrode PH 7.146 7.35-7.45PCO2 47.1 mmHg 35-45 mmHgPO2 81.6 mmHg 85-95 mmHgHCO3 15.6 mmol/LSt.HCO3 14.6 mmol/L BEB -12.4 mmol/L BEecf -11.7 mmol/LTCO2 34.7 VOLO2 Sat 94.8 %O2 Count 12.3 vol %
HAEMOGLOBIN 10.5 gm/dl 13.0 - 17.0 Colorimetric LOX -PAPTOTAL COUNT 29,500 cells/cumm
4000 - 10000 Impedence NEUTROPHILS 89 % 40 - 80 Light Microscopy LYMPHOCYTES 05 % 20 -
40 Light Microscopy EOSINOPHILS 01 % 01 - 06 Light Microscopy MONOCYTES 05 % 02 - 10 Light Microscopy BASOPHILS 00 % 0 - 2 Light Microscopy PCV 29.7 vol % 40 - 50 Calculation
M C V 88.4 fl 83 - 101 Calculation M C H 31.3 pg 27 - 32 Calculation M C H C 35.4 % 31.5 - 34.5 Calculation RDW ďżľ CV 16.2 % 11.6 - 14.0 Histogram RDW-SD 52.4 fl 39.0-46.0 Histogram RBC COUNT 3.3 millions/cumm 4.5 - 5.5 Impedence PLATELET COUNT 1.6 lakhs/cu.mm 1.5-4.1
Impedence SMEAR RBC Normocytic normochromic Light Microscopy WBC neutrophilic leukocytosis
Light Microscopy PLATELETS Adequate Light Microscopy HEMOPARASITES No hemoparasites seen Light Microscopy IMPRESSION Normocytic normochromic anemia with neutrophilic leukocytosis
Prothrombin Time 18 10-16secINR 1.33
HAEMOGLOBIN 9.0 gm/dl 13.0 - 17.0 Colorimetric LOX -PAPTOTAL COUNT 19,700 cells/cumm
4000 - 10000 Impedence NEUTROPHILS 94 % 40 - 80 Light Microscopy LYMPHOCYTES 02 % 20 -
40 Light Microscopy EOSINOPHILS 02 % 01 - 06 Light Microscopy MONOCYTES 02 % 02 - 10 Light Microscopy BASOPHILS 00 % 0 - 2 Light Microscopy PCV 26.6 vol % 40 - 50 Calculation
M C V 91.3 fl 83 - 101 Calculation M C H 31.1 pg 27 - 32 Calculation M C H C 34.0 % 31.5 - 34.5 Calculation RDW ďżľ CV 15.3 % 11.6 - 14.0 Histogram RDW-SD 50.2 fl 39.0-46.0 Histogram RBC COUNT 2.9
millions/cumm 4.5 - 5.5 Impedence PLATELET COUNT 1.2 lakhs/cu.mm 1.5-4.1
Impedence SMEAR RBC Normocytic normochromic Light Microscopy WBC neutrophilic leukocytosis
Light Microscopy PLATELETS inadequate Light Microscopy HEMOPARASITES No hemoparasites
seen Light Microscopy IMPRESSION Normocytic normochromic anemia with neutrophilic leukocytosis and mild thrombocytopenia
UREA 86 mg/dl 12 - 42 Urease-GLDHCREATININE 3.4 mg/dl 0.9 - 1.3 Modified Jaffe's URIC ACID
2.9 mmol/L 3.5 - 7.2 Uricase-POD With DHBS CALCIUM 8.5 mg/dl 8.6 - 10.2 Arsenazo
III PHOSPHOROUS 5.1 mg/dl 2.5 - 4.5 Direct UV without reduction SODIUM 138 mmol/L 136 - 145 Ion Selective Electrode POTASSIUM 5.5 mmol/L. 3.5 - 5.1 Ion Selective Electrode CHLORIDE 99 mmol/L 98 - 107 Ion Selective Electrode PH 7.10 7.35-7.45PCO2 45.8 mmHg 35-45 mmHg PO2 87.0 mmHg 85-95 mmHgHCO3 13.8 mmol/LSt.HCO3 13.0 mmol/LBEB -14.7 mmol/L BEecf -14.0mmol/LTCO2 31.2 VOLO2 Sat 94.3 %O2 Count 12.0 vol %
** Tentative Date Page-9
KIMS HOSPITALS
HAEMOGLOBIN 10.5 gm/dl 13.0 - 17.0 Colorimetric LOX -PAPTOTAL COUNT 40,000 cells/cumm
4000 - 10000 Impedence NEUTROPHILS 96 % 40 - 80 Light Microscopy LYMPHOCYTES 01 % 20 -
40 Light Microscopy EOSINOPHILS 00 % 01 - 06 Light Microscopy MONOCYTES 03 % 02 - 10 Light Microscopy BASOPHILS 00 % 0 - 2 Light Microscopy PCV 31.0 vol % 40 - 50 Calculation M C V 91.9 fl 83 - 101 Calculation M C H 31.2 pg 27 - 32 Calculation M C H C 33.9 % 31.5 - 34.5 Calculation RDW ďżľ CV 15.8 % 11.6 - 14.0 Histogram RDW-SD 52.8 fl 39.0-46.0 Histogram RBC COUNT 3.38 millions/cumm 4.5 - 5.5 Impedence PLATELET COUNT 1.53 lakhs/cu.mm 1.5-4.1
Impedence SMEAR RBC Normocytic normochromic Light Microscopy WBC Increased counts on smear with increased neutrophils Light Microscopy PLATELETS Adequate in number and distribution Light Microscopy HEMOPARASITES No hemoparasites seen Light Microscopy IMPRESSION Normocytic normochromic anemia with neutrophilic leucocytosis
UREA 114 mg/dl 12 - 42 Urease-GLDH CREATININE 3.8 mg/dl 0.9 - 1.3 Modified Jaffe's URIC ACID 3.2 mmol/L 3.5 - 7.2 Uricase-POD With DHBS CALCIUM 8.4 mg/dl 8.6 - 10.2 Arsenazo
III PHOSPHOROUS 6.3 mg/dl 2.5 - 4.5 Direct UV without reduction SODIUM 134 mmol/L 136 - 145 Ion Selective Electrode POTASSIUM 5.0 mmol/L. 3.5 - 5.1 Ion Selective Electrode CHLORIDE 98 mmol/L 98 - 107 Ion Selective Electrode PH 7.00 7.35-7.45PCO2 51.8 mmHg 35-45 mmHgPO2 59.8 mmHg 85-95 mmHgHCO3 12.2 mmol/L St. HCO3 10.6 mmol/L BEB -18.5 mmol/L BEecf -16.9 mmol/LTCO2 28.3 VOLO2 Sat 82.9 %O2 Count 11.8 vol %
UREA 136 mg/dl 12 - 42 Urease-GLDH CREATININE 3.9 mg/dl 0.9 - 1.3 Modified Jaffe's URIC ACID 3.7 mmol/L 3.5 - 7.2 Uricase-POD With DHBS CALCIUM 8.5 mg/dl 8.6 - 10.2 Arsenazo
III PHOSPHOROUS 5.8 mg/dl 2.5 - 4.5 Direct UV without reduction SODIUM 135 mmol/L 136 - 145 Ion Selective Electrode POTASSIUM 4.6 mmol/L. 3.5 - 5.1 Ion Selective electrode CHLORIDE 102 mmol/L 98 - 107 Ion Selective Electrode
PH 7.04 7.35-7.45PCO2 67.7 mmHg 35-45 mmHgPO2 56.1 mmHg 85-95 mmHg HCO3 17.6
mmol/L St. HCO3 14.3 mmol/L BEB -12.6 mmol/L BEecf -11.3 mmol/LTCO2 40.8 VOLO2 Sat 83.7 %O2 Count 10.3 vol %
HAEMOGLOBIN 9.1 gm/dl 13.0 - 17.0 Colorimetric LOX -PAPTOTAL COUNT 25,000 cells/cumm
4000 - 10000 Impedence NEUTROPHILS 91 % 40 - 80 Light Microscopy LYMPHOCYTES 03 % 20 -
40 Light Microscopy EOSINOPHILS 01 % 01 - 06 Light Microscopy MONOCYTES 05 % 02 - 10 Light
Microscopy BASOPHILS 00 % 0 - 2 Light Microscopy PCV 27.8 vol % 40 - 50 Calculation M C V 95.0 fl 83 - 101 Calculation M C H 31.3 pg 27 - 32 Calculation M C H C 32.9 % 31.5 - 34.5 Calculation RDW dzl CV 15.6 % 11.6 - 14.0 Histogram RDW-SD 51.6 fl 39.0-46.0 Histogram RBC COUNT 2.9
millions/cumm 4.5 - 5.5 Impedence PLATELET COUNT 1.5 lakhs/cu.mm 1.5-4.1
Impedence SMEAR RBC Normocytic normochromic Light Microscopy WBC increased count on smear with increased neutrophilis Light Microscopy PLATELETS Adequate Light Microscopy HEMOPARASITES No hemoparasites seen Light Microscopy IMPRESSION Normocytic
normochromic anemia with neutrophilic leukocytosis
** Tentative Date Page-10
KIMS HOSPITALS
UREA 160 mg/dl 12 - 42 Urease-GLDH CREATININE 4.6 mg/dl 0.9 - 1.3 Modified Jaffe'sURIC ACID
4.0 mmol/L 3.5 - 7.2 Uricase-POD With DHBS CALCIUM 8.5 mg/dl 8.6 - 10.2 Arsenazo
IIIPHOSPHOROUS 6.4 mg/dl 2.5 - 4.5 Direct UV without reduction SODIUM 140 mmol/L 136 - 145 Ion Selective Electrode POTASSIUM 5.2 mmol/L. 3.5 - 5.1 Ion Selective Electrode CHLORIDE 106 mmol/L 98 - 107 Ion Selective Electrode
Treatment Given (Enter only Generic Name)
RT FEEDS 50ML WATER 2ND HRLY
50MILK 4TH HRLY WITH 2 SCOOPS OF PROTEIN POWDER TWICE DAILY
INJ MEROPENEM 500MG IV/BD
INJ LEVOFLOXACIN 500MG IV/OD
INJ NORAD 2 AMP IN 45ML NS @11ML/HRT
INJ DOPAMINE 1 AMP 200 IN 45 ML NS @2.5 ML/HR
TAB NODOSIS 1000MG RT/BD
NEB WITH BUDECORT 12TH HRLY3%NS MUCOMIST 4TH HRLY
NEB WITH IPRAVENT 6TH HRLY
TAB ISONIAZID 75MG RT/OD
TAB RIFAMPICIN 150MG RT/OD
TAB PYRAZINAMIDE 400MG RT/OD
TAB ETHAMBUTOL 275MG RT/OD
INJ PIPTAZ 2.25G IV /TID
INJ AZITHROMYCIN 500MG IV /OD
Follow Up
** Tentative Date Page-11
KIMS HOSPITALS
53 YRS OLD MALE K/C/O CKD WAS BROUGHT TO CASUALTY IN ALTERED SENSORIUM
SINCE 4 DAYS, WITH H/O FEVER, COUGH WITH SPUTUM 15DAYS AGO, H/O HEAD TRAUMA
P/H/O TB 2 YRS AGO VITALS ON PRESENTATION: TEMP - AFEBRILE, BP -170/90MMHG, PR-
82BPM, RR -18CPM SPO2 -98% ON RA, ON AUSCULTATION B/L DIFFUSE COARSE CREPTS +
, ABG REVEALED PH -7.4, PCO2 -21, PO2 -98.1, SO2-99, HCO3 -13. ALL NECESSRY
INVESTIGATION WERE SENT ALONG WITH BLOOD AND URINE C/S, IMMEDIATE CT BRAIN AND CT CHEST WERE DONE, CT BRAIN SHOWED NO ABNORMALITY, CT CHEST REVEALED. CHRONIC GRANULOMATOUS INFECTION LIKE TUBERCULOSIS.STARTED ON ANTIBIOTIC AND SUPPORTIVE TREATMENT, SHIFTED TO ICU. INVESTIGFATION REVEALED HYPOOSMOLAR HYPONATREMIA AND UREMIA, ELEVELATED COUNTS, SEVERE ANEMIA, CONSIDERING ALTERED SENORIUM D/T METABOLIC ENCEPHALOPATHY, PT STARTED ON 3% NACL INFUSION AND CONTINUED WITH REST ON DAY 1 AND DAY 2, ON DAY 3 INSPITE OF ALL ABOVE TREATMENT, THERE WAS DECREASE IN SENOSRIUM AND FALL IN SATURATION WITH GCS - E4V1M1, PATIENT WAS INTUBATED AND CONNECTED TO MECHANICAL VENTILATOR. AFTER STABILISATION PATIENT WAS TAKEN FOR 2 SESSIONS OF HEMODIALYSIS WITH 2 PRBC TRANSFUSION ON DAY 3 AND 4. SENSORIUM IMPROVED GRADUALLY SIMULTANEOSLY SPONTANEOUS BREATH TRIAL WAS TRIED AND WEANED OFF FROM VENTILALTORY SUPPORT, EXTUBATED ON DAY 5. VITALS WERE STABLE POST EXTUBATION. CONTINUED WITH HEMODIALYSIS SESSIONS ON DAY 5. I/V/O INADEQUATE COUGH POST EXTUBATION, POOL UP OF SECRETIONS IN LOWER RESPIRATORY TRACT, FREQUENT NEBULISATION ORAL SUCTIONING, ANTISIALOGUE MEDICATIONS, CHEST
PHYSIOTHERPAY WERE DONE, REPEAT HRCT CHEST DONE - SHOWED? REACTIVATION
OF GRANULOMATOUS INFECTION, LEFT LOWER LOBE COLLAPSE, PULMONOLOGY OPINION WAS TAKEN AND BRONCHOSCOPY WAS DONE I/V/O OBSTRUCTIVE LUNG COLLAPSE, BAL WAS DONE, SECRETIONS SENT FOR CULTURES AND SENSITIVITY. INCREASED RESPIRATORY EFFORTS, RETENTION OF CO2 -PT WAS INTUBATED ON DAY 7 I/V/O .IN VIEW OF RAISED TLC ANTIBIOTICS WAS ESCALATED, ATT WAS STARTED IN VI
** Tentative Date Page-12
KIMS HOSPITALS
EW OF SUSPICION OF TB, VENTILATION AND SUPPORTIVE TREATEMENT WERE
CONTINUED. HEMODILAYSIS SESSIONS WERE DONE SIMULTANEOUSLY, BLOOD CULTURE REVELAED BACTERIAL GROWTH. PATIENT SPONTANOEUS BREATH TRIALS WERE DONE BUT PATIENT COULDNT TOLERATE WEANING OFF FROM VENTILALTION. THERE WERE MORE INCREASE IN SECRETIONS IN LOWER RESPIRATORY TRACT, DECREASE LUNG COMPLIANCE, SEDATION AND PARAYLTICS WERE CONTINUED, ON DAY 9 THERE WAS SUDDEN BRADYCARDIA AND ABSENT CENTRAL PULSES WERE ABSENT, 2 CYCLES OF CPRWAS DONE AND ROSC ACHIEVED. ON DAY 11 IONOTROPIC SUPPORT WITH INJ NORAD WAS STARTED I/V/O HYPOTENSION, 2ND INOTROPIC INJ DOPAMINE STARTED AS THERE WAS NO IMPROVEMENT IN THE BLOOD PRESSURE. WITH ABOVE ALL TREATMENT MEASURES THERE IS NO SIGNIFICANT IMPROVEMENT IN PATIENT'S CONDITION, SO TRACHEOSTOMY WAS DONE ON DAY 5 POST INTUBATION. [DAY 11]. WITH ADEQUATE VENTILATORY MEASURES, AND OTHER SUPPORTIVE TREATMENT, ON DAY 13 PATIENT DEVELOPED BRADYCARDIA, ABSENT CENTRAL PULSES, NON RECORDABLE BP, IMMEDIATE CPR WAS STARTED ACCORDING TO LATEST ACLS GUIDELINES. INSPITE OF ABOVE RESUSCITATIVE EFFORTS, PATIENT COULDNT BE REVIVED AND DECLARED DEATH
AT 9:05 AM ON 17/7/2025, SUREGERY REFFERAL WAS TAKEN ON 15/7/25 I/V/O BED SORE
GRADE 2 AND THEIR ADVICE WAS FOLLOWED
IMMEDIATE CAUSE OF DEATH: TYPE 1 RESPIRATORY FAILURE, SPESIS WITH VENTILLATOR ASSOCIATED PNEUMONIA, LEFT LUNG COLLAPSE? REACTIVATION OF TB
ANNTECEDENT CAUSE OF DEATH: UREMIC ENCEPHALOPATHY, TRUE HYPONATREMIA
[RESOLVED], ACUTE ON CHRONIC KIDNEY DISEASE, ANEMIA OF CHRONIC DISEASE, PAST HISTORY OF PULMONARY TB
Death Date
Date:17/7/25
Ward: ICU
Unit:4
Faculty Signature
SIGNATURE OF PATIENT /ATTENDER:
SIGNATURE OF PG/INTERNEE:
SIGNATURE OF ADMINISTRATOR
No comments:
Post a Comment