Pulmonary Pathology Case 6
1. The patient is a 63-year-old Caucasian woman with a history of
alpha-1 antitrypsin deficiency diagnosed in 1986. She underwent a right lung
transplant in 1996. In April of 2003, she was diagnosed with post transplant
lymphoma of the jejunum with nodules in the right transplanted lung. Her past
medical history is also significant for chronic renal insufficiency,
diabetes mellitus type II, hypertension and diverticulitis. She presents on
10-22 with hypotension. Her hospital course was complicated by sepsis, atrial
fibrillation with a rapid ventricular response and perforated bowel. The
patient underwent two surgical procedures for resection of bowel and
exploration. Despite aggressive medical
therapy, the patient remained dependent on mechanical ventilation and total
parenteral nutrition until her death.
Admission H&P
MICU Note
Surgical H&P
Operative note
Operative note
Death Summary
Autopsy Report
Radiology
Reports X-ray Images
CXR 5-11-99 (baseline)
2. Review the case in order to answer the following questions:
1. What is the pertinent Clinical
History?
2. What is her underlying lung
disease?
3. What treatment did she receive
for this disease and how did it predispose her for the acute disease?
4. What are the pertinent Laboratory
findings to her lung disease and cause of death?
5. What was his hospital course?
6. Why did she die?
7. Give an academic review of:
Alpha-1
antitrypsin deficiency
Panlobular
emphysema
3. Prepare a
power point presentation including the above material to present to the entire
class. Make this a formal presentation
as if you were presenting at a major conference. You will have ten minutes to present and 5
minutes for questions. Be prepared to
answer questions about the case from the clinical faculty.
Radiology
CXR 5-11-99 Post
transplant film for baseline
CXR 10-7-03 PA and Lateral report
Lungs in-situ
Lungs inflated with formalin
Cross section of native lung with alpha-1 anti-trypsin deficiency
Sections of native lung
Sections of transplanted lung with nodule of lymphoma
High power of lung nodule of lymphoma
Liver low power, H&E
Liver low power, PAS with diastase
High power liver with PAS/D stain showing pink globules
|
PMH: ALLERGIES:
Codeine, Phenergan, No ASA products, Avoids narcotics Meds: PE:
130/70 130 20 Tm 36.7 A/P -pt
has had chest pressure for last several days, raising question of whether
A-flutter has been going on for > 48 hours -will
see whether EKG was done in clinic or on admit for comparison 2)
Renal 3) abdominal
pain 4)
heme |
|
HPI:
The Patient is a 63 yo female with a history of alpha-1-antitrypsin deficiency
first diagnosed in 1986; right lung transplant was performed in 1996. Mild
post transplant rejection. Was diagnosed with B-cell lymphoma in the jejunum
in April of this year after several months of abdominal pain and melena. Of
note, staging workup showed multiple lung nodules in transplanted lung,
pericardial effusion. Failed Rituxan; started CHOP therapy Pt
was admitted to the oncology service again on approximately 10/22 with
hypotension. She developed A-fib with RVR and was transferred to the MICU
service (10/23), where she was observed to have MAT. The patient's
hypotension and acute-on-chronic renal insufficiency responded well to
hydration; however, the patient had persistent MAT and was cardioverted
electively. Then the patient was transferred back to heme/ oncology (10/25).
On the night after transfer, the patient reverted to Atrial fibrillation with
RVR and was transferred to 4N. The patient was amiodarone loaded, continued
on an amiodarone oral dose, and started on a diltiazem gtt. On the night of
10/26-10/27, the patient became tachypneic and hypotensive. This was after starting
on oral diltiazem, with the gtt still going after starting PMH: PSurgHx: ALLERGIES:
Codeine, Phenergan, ASA products, Avoids narcotics Outpatient
Meds: FH: SH: ROS: PE: LABS: CXR:
L lung with bullous emphysema and a pleural effusion. Right lung with
vascular congestion. A: 63
YOF s/p Right lung transplant for A1AT deficiency, with lymphoma, in the
midst of CHOP, with neutropenia and recurrent a-fib, hypotension, and an
increasing left pleural effusion. Problem
List: 2.
A-fib with RVR 3.
Hypotension: DDX= hypothyroid, adrenal failure, diltiazem, sepsis (early),
hemorrhage, 4.
Tachypnea 5.
S/P Lung txp 6.
CRI 7.
DM2, slightly suppressed TSH. Plan
by problem: 2.
Continue amiodarone orally; cardiovert if pt becomes unstable. Keep electrolytes
optimized. Continue heparin gtt. Not
starting Coumadin in case pt will have effusion tapped soon. 3.
Fluid bolus challenge. If T>38.3, start neutropenic coverage. Stop diltiazem
gtt. Reduce oral diltiazem if BP remains low. Check EKG, troponin, FT4.
Recheck HCT. 4.
BiPAP at night, consider diagnostic AND therapeutic pleural tap. 5.
Continue prednisone and tacrolimus, followed by lung transplant service. 6.
CRI- renal dose medications 7.
NPH when eating, FSBG, SSI HOUSEKEEPING ADDENDUM: Plan
for today: |
|
cc: abdominal pain/acute abdomen HPI:
The Patient is a 63 yo female with a history of alpha-1-antitrypsin
deficiency diagnosed 1986; s/p r lung transplant 1996, recently diagnosed
with B-cell lymphoma involving jejunum in April of this year after several
months of abdominal pain and melena. Staging w/u showed multiple lung nodules
in transplanted lung, pericardial effusion. Pt had 2 recent flare ups of
diverticulitis early September and again 10/7. Pt admitted on 10/22 for
hypotension, acute/chronic renal failure. Transferred to MICU for A-fib with
RVR and again for tachypnea and hypotension. She has had abdominal pain for
about 6 or 7 days, which has become progressively worse over this time. She
has been constipated since her PMH: PSurgHx: ALLERGIES:
Codeine, Phenergan, ASA products, Avoids narcotics Meds: FH: SH: ROS: PE: LABS: CXR--r
sided consolidation, IMPROVED LUNG OPACITIES, MOST LIKELY PNEUMONIA WITHIN
THE PATIENT'S TRANSPLANTED RIGHT LUNG. |
|
Surgical Pathology Report |
|||||||
|
SP FINAL REPORT Sigmoid
|
|||||||
|
|||||||
|
|
|||||||
|
SP FINAL REPORT Stomach Nodule |
|||||||
|
|
|
|
|
|
|
||||||||||||||||||
|
Collected D/T |
WBC |
RBC |
Hgb |
Hct |
MCV |
Plt |
%P |
%Bd |
%L |
%M |
%E |
%BA |
ANC |
#P |
#L |
#M |
#E |
#BA |
|
|
58.57 |
3.44 |
10.0 |
32.3 |
93.7
|
229
|
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
|
|
58.37 |
3.47 |
10.2 |
31.0 |
89.3
|
247
|
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
|
|
72.91 |
3.43 |
10.0 |
30.7 |
89.5
|
286
|
93 |
5
|
1 |
1 |
-- |
-- |
71.5 |
-- |
-- |
-- |
-- |
-- |
|
|
68.38 |
3.56 |
10.5 |
33.2 |
93.1
|
271
|
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
|
|
62.73 |
2.40 |
7.1 |
22.2 |
92.5
|
333
|
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
|
|
67.91 |
3.56 |
10.5 |
32.1 |
90.1
|
483 |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
|
|
56.25 |
3.37 |
9.6 |
29.6 |
87.9
|
453 |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
|
|
53.35 |
3.48 |
9.9 |
30.6 |
87.9
|
428 |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
|
|
60.08 |
3.74 |
10.6 |
32.8 |
87.7
|
506 |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
|
|
66.77 |
3.98
|
11.4 |
36.2
|
90.8
|
567 |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
|
|
58.11 |
3.90
|
11.2 |
34.9
|
89.4
|
436 |
86.3 |
--
|
11.9 |
1.5 |
0.0 |
0.4 |
--
|
50.1 |
6.9 |
0.9 |
0.0
|
0.2 |
|
|
53.46 |
4.12
|
11.9 |
36.8
|
89.5
|
460 |
88 |
3
|
3 |
6
|
-- |
-- |
48.6 |
-- |
-- |
-- |
-- |
-- |
|
|
39.53 |
3.86 |
11.1 |
34.0 |
88.2
|
221
|
95 |
--
|
1 |
4
|
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
|
|
38.41 |
4.04
|
11.5 |
35.3
|
87.4
|
263
|
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
|
|
-- |
-- |
-- |
-- |
-- |
-- |
78 |
16 |
3 |
1 |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
|
|
44.94 |
4.25
|
12.6
|
38.1
|
89.8
|
454 |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
|
|
34.32 |
3.88
|
11.6 |
35.1
|
90.3
|
318
|
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
|
|
27.27 |
3.06 |
9.0 |
26.7 |
87.4
|
315
|
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
|
|
-- |
-- |
-- |
-- |
-- |
-- |
53
|
36 |
6 |
5
|
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
|
|
23.34 |
3.12 |
8.9 |
27.6 |
88.4
|
236
|
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
|
|
12.58 |
3.14 |
9.0 |
27.6 |
87.8
|
156 |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
|
|
-- |
-- |
-- |
-- |
-- |
-- |
36 |
45 |
4 |
11 |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
|
|
3.15 |
3.36 |
9.7 |
29.3 |
87.2
|
95 |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
|
|
0.49 |
2.87 |
8.4 |
24.7 |
85.8
|
35 |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
|
|
0.14 |
3.15 |
9.1 |
27.3 |
86.7
|
28 |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
|
|
0.14 |
3.58 |
10.3 |
30.7 |
85.9
|
41 |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
|
|
0.13 |
3.27 |
9.4 |
29.0 |
88.5
|
61 |
60
|
--
|
40
|
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
|
|
0.15 |
3.18 |
9.4 |
27.6 |
86.8
|
76 |
55
|
--
|
45 |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
|
|
0.7 |
3.44 |
10.2 |
28.8 |
84.0
|
101 |
68
|
|
24
|
2
|
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
|
|
34.6 |
3.81 |
11.2 |
32.1 |
84.0
|
503 |
96 |
--
|
2 |
2
|
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
|
|
33.73 |
4.23
|
12.3
|
37.6
|
88.9
|
815 |
87.7 |
--
|
8.1 |
3.1 |
0.3 |
0.8 |
--
|
29.6 |
2.7
|
1.1 |
0.1 |
0.3 |
|
|
35.34 |
4.08
|
11.9 |
36.2
|
88.8
|
798 |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
|
|
31.30 |
3.98
|
11.2 |
35.3
|
88.8
|
847 |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
|
|
26.19 |
3.97
|
11.4 |
34.0 |
85.8
|
830 |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
|
|
26.54 |
4.21
|
12.2
|
35.8
|
85.1
|
888 |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
|
|
23.99 |
4.58
|
13.0
|
38.1
|
83.1
|
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
|
|
23.95 |
4.40
|
12.2
|
36.7
|
83.3
|
800 |
87.2 |
--
|
9.3 |
3.2 |
0.1 |
0.3 |
--
|
20.9 |
2.2 |
0.8 |
0.0 |
0.1 |
|
|
22.32 |
4.52
|
12.8
|
37.8
|
83.7
|
660 |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
|
|
22.03 |
3.50 |
9.3 |
28.7 |
82.0
|
689 |
85.0 |
--
|
12.0 |
2.8 |
0.1 |
0.3 |
--
|
18.7 |
2.6
A |
0.6 |
0.0 |
0.1 |
|
|
11.3 |
3.24 |
9.0 |
25.8 |
80.0
|
132 |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
|
|
20.6 |
3.97
|
11.2 |
32.8 |
83.0
|
543 |
76
|
6 |
9 |
7
|
--
|
1
|
16.9 |
-- |
-- |
-- |
-- |
-- |
|
|
20.0 |
4.00
|
11.3 |
33.0 |
83.0
|
536 |
83 |
5
|
5 |
6
|
1
|
-- |
17.6 |
-- |
-- |
-- |
-- |
-- |
|
|
|||||||||||
|
Collected Date/Time |
Na |
K |
Cl |
CO2 |
BUN |
SCr |
Glc |
Ca |
TP |
PO4 |
Mg |
|
|
136 |
3.7 |
104 |
22 |
113 |
3.0 |
348 |
8.9 |
-- |
7.7 |
-- |
|
|
138 |
3.3 |
103 |
26 |
108 |
3.1 |
106 |
8.3 |
4.2 |
-- |
-- |
|
|
137 |
4.0 |
99 |
29 |
109 |
3.2 |
106 |
8.7 |
-- |
-- |
-- |
|
|
136 |
4.4 |
99 |
26 |
103 |
3.1 |
180 |
8.4 |
-- |
-- |
-- |
|
|
137 |
4.3 |
95 |
25 |
100 |
3.2 |
151 |
8.4 |
-- |
10.2 |
-- |
|
|
134 |
3.7 |
95 |
28 |
111 |
3.1 |
65 |
7.7 |
4.0 |
-- |
-- |
|
|
134 |
3.0 |
95 |
28 |
114 |
3.3 |
67 |
7.3 |
-- |
9.6 |
-- |
|
|
134 |
4.3 |
103 |
20 |
116 |
3.3 |
90 |
8.1 |
-- |
10.7 |
-- |
|
|
135 |
4.0 |
103 |
22 |
117 |
3.3 |
90 |
8.1 |
-- |
-- |
-- |
|
|
135 |
3.9 |
104 |
20 |
110 |
3.3 |
125 |
7.7 |
-- |
-- |
-- |
|
|
136 |
3.9 |
106 |
16 |
114 |
3.4 |
119 |
7.9 |
-- |
-- |
-- |
|
|
136 |
4.3 |
112 |
14 |
114 |
3.3 |
74 |
8.4 |
-- |
9.7 |
-- |
|
|
137 |
4.2 |
111 |
16 |
116 |
3.5 |
130 |
8.7 |
-- |
9.8 |
2.2 |
|
|
135 |
4.7 |
113 |
14 |
113 |
3.3 |
107 |
7.8 |
-- |
9.2 |
-- |
|
|
137 |
4.7 |
113 |
15 |
107 |
3.4 |
79 |
8.1 |
-- |
9.0 |
-- |
|
|
139 |
4.8 |
114 |
17 |
101 |
3.2 |
103 |
7.9 |
-- |
7.8 |
-- |
|
|
135 |
5.0 |
112 |
17 |
100 |
3.2 |
123 |
8.1 |
-- |
-- |
-- |
|
|
138 |
4.8 |
113 |
16 |
96 |
3.1 |
274 |
7.5 |
4.7 |
6.9 |
2.1 |
|
|
136 |
5.1 |
112 |
18 |
95 |
2.9 |
289 |
6.8 |
-- |
-- |
-- |
|
|
137 |
4.3 |
110 |
20 |
115 |
3.5 |
103 |
7.7 |
4.7 |
5.9 |
-- |
|
|
139 |
4.3 |
111 |
20 |
107 |
3.4 |
125 |
7.9 |
-- |
-- |
-- |
|
|
140 |
3.9 |
110 |
22 |
105 |
3.3 |
75 |
8.2 |
-- |
-- |
-- |
|
|
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
4.4 |
-- |
-- |
|
|
140 |
4.3 |
107 |
24 |
114 |
3.1 |
213 |
8.0 |
4.8 |
-- |
-- |
|
|
143 |
3.9 |
110 |
26 |
119 |
2.8 |
100 |
8.1 |
-- |
-- |
-- |
|
|
146 |
3.3 |
114 |
23 |
141 |
2.9 |
96 |
7.8 |
-- |
-- |
-- |
|
|
142 |
4.9 |
113 |
18 |
145 |
3.1 |
297 |
7.9 |
-- |
-- |
-- |
|
|
144 |
4.6 |
112 |
20 |
154 |
3.6 |
131 |
8.8 |
5.0 |
-- |
2.4 |
|
|
138 |
5.6 |
111 |
15 |
157 |
3.7 |
200 |
9.3 |
-- |
-- |
-- |
|
|
139 |
5.3 |
111 |
16 |
149 |
3.8 |
280 |
9.0 |
5.3 |
-- |
-- |
|
|
139 |
5.3 |
114 |
15 |
148 |
3.8 |
275 |
8.5 |
-- |
-- |
-- |
|
|
137 |
4.5 |
111 |
16 |
140 |
3.7 |
274 |
7.6 |
-- |
8.2 |
2.1 |
|
|
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
4.8 |
8.3 |
-- |
|
|
134 |
5.0 |
104 |
18 |
153 |
4.2 |
318 |
8.4 |
-- |
-- |
-- |
|
|
131 |
5.5 |
100 |
19 |
110 |
4.3 |
483 |
8.3 |
-- |
-- |
-- |
|
|
138 |
5.6 |
104 |
27 |
57 |
2.7 |
209 |
9.4 |
-- |
-- |
1.4 |
|
|
135 |
5.1 |
103 |
27 |
58 |
2.4 |
218 |
8.9 |
5.6 |
-- |
-- |
|
|
139 |
5.0 |
104 |
29 |
60 |
2.6 |
178 |
9.0 |
-- |
-- |
-- |
|
|
138 |
4.7 |
105 |
28 |
57 |
2.4 |
175 |
8.9 |
5.6 |
-- |
-- |
|
|
140 |
4.4 |
103 |
29 |
53 |
2.6 |
159 |
8.7 |
-- |
-- |
-- |
|
|
140 |
4.6 |
105 |
26 |
54 |
2.6 |
174 |
8.5 |
-- |
-- |
-- |
|
|
138 |
3.4 |
103 |
28 |
50 |
2.5 |
149 |
7.8 |
5.9 |
-- |
-- |
|
|
139 |
3.5 |
105 |
25 |
55 |
2.6 |
121 |
8.1 |
6.0 |
-- |
-- |
|
|
136 |
3.2 |
103 |
26 |
59 |
2.5 |
68 |
8.1 |
5.6 |
-- |
-- |
|
|
141 |
4.5 |
113 |
24 |
23 |
2.0 |
73 |
8.9 |
5.7 |
-- |
-- |
|
|
139 |
5.2 |
114 |
21 |
32 |
2.1 |
172 |
8.0 |
-- |
-- |
-- |
|
|
|||
|
Collected Date/Time |
ABO RH |
Antibody Screen |
Direct Coombs |
|
|
A
POS |
NEG |
-- |
|
|
A
POS |
NEG |
-- |
|
|
A
POS |
NEG |
-- |
|
|
A
POS |
NEG |
-- |
|
|
A
POS |
NEG |
|
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
||||
|
Collected Date/Time |
Lab Description |
Result/Unit |
H/L |
Ref Interval |
|
|
VANCOMYCIN,
RANDOM LEVEL |
30.9
ug/mL |
|
|
|
|
VANCOMYCIN,
TROUGH LEVEL |
15.6 ug/mL |
H |
5.0-10.0
|
|
|
TACROLIMUS
|
9.6
ng/mL |
|
|
|
|
VANCOMYCIN,
RANDOM LEVEL |
17.5
ug/mL |
|
|
|
|
VANCOMYCIN,
RANDOM LEVEL |
19.8
ug/mL |
|
|
|
|
TACROLIMUS
|
9.4
ng/mL |
|
|
|
|
TACROLIMUS
|
10.1
ng/mL |
|
|
|
|
VANCOMYCIN,
RANDOM LEVEL |
18.2
ug/mL |
|
|
|
|
VANCOMYCIN,
TROUGH LEVEL |
18.9 ug/mL |
H |
5.0-10.0
|
|
|
TACROLIMUS
|
12.1
ng/mL |
|
|
|
|
VANCOMYCIN,
TROUGH LEVEL |
19.7 ug/mL |
H |
5.0-10.0
|
|
|
TACROLIMUS
|
11.2
ng/mL |
|
|
|
|
TACROLIMUS
|
12.0
ng/mL |
|
|
|
|
VANCOMYCIN,
TROUGH LEVEL |
18.1 ug/mL |
H |
5.0-10.0
|
|
|
TACROLIMUS
|
21.9
ng/mL |
|
|
|
|
TACROLIMUS
|
15.7
ng/mL |
|
|
|
|
TACROLIMUS
|
10.2
ng/mL |
|
|
|
|
TACROLIMUS
|
12.7
ng/mL |
|
|
|
|
TACROLIMUS
|
14.4
ng/mL |
|
|
|
|
VANCOMYCIN,
TROUGH LEVEL |
13.7 ug/mL |
H |
5.0-10.0
|
|
|
CYCLOSPORINE
A |
<25
ng/mL |
|
|
|
|
||||
|
Collected Date/Time |
Lab Description |
Result/Unit |
H/L |
Ref Interval |
|
|
LIPASE,
SERUM or PLASMA |
115
U/L |
|
30-190
|
|
11/11/03
12:20 |
CREATININE,
URINE - mg/dL |
37
mg/dL |
|
|
|
|
CREATININE,
URINE - mg/day |
NOT
APPL mg/d |
|
800-1800
|
|
|
TIME
|
RANDOM
hr |
|
|
|
|
TOTAL
VOLUME |
RANDOM
mL |
|
|
|
|
SODIUM,
URINE mmol/L |
<
5 mmol/L |
|
|
|
|
SODIUM,
URINE mmol/day |
NOT
APPL mmol/d |
|
51-286
|
|
|
TIME
|
RANDOM
hr |
|
|
|
|
TOTAL
VOLUME |
RANDOM
mL |
|
|
|
|
TROPONIN
I |
1.6 ng/mL |
H |
0.0-0.4
|
|
|
FIBRINOGEN
|
508 mg/dL |
H |
150-430
|
|
|
D-DIMER
|
7.8 ug/mL |
H |
0.0-0.5
|
|
|
NUCLEATED
RED BLOOD CELL |
2 % |
H |
<
0 |
|
|
POLYCHROMASIA
|
1+ |
A |
|
|
|
TARGET
CELLS |
1+ |
A |
|
|
|
HAPTOGLOBIN
|
96
mg/dL |
|
30-200
|
|
11/10/03
12:15 |
FIBRINOGEN
|
479 mg/dL |
H |
150-430
|
|
|
D-DIMER
|
4.0 ug/mL |
H |
0.0-0.5
|
|
|
HAPTOGLOBIN
|
98
mg/dL |
|
30-200
|
|
|
TROPONIN
I |
1.4 ng/mL |
H |
0.0-0.4
|
|
|
GRAM
STAIN SOURCE |
ABD
FLD |
|
|
|
11/10/03
07:00 |
GRAM
STAIN WHITE BLOOD CELLS |
1+
|
|
|
|
11/10/03
07:00 |
GRAM
STAIN ORGANISMS |
NONE
|
|
|
|
11/10/03
07:00 |
PLEASE
NOTE: |
SEEBELOW
|
|
|
|
11/09/03
20:30 |
TROPONIN
I |
1.0 ng/mL |
H |
0.0-0.4
|
|
11/09/03
20:10 |
C.DIFFICILE
TOXINS (A |
NEGATIVE
|
|
NEGATIVE
|
|
11/05/03
18:00 |
C.DIFFICILE
TOXINS (A |
NEGATIVE
|
|
NEGATIVE
|
|
11/03/03
10:45 |
OSMOLALITY,
URINE |
358
mOs/kg |
|
50-800
|
|
11/03/03
10:45 |
CREATININE,
URINE - mg/dL |
48
mg/dL |
|
|
|
11/03/03
10:45 |
TIME
|
RANDOM
hr |
|
|
|
11/03/03
10:45 |
CREATININE,
URINE - mg/day |
NOT
APPL mg/d |
|
800-1800
|
|
11/03/03
10:45 |
TOTAL
VOLUME |
RANDOM
mL |
|
|
|
11/03/03
10:45 |
URINE
UREA NITROGEN - g/dL |
0.533
g/dL |
|
|
|
|
TIME
|
RANDOM
hr |
|
|
|
|
URINE
UREA NITROGEN - g/day |
NOT
APPL g/d |
|
12.0-20.0
|
|
|
TOTAL
VOLUME |
RANDOM
mL |
|
|
|
|
POTASSIUM,
URINE mmol/L |
48.1
mmol/L |
|
|
|
|
TIME
|
RANDOM
hr |
|
|
|
|
TOTAL
VOLUME |
RANDOM
mL |
|
|
|
|
POTASSIUM,
URINE mmol/day |
NOT
APPL mmol/d |
|
40-80
|
|
|
CHLORIDE,
URINE mmol/L |
12
mmol/L |
|
|
|
|
CHLORIDE,
URINE mmol/day |
NOT
APPL mmol/d |
|
140-250
|
|
|
TOTAL
VOLUME |
RANDOM
mL |
|
|
|
|
TIME
|
RANDOM
hr |
|
|
|
11/03/03
10:45 |
SODIUM,
URINE mmol/L |
<
5 mmol/L |
|
|
|
11/03/03
10:45 |
SODIUM,
URINE mmol/day |
NOT
APPL mmol/d |
|
51-286
|
|
|
TOTAL
VOLUME |
RANDOM
mL |
|
|
|
|
TIME
|
RANDOM
hr |
|
|
|
|
OSMOLALITY,
SERUM or PLASMA |
324 mOs/kg |
H |
280-303
|
|
11/03/03
18:50 |
POTASSIUM,
URINE mmol/L |
47.9
mmol/L |
|
|
|
|
TOTAL
VOLUME |
RANDOM
mL |
|
|
|
11/03/03
18:50 |
TIME
|
RANDOM
hr |
|
|
|
|
POTASSIUM,
URINE mmol/day |
NOT
APPL mmol/d |
|
40-80
|
|
|
CHLORIDE,
URINE mmol/L |
17
mmol/L |
|
|
|
|
TOTAL
VOLUME |
RANDOM
mL |
|
|
|
|
CHLORIDE,
URINE mmol/day |
NOT
APPL mmol/d |
|
140-250
|
|
|
TIME
|
RANDOM
hr |
|
|
|
11/03/03
18:50 |
SODIUM,
URINE mmol/L |
7
mmol/L |
|
|
|
11/03/03
18:50 |
SODIUM,
URINE mmol/day |
NOT
APPL mmol/d |
|
51-286
|
|
11/03/03
18:50 |
TOTAL
VOLUME |
RANDOM
mL |
|
|
|
11/03/03
18:50 |
TIME
|
RANDOM
hr |
|
|
|
11/03/03
18:13 |
C.DIFFICILE
TOXINS (A |
NEGATIVE
|
|
NEGATIVE
|
|
10/30/03
03:00 |
LIPASE,
SERUM or PLASMA |
51
U/L |
|
30-190
|
|
10/30/03
03:00 |
AMYLASE,
SERUM - U/L |
<
30 U/L |
|
30-110
|
|
10/27/03
16:00 |
TROPONIN
I |
0.7 ng/mL |
H |
0.0-0.4
|
|
10/27/03
14:00 |
LD,
BODY FLUID |
379
IU/L |
|
|
|
10/27/03
14:00 |
GRAM
STAIN SOURCE |
EFFUSION
|
|
|
|
10/27/03
14:00 |
GRAM
STAIN PMN'S |
1+
|
|
|
|
10/27/03
14:00 |
GRAM
STAIN ORGANISMS |
NONE
|
|
|
|
10/27/03
14:00 |
GRAM
STAIN WHITE BLOOD CELLS |
1+
|
|
|
|
10/27/03
14:00 |
TOTAL
PROTEIN, BODY FLUID |
< 2.0 gm/dL |
A |
|
|
|
AMYLASE,
BODY FLUID |
<
30 IU/L |
|
|
|
|
SR
SOURCE |
EFFUSION
|
|
|
|
|
|
NOT
APPL |
|
NEGATIVE
|
|
|
BODY
FLUID SOURCE |
SEE
NOTE |
|
|
|
|
APPEARANCE
|
CLEAR
|
|
|
|
|
RED
BLOOD CELLS, FLUID |
666
/uL |
|
|
|
|
%
LYMPHOCYTES FLUID |
57
% |
|
|
|
|
%
MONONUCLEAR CELLS FLUID |
33
% |
|
|
|
|
TOTAL
NUCLEATED CELL FLUID |
154
/uL |
|
|
|
|
COLOR
|
YELLOW
|
|
|
|
|
%
PMN FLUIDS |
10
% |
|
|
|
|
DIFFERENTIAL
TOTAL CELL COUNT |
100
|
|
|
|
|
CLOTS
|
NONE
|
|
NONE
|
|
|
CREATININE,
URINE - mg/dL |
66
mg/dL |
|
|
|
10/27/03
10:54 |
TIME
|
RANDOM
hr |
|
|
|
|
CREATININE,
URINE - mg/day |
NOT
APPL mg/d |
|
800-1800
|
|
|
TOTAL
VOLUME |
RANDOM
mL |
|
|
|
|
SODIUM,
URINE mmol/L |
17
mmol/L |
|
|
|
|
TIME
|
RANDOM
hr |
|
|
|
10/27/03
10:54 |
TOTAL
VOLUME |
RANDOM
mL |
|
|
|
|
SODIUM,
URINE mmol/day |
NOT
APPL mmol/d |
|
51-286
|
|
|
LACTATE
DEHYDROGENASE |
519
U/L |
|
300-600
|
|
|
TROPONIN
I |
<
0.4 ng/mL |
|
0.0-0.4
|
|
|
THYROXINE,
FREE |
1.2
ng/dL |
|
0.8-1.5
|
|
10/25/03
21:40 |
CREATINE
KINASE, ISOENZYME MB |
1.3
ug/L |
|
0.0-5.0
|
|
|
TROPONIN
I |
0.7 ng/mL |
H |
0.0-0.4
|
|
|
CREATINE
KINASE, TOTAL |
<
20 U/L |
|
20-180
|
|
|
C.DIFFICILE
TOXINS (A |
NEGATIVE
|
|
NEGATIVE
|
|
|
THYROXINE,
FREE |
0.7 ng/dL |
L |
0.8-1.5
|
|
10/24/03
19:40 |
TROPONIN
I |
0.7 ng/mL |
H |
0.0-0.4
|
|
|
LIPASE,
SERUM or PLASMA |
22 U/L |
L |
30-190
|
|
|
AMYLASE,
SERUM - U/L |
<
30 U/L |
|
30-110
|
|
|
THYROID
STIMULATING HORMONE |
0.38 mU/L |
L |
0.40-5.00
|
|
10/23/03
20:53 |
TROPONIN
I |
0.6 ng/mL |
H |
0.0-0.4
|
|
|
LIPASE,
SERUM or PLASMA |
550 U/L |
H |
30-190
|
|
|
GAMMA
GLUTAMYL TRANSFERASE |
877 U/L |
H |
10-55
|
|
|
TROPONIN
I |
0.6 ng/mL |
H |
0.0-0.4
|
|
10/22/03
21:45 |
LIPASE,
SERUM or PLASMA |
28 U/L |
L |
30-190
|
|
|
GAMMA
GLUTAMYL TRANSFERASE |
490 U/L |
H |
10-55
|
|
|
CREATININE,
URINE - mg/dL |
46
mg/dL |
|
|
|
|
CREATININE,
URINE - mg/day |
NOT
APPL mg/d |
|
800-1800
|
|
|
TOTAL
VOLUME |
RANDOM
mL |
|
|
|
|
TIME
|
RANDOM
hr |
|
|
|
|
POTASSIUM,
URINE mmol/L |
26.9
mmol/L |
|
|
|
|
TOTAL
VOLUME |
RANDOM
mL |
|
|
|
|
TIME
|
RANDOM
hr |
|
|
|
|
POTASSIUM,
URINE mmol/day |
NOT
APPL mmol/d |
|
40-80
|
|
|
CHLORIDE,
URINE mmol/L |
25
mmol/L |
|
|
|
|
TIME
|
RANDOM
hr |
|
|
|
|
TOTAL
VOLUME |
RANDOM
mL |
|
|
|
|
CHLORIDE,
URINE mmol/day |
NOT
APPL mmol/d |
|
140-250
|
|
|
SODIUM,
URINE mmol/L |
30
mmol/L |
|
|
|
|
SODIUM,
URINE mmol/day |
NOT
APPL mmol/d |
|
51-286
|
|
|
TIME
|
RANDOM
hr |
|
|
|
|
TOTAL
VOLUME |
RANDOM
mL |
|
|
|
10/12/03
19:04 |
OCCULT
BLOOD, FECAL |
POSITIVE |
A |
NEGATIVE
|
|
|
OCCULT
BLOOD, FECAL 1 |
POSITIVE |
A |
NEGATIVE
|
|
|
OCCULT
BLOOD, FECAL 3 |
NOT
APPL |
|
NEGATIVE
|
|
|
OCCULT
BLOOD, FECAL 2 |
NOT
APPL |
|
NEGATIVE
|
|
|
OCCULT
BLOOD, FECAL 1 |
POSITIVE |
A |
NEGATIVE
|
|
|
OCCULT
BLOOD, FECAL 3 |
NOT
APPL |
|
NEGATIVE
|
|
|
OCCULT
BLOOD, FECAL 2 |
NOT
APPL |
|
NEGATIVE
|
|
|
GAMMA
GLUTAMYL TRANSFERASE |
253 U/L |
H |
10-55
|
|
10/11/03
06:30 |
C-REACTIVE
PROTEIN |
17.9 mg/dL |
H |
0.0-0.8
|
|
10/10/03
09:45 |
C.DIFFICILE
TOXINS (A |
NEGATIVE
|
|
NEGATIVE
|
|
|
TROPONIN
I |
0.6 ng/mL |
H |
0.0-0.4
|
|
|
GAMMA
GLUTAMYL TRANSFERASE |
349 U/L |
H |
10-55
|
|
10/09/03
20:07 |
TROPONIN
I |
0.6 ng/mL |
H |
0.0-0.4
|
|
|
GAMMA
GLUTAMYL TRANSFERASE |
365 U/L |
H |
10-55
|
|
|
CYTOMEGALOVIRUS
DETECTION, PCR |
NEGATIVE
|
|
|
|
|
SR
SOURCE |
BUFFY
|
|
|
|
|
TROPONIN
I |
0.5 ng/mL |
H |
0.0-0.4
|
|
10/07/03
23:00 |
TROPONIN
I |
0.5 ng/mL |
H |
0.0-0.4
|
|
|
CHOLESTEROL
|
184
mg/dL |
|
|
|
|
LIPASE,
SERUM or PLASMA |
63
U/L |
|
30-190
|
|
|
AMYLASE,
SERUM - U/L |
31
U/L |
|
30-110
|
|
|
THYROID
STIMULATING HORMONE |
1.18
mU/L |
|
0.40-5.00
|
|
|
HEMOGLOBIN
A1C |
7.1 % |
H |
4.0-6.0
|
|
09/24/03
08:20 |
LACTATE
DEHYDROGENASE |
587
U/L |
|
300-600
|
|
11/14/03 WOUND CULTURE, BOIL, RIGHT LEG |
||||||||||||||||||||||
|
||||||||||||||||||||||
|
|
||||||||||||||||||||||
|
WOUND CULTURE, ABDOMEN |
||||||||||||||||||||||
|
||||||||||||||||||||||
|
|
||||||||||||||||||||||
|
WOUND CULTURE, PERITONEAL FLUID |
||||||||||||||||||||||
|
||||||||||||||||||||||
|
Radiology Report |
|
CHEST XRAY 1V |
|
|
|
CHEST XRAY 1V |
|
|
|
THORAX CT WO |
|
|
|
Radiology Report |
|
CHEST XRAY 1V |
|
|
|
|
|
CHEST XRAY 2VWS |
|
|
|
|
|
|
|||||||
|
AUTOPSY FINAL REPORT |
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