SERVICE A

WARD ENDORSEMENTS
Drs. Santos / Osia, Taringting / Gamboa, Salvan TOTAL PATIENTS: 14
February 3 – February 4, 2019
JIs Maramot, Martinez, Mendoza, K, Monreal

400 ABDUL, SATAR Intracerebral Maintain NGT. Blenderized Hematology and FOR
42/M Hemorrhage, left basal feeding 1800 kcal in 6 divided Coagulation 1/28 1/29 1/30 2/01
2019-006152 ganglia secondary to doses 1:1 dilution per serving: Studies  2D ECHO
6TH HD hypertensive bleed (3cc) CHO 180 g, CHON 90g and Fat WBC 8.8 10.7 14.5
DOA: 1/28/2019 ; ICH =0 rest 66 71.7 78.3
Neutrophils
CIC: HCVD, LVH, RSR, I PLR 1L x60 cc/hour FF Up
RIC: Stroke in the Young Lymphocytes 27.5 22.8 9.1 WAB UTZ results
Secondary HPN Medications: Monocytes 6.5 5.5 12.6
CC: RIGHT SIDED BODY Gouty Arthritis, left 1. Continue Mannitol Eosinophils
WEAKNESS knee, in flare tapering Basophils
2/2 Mannitol 80 cc q12 x RBC 4.85 5.20 5.09
This is a case of a 42 years old male 2 doses
HGB 13.9 14.8 14.8
who came in due to right sided body 2/3 Mannitol 80 cc q24 x
weakness 1 dose HCT 43.9 48.3 47.2
2. Atorvastatin 80mg/tab MCV 90.4 93 92.8
HISTORY OF PRESENT ILLNESS ODHS MCH 28.7 28.4 29.1
3. Amlodipine 10 mg tab MCHC 31.7 30.6 31.3
Patient is a known Hypertensive for > 8 ODPM RDW 12.5 13.4 13.5
years , HBP 200/120 LBP 140-160/90, 4. Increase Enalapril 20 mg Platelet 306 280 286
non-compliant to unrecalled tab ODAM BT Rh
medications. No prior MI or Stroke. 5. Colchicine 0.5 mg tab q8 Bleeding time
6. Lactulose 30cc ODHS INR
Patient has a good baseline functional 7. Chlorhexidine gargle, Clotting time
capacity with no failure. No easy swab to oral mucosa TID Protime 15sec
fatigability, dyspnea, orthopnea or Control
paroxysmal/ nocturnal dyspnea. INR 1.0
% Activity
Few Hours PTA, the patient had ApTT
sudden onset of right sided body Control
weakness, associated with right facial
ESR 42
asymmetry and slurring of speech. He
denies having headache, blurring of
Clin 1/28 1/29 1/30 1/31 2/02
vision, nausea, vomiting, chest pain
Chem
nor dyspnea. He tried to reach for his
phone however he noticed that it was BUN 3.44 4.51
difficult to lift his right upper extremity CREA 104.3 70.3
and patient was unable to grasp. Due ALT 37.9 29.3
to persistence and progression of AST 26.6 28.5
symptoms, these opted to seek consult Na 137.6 137.7 136
at our institution. K 3.7 3.9 4.3
Cl 103.9 100.1 102.4
Ca
Mg
Glu-G 5.05
TC 5.91
Page 1 of 15
 TG 1.05
HDL
LDL
VLDL 0.48
BUA 413.1
HBa1c
Troponin 0.352
I
Uric 558.6
Acid
Total
Protein
Albumin
Globulin
A/G
Ratio
CRP Neg

Imaging Studies Impression

Plain Cranial CT A 1.5x1.5x2.0cm acute parenchymal hematoma involving the left basal ganglia and left
Scan (1/28) corona radiate
CXR-PA (1/28) Tortous aorta

400 CURADA, GINA Diabetic Ketoacidosis, DM with SAP 2/2 FOR

46/F severe, resolving PNSS 1L x 80 cc/hr Clin Chem 1/26 1/27 1/28 1/29 1/31
2019-005425 HCVD, LVH, ST  KUB UTZ
7TH HD DM type 2, uncontrolled Therapeutics BUN 11.4 11.65 11.11 7.32
DOA:01/29 Cerebral Infarction, right 1. Atorvastatin 40mg/tab, 1 277.6 273.0 190.9  Lumbar tap
CREA 241
thalamus tab ODHS
ALT 11 12
CC: CHANGES IN BEHAVIOR CNS infection, prob. 2. Omeprazole 40mg/tab, OD
AST 22 14.1  Mg, Ca
Bacterial 3. Enalapril 5mg/tab, 1 tab
This is a case of a 46-year old male t/c CKD OD Na 129.0 - 143
who came in due to changes in Anemia, etiology to be 4. Meropenem 2g TIV every K 4.23 3.72 3.8  Serum
behavior determined 8 hours Cl 96.3 - ferritin,
5. Paracetamol 300mg TIV Ca 1.69 TIBC, Iron
HISTORY OF PRESENT ILLNESS every 4 hours for T>37.8 Mg 0.69
Patient is a newly diagnosed case of 6. Vancomycin 1g TIV every
diabetes mellitus type 2 for 10 months P 0.82
12 hours
with poor complia005nce to unrecalled Glu-G
7. Insulin Glargine 25 units
medications. Allegedly hypertensive SQ ODHS TC
maintained on losartan 50mg/tab OD. 8. Regular insulin 7 units TG
premeals HDL
Has good baseline functional capacity Sliding scale: LDL
with no episodes of easy fatiguability, 140-170 add 1 unit VLDL
no chest pain, no bipedal edema, no 171-200 add 2 units HBa1c 15.2
orthopnea. 201-230 add 3 units Troponin I
231-260 add 4 units Uric Acid
Apparently well until, 4 days prior to 261-290 add 5 units
consult, patient allegedly had episodes Total
291-320 add 6 units Protein
of fever, undocumented with no other >or= 320 add 7 units
associated symptoms until. Albumin Page 2 of 15
 9. D5050 vial if CBG < 80 mmHg Globulin
On the day of consult, patient had 10. Sitagliptin 100 mg tab lunch A/G Ratio
episode of changes in behavior. She time
was then brought in to Southeast Asian
CBC with PC 1/26 2/01
medical center managed as a case of
22.9 14.8 Imaging
t/c diabetic ketoacidosis, Acute seizure WBC
Studies
episode r/o CVD. Patient was then Neutrophils 91.1 84.7
given 1l of PNSSx 2 hours with 1. Multiple small
documented CBG of “high”. They were Lymphocytes 3.7 9.5 Plain vessel infarcts of
advised for ICU admission. But due to Monocytes 5.2 5.8 Cranial varying ages, most
financial reasons. Opted to transfer to CT Scan recent one in the
Eosinophils -
hospital of choice. 1/27 right thalamus
Basophils -
2. Cerebral atrophy
RBC 4.19 3.9
Received patient at ER level agitated HGB 10.9 9.9
not in distress, does not follow HCT 33.8 32.8
command with VS of 100/60, 121 GS/C
MCV 80.5 84
103, 38.3 37.5 98% O2 saturation S
MCH 26.0 25.5
MCHC 32.3 30.3 1. No microorganism seen
Urine
RDW 12.5 13.8 2. No growth after 2 days of
1/30
Platelet 358 285 incubation
BT Rh
Bleeding time Reticulocyte Count (2/2): 0.018 H
INR HbA1C (1/31): 15.2
Clotting time
PBS (2/1/19)
Protime
RBCs normochromic ith mild anisopokilocytosis
Control
WBC count is increased with predominance of neutrophils.
INR Platelets are adequate, occasional clumping is seen.
% Activity
ApTT
Control
ABG
Ph 7.363
Pco2 23.5
PO2 109.4
HCO3 13.3

401 SAYOC, ALLAN (Q4) Chronic Pancreatitis Soft diet FOR

52/F BISAP=0 IVF: PNSS 1L x 160 cc/hr CBC with PC 2/1
2018-018516 Cholelithiasis with WBC 13.5  AST, ALT
1ST HD Cholecystitis Therapeutics: Neutrophils 88.6
DOA: 2/2/19 HCVD, LVH, NSR I 1. Meperidine 50mg/ amp TIV q4 Lymphocytes 7.5  WAB UTZ
RIC: Type 2 DM as needed for pain Monocytes 3.9
CIC: Acute Kidney Injury, 2. Omeprazole 40mg/amp TIV Eosinophils
 PT, PTT
Intrinsic Basophils
OD
Cc: epigastric pain To consider, Chronic RBC 4.93
Kidney Disease 3. Metronidazole 500mg TIV q8  TB, B1, B2
HGB 13.0
This is a case of 57 year old male who Secondary to 4. Ciprofloxacin 500mg/TIV q12
HCT 42.3
came in due to abdominal pain. Hypertensive MCV 85.9  For
Nephrosclerosis MCH 26.3 possible
Patient is a known hypertensive for 6 MCHC 30.7 ERCP
months, with HBP of 200/100, UBP of Page 3 of 15
RDW 14.1
 140-160/100 mmHg with good Chronic Liver Disease Platelet 340  Drop
compliance to Losartan 500mg/tab OD Secondary to Alcoholic referral to
and Amlodipine 5mg/tab OD. He is a Liver Disease Surgery
known diabetic for 6 months with Rule out Hepatitis
Clin 2/1
highest CBG of 300md/dl and usual infection
Chem  FBS, LP,
CBG of 160mg/dl with compliance to s/p Tonsillectomy
BUN 6.35 BUA
Metformin 500mg/tab BID. (OMMC, 1996)
CREA 186.9
Three weeks PTA, patient had onset of ALT 164.6  ALP, GGT
epigastric pain, consulted at OMMC AST 136.2
Surgery ER assessed as gastric ulcer. Na 131.3  TPAG
He was sent home improved with K 4.3
unrecalled antibiotics. Cl 98.1  HbA1c
Two weeks PTA, noted with icteric Amylase 742
sclerae and generalized jaundice. No  HBsAg
Lipase 4408
associated fever, nausea, or vomiting
but still with epigastric pain this time
with radiation to left quadrant and left
flank area. Follow up consult at the ER
was done. WAB ultrasound showed Urinalysis 2/1
gall bladder stones but no significant Color Dark yellow
intervention was done. Patient then Transparency Turbid
decided to transfer at UST hospital, EC Few
admitted from January 21-24 managed MT Occasional
as a case of Acute Pancreatitis BISAP AU Many
0, cholelithiasis. He was then sent WBC 15-18
home with Ciprofloxacin 500mg/cap RBC 0-1
BID and Buscopan tab as needed for Albumin +1
pain. Patient was then scheduled for Sugar Negative
elective surgery for gallstone. SG 1.025
pH 5.0
Interval history showed no recurrence
Bacteria Many
of epigastric pain until,
Fecalysis
On the day consult, when he Color
complained of severe epigastric pan Consistency
with radiation to left flank area not WBC
totally relieved with intake of Buscopan RBC
tablet. No nausea, vomiting of change Ova/Parasite
in sensorium. Persistence of pain
prompted consult and subsequent
admission.

402 SIBAL, ROSARIO MALIGALIG (Q4) DIABETIC DM diet CBC 1/13 1/17 1/25 1/31 FOR
62/F KETOACIDOSIS, Heplock
WBC 20.8 20.7 21.1 15.6
2019-002813 SEVERE  Repeat
Lymphocyte 4.6 1.7 3.4 4.8
16 th HD CEREBRAL Medications: CXR PA
Monocytes 4.0 4.2 5.8 5.7
DOA: 1/18/2019 INFARCTION, LEFT 1. Insulin glargine 21 units
RIC: Dr. Osia PARIETAL AREA Neutrophils 91.4 94.1 90.8 89.5
BID  Blood CS
CIC: JI Maramot SECONDARY TO RBC 3.8.2 4 3.52 3.07
Hgb 11.3 11.6 10.1 8.6 X2
ATHEROTHROMBOSIS
CC: Decrease in sensorium T/C CAD, RSR Hct 33.1 36 30.6 27.7 Page 4 of 15
 TYPE 2 DIABETES 2. Regular Insulin 13 units MCV 86.7 89.9 86.8 90.2  MRI of left
Patient is a known diabetic for 10 years MELLITUS premeals MCH 29.6 28.9 28.8 27.9 lower
maintained on gliclazide 30 mg/tab 1 ACUTE KIDNEY INJURY MCHC 34.1 32.3 33.1 31.0 extremity
tab OD with no poor compliance. Not PRESUMPTIVE PTB 3. Metformin 500 mg tab OD CV 11.7 12.1 12.1 13.0
known hypertensive. She has good Platelet 290 431 289 353  GeneXpert
baseline functional capacity.no episode
of easy fatigability, no chest pain, no 4. Sitagliptin + metformin OD
palpitation. She is apparently well until 1/17 1/18 1/22 1.23 1/24 1/26 1/28 1/30 1/31  Referral to
Clinical
5. Enalapril 10 mg tab OD 1/13 1/17 (8:00 TB DOTS
Chemistry
6 days prior to consult, patient went pm)
mountain hiking which triggered knee 6. Atorvastatin 40 mg tab BUN 6.48 10.52 7.34 7.18 6.32 FFUP
pain, left. She tolerated symptom until ODHS Crea 104.2 123.1 74.4 68.6 63.3
ALT 11.5 17.7  Official
5 days prior to consult, she sought AST 13.8 12.3 plain CT
7. Omeprazole 40 mg tab OD
consult at IM - OMMC managed as a Na 130.5 129.1 129.7 140.1 138.6 132.5 134.0 scan result
case of arthritis, sent home with K 5.3 3.5 3.45 2.61 3.05 3.64 3.9 3.76
ketoprofen gel, paracetamol tramadol 8. ASA 50 mg tab OD
Cl 95 99.4 100.3 112.2 107.5 101.5 102.9  Synovial
tablet. Glu 12.80 9.93
9. Carvedilol 6.25 g tab ½ tab Fluid
TC 3.05
During the interim, patient had BID analysis
TG 0.70
progressive episodes of decrease in
VLDL 0.32
sensorium. No loss of consciousness. 10. Ceftriaxone 2g TIV OD
no chest pain.
1 day prior to consult, patient was
11. Vancomycin 2g TIV Q12 in Clinical 2/3
noted to have slurring of speech. No
100 cc PNSS Chemistry
loss of consciousness, no lateralization
BUN KUB UTZ (1/23)
signs, no vomiting.
Crea 77.8 Normal kidneys and urinary
12. Enoxaparin 0.66 q12
ALT bladder
Upon receiving the patient at the ER,
she had a VS of 110/60, 128, 18, 37.1, AST
13. Enalapril 10 mg OD PELVIC AP/THIGH APL (1/24)
98%, drowsy with + 16 on urine ketone Na
K Osteodegenerative changes left
with CBG of high. Revealed metabolic
14. ASA 80 mg 1 tab OD knee
acidosis hence managed as diabetic Cl
Intact bone and left thigh
ketoacidosis. Glu
TC
VSq4 TG
VLDL
Total 70.5 BTRH 2/1 O Positive
Protein
Albumin 25.4
Globulin 45.10
A/G Ratio 0.56

Page 5 of 15
 UA 1/13
Color Light Yellow
Trans Slightly Turbid
EC Moderate
MT Moderate
AU Moderate
WBC 1-3
RBC 1-3
Alb Negative
Sugar +1
SG 1.020
pH 6.0
Bact Few

402 NALUIS, MARCIANA (Q4) NSTEMI; Healthy heart diet FOR

48/F CHD, OLD INFERIOR Heplock Clinical Chemistry 01/30 2/2
HD AND ANTERIOR WALL BUN 3.42  Serum
DOA: 1/31/19 MI, LATERAL WALL Medications: Crea 82.8 Ferritin
CC: chest pain ISCHEMIA, MSR, I; 1. ASA 80 mg/tab OD AST
RIC: Dr. Gamboa HCVD, LVH; 2. Clopidrogel 75 mg/tab OD  2D Echo
ALT
CIC: ANEMIA ETIOLOGY TO 3. Enoxaparin 0.6 cc
Na 137.4 with DS
BE DETERMINED 4. Atorvastatin 40mgtab 1 tab
K 3.3
This is a case of a 48/F who was ODHS
brought in due to chest pain. 5. ISDN 5 mg/tab Q8 PRN x Cl 100.8  FOBT
chest pain Troponin I 20.20
The patient is a known hypertensive for 6. Captopril 25 mg/tab Q8 Glu 5.13
more than 5 years with maintenance 7. Metoprolol 50 mg/tab Q6 TC 5.55 FFUP
medication of Metoprolol 50 mg BID, 8. Morphine 2 g TIV PRN TG 1.TG08
Irbesartan + HCTZ with good 9. Omeprazole 40 mg TIV OD VLF 0.49  Post BT
compliance. 10. Lactulose 30 cc ODHS CBC
CBC with PC 1/30 2/1
WBC 9.0
The patient has a fair baseline VSq4  BUA
functional capacity in which the patient I and O shift Neutrophils 76.7
has exertional dyspnea but without Lymphocytes 16.0
orthopnea and non-productive cough Monocytes
for 3 months, but no PND. Eosinophils
Basophils
5 hours PTC, the patient develop RBC 4.69
sudden onset of chest pain (10/10, with HGB 7.4
pins and needles sensation) on the left HCT 28.5
side of the chest. The patient noted no MCV 60.9
change in sensorium and no MCH 15.8
associated nausea and vomiting. The MCHC 25.9
chest pain did not decrease in severity RDW 22.9
upon resting. Persistence of the chest Platelet 393
pain prompted consult.
Urinalysis 1/30
Color Light yellow
transparency Slightly turbid
EC Moderate
MT Few
AP Occasional Page 6 of 15
 WBC 3-1
RBC 0-2
Albumin +1
Sugar Negative
SG 1.020
pH 6.0
Bacteria Moderate

BTRh B positive

PBS
- RBC’s: Hypochromic with mild anisopoikilocytosis
- WBC count is within normal limits with predominance of neutrophils
- Platelets are adequate
- No blasts or immature forms seen

Reticulocyte count (2/3): 0.005

403 NUGUID, GODOFREDO (Q4) PULMONARY MASS, DAT with SAP CBC with PC 1/29 2/2 FOR
67/M PROBABLY Heplock WBC 2.6 3.3
2019-006589 MALIGNANT Lymphocytes 60.4 33.9  BUA
3rd HD CHRONIC Therapeutics: Neutrophils 30.4 7.9
DOA: 01/30/2019 OBSTRUCTIVE 1. Aspirin 80mg/tab 1 tab OD RBC 4.67 3.45  WAB UTZ
PULMONARY DISEASE 2. Atorvastatin 40mg/tab 1 tab HGB 11.8 8.6 (2/4/19)
Patient is not known hypertensive or CEREBROVASCULAR OD
HCT 35.0 25.3
diabetic and currently not on any DISEASE PROBABLY 3. Enalapril 5mg/tab ½ tab
MCV 74.9 73.4  HBT UTZ
maintenance medications. Denies SECONDARY TO NASH OD
history of CVD/MI. BENIGN PROSTATIC 4. Omeprazole 40 mg TIV OD MCH 25.3 25.0
HYPERPLASIA 5. Combivent neb q8 MCHC 33.8 34.1  TB, DB, IB
He has fair baseline functional capacity ANEMIA, 6. Tamsulosin 0.4mg/tab 1 RDW 15.5 16.2
with some degree of easy fatigability, MULTIFACTORIAL tab ODHS Platelet 87 78  HBsAg,
2-pillow orthopnea, but no PND and PROBABLY 7. Regular Insulin 5ü SQ PRN Anti-HBe,
intermittent edema. SECONDARY TO (1) for CBG> 180mg/dL. Urinalysis 1/29
IgG, IgM
MALIGNANCY (2) 8. Lactulose 30 cc q1 with BM Color dark yellow
3 weeks prior to consult, patient started ANEMIA OF RENAL 3-4/ day Transparency turbid
to have dysphagia with solid foods. No DISORDER 9. Rifaximin 500mg/tab BID.  Supraglottic
EC few
fever, no chest pain noted. No CHRONIC KIDNEY 10. Clopidogrel 75 mg tab OD mass
MT occasional
medications taken, no consult done. DISEASE PROBABLY AU many biopsy
SECONDARY TO DM VSq4 WBC 0-2
On the interim, there was note of NEPHROPATHY I and O shift RBC 0-2  Anes
worsening of dysphagia even on TYPE 2 DIABETES clearance
Albumin negative
blenderized foods and now associated MELLITUS SUSPECT
Sugar negative
with loss of appetite, weight loss, and PULMONARY
generalized body weakness. TUBERCULOSIS SG 1.030  Serum iron,
TREATMENT pH 6.0 ferritin,
On the day of consult, patient still has COMPLETED (2017, Calcium oxalate moderate TIBC
the persistence of symptoms hence DOTS) Coarse Granular Cast 1-3
sought consult to a private MD. Chest T/C CORONARY Follow up
Xray and WAB ultrasound done ARTERY DISEASE, OLD Clin Chem 1/29 1/30 1/31 2/1 2/3  Official
revealing the following result: (CXR) ANTEROSEPTAL AND BUN 12.71 10.73 8.92 5.44 reading of
Old PTB; (WAB UTZ) hepatomegaly, HIGH LATERAL WALL Crea 133.7 103.6 94.1 57.0
CT Scan of
mild; thickened gallbladder wall; renal MYOCARDIAL ALT 73 51.4 Page 7 of 15
 parenchymal disease, bilateral; renal INFARCTION, NORMAL AST 261.4 153.8 neck, chest,
cortical cyst, left; enlarged prostate SINUS RHYTHM Na 131.7 128.3 133.4 and
gland. Patient was then transferred to K 4.72 4.1 4.0 abdomen
our institution. Cl 94.2 96.6 102.2
TP 43.5
Alb 26.3
Glob 17.2
A/G ratio 1.53
TC 4.90
TG 2.90
VLDL 1.32

404 ARPON, MARCIANA (Q4) ACUTE DM diet FOR

82/F PYELONEPHRITIS; Heplock Clin Chem 2/1
2016-019807 ACUTE KIDNEY INJURY, BUN 8.75  FBS, LP,
1st HD INTRINSIC, Medications: Crea 187.1 BUA
DOA: 02/02/2019 SECONDARY TO 1. Ceftriaxone 2 g TIV q24 ALT 28.9
RIC: INFECTION; 2. Omeprazole 40 mg TIV OD AST 41.6  CBC
CIC: HYPERTENSIVE 3. Paracetamol 300 mg TIV q4 Na 133.6
CARDIOVASCULAR PRN x Temp > 37.8 K 3.6
CC: Vomitng DISEASE; LEFT 4. amlodipine 10 mg tab ODHS  BUN, Crea
Cl 101.3
VENTRICULAR 5. Captopril 25 mg tab prn if BP >
TP  Urine
Patient has no known comorbidities HYPERTROPHY; SINUS 160/100
and currently not on any maintenance TACHYCARDIA; 6. Metoclopromide 10 mg TIV prn Alb GS/CS
medications. Patient denies history of DIABETES MELLITUS for vomiting Glob
CAD/MI. She has poor baseline SUSPECT; S/P 7 . Tramadol 50 mg TIV q8 prn A/G ratio  KUB UTZ
functional capacity with easy CATARACT for pain.
fatigability. Patient has no orthopnea, EXTRACTION (2017) Urinalysis 2/1
 Blood CS
paroxysmal nocturnal dyspnea, or VSq4 Color Light yellow
intermittent bipedal edema. on 2 sites
Transparency Turbid
EC Occ
1 day PTC, patient had a new onset
MT Occ
flank pain, right, with associated
AU Occ
undocumented fever and chills. No
WBC Abundant
meds taken, no consult done. No
dysuria, no difficulty of breathing, and RBC 0-2
no chest pain noted. Albumin +2
Sugar Negative
On the interim, there is persistence of SG 1.025
the above mentioned symptoms now pH 5.0
with associated 3 episodes of vomiting Bacteria Mod
of previously ingested food, which WBC Cast 0-2
prompted consult at our institution.

404 INVENTOR, MADELINE (Q1) SHOCK, MULTIFOCAL Insert NGT: blenderized feeding CBC 12/16 12/18 12/24 12/29 1/15 1/16 1/17 1/19 1/24 1/31 2/1 FOR
41/F CONSIDERATIONS: 1) IVF: PLR 200 cc/hour
2016-008112 CARDIOGENIC 2) SD: Norepinephrine 8 mg in D5W WBC 15.8 10 9 8 32.8 22.8 24.1 18.0 9.5 10.3 15.2  Stool CS
16thHD SEPTIC 3) 250 cc to run for 18 cc/hour max Lymphocyte 11.5 12.6 12.7 23.1 20.6 11.5 7.1 6.0 16.4 20.4 19.8
DOA: 01/16/2019 HYPOVOLEMIC; TO Page 8 of 15
RIC: Dr. Gler CONSIDER C. of 90 cc/hour, increase/decrease Mid 5.7 13.7 11.6 18.3 12.6 3.5 3.2 3.5 7.2 5.5 9.1  Blood CS x
CIC: JI Monreal DIFFICELE COLITIS; DM to maintain a MAP of > 65 mmHg Neutrophils 82.8 73.7 75.7 66.8 85.0 89.7 90.5 76.4 74.1 71.1 2 sites
TYPE 2, UNKNOWN RBC 4.88 10.0 9.4 2.90 2.71 2.51 2.41 3.23 3.62
CC: Fever CONTROL; AKI PROB Medications: Hgb 14.5 13.0 31.2 9.3 7.6 7.3 6.9 6.3 8 10.0  ABG
SECONDARY TO 1. Shift to Meropenem Hct 47.7 41.4 29.5 25.3 22.9 22.2 20.3 27 29.7
Patient is a known diabetic for 8 years, INFECTION; CKD PROB 1 g TIV q12 MCV 87.0 84.6 88.7 84.3 83.5 81.8
maintained on insulin glargine 12 u SC SECONDARY TO DM  Trop I
MCH 26.3 27.0 27.4 26.2 24.9 27.5
ODHS and amlodipine 40 mg/tab 1 tab NEPHROPATHY, ICC 2. Vancomycin 1 g TIV MCHC 30.2 31.9 30.9 31 29.8 33.6
ODHS. Previous admission: SUSPECT;  CBC
q24 CV 10.8 11.9 11.8 12.2 13.8 13.7
uncontrolled diabetes mellitus and S/P HYSTERECTOMY
Platelet 391 292 288 281 608 559 579 454 68 33
gluteal thigh abscess. (OMMC, 2011); S/P I&D  BUN, Crea,
GLUTEAL AREA 3. Vancomycin 125 g
Na, K, Cl,
Two months PTC, (+) episode of (OMMC, 2018); S/P PTB tab q6 per orem
Clinical Chemistry 1/13 1/17 1/17 1/19 1/22 1/24 1/28 1/31 Ca, Mg
undocumented fever, no cough, no TREATMENT (DOTS,
dyspnea, no chest pain. No other 2011) BUN 7.42 13.02 3.11 5.21
4. HOLD Insulin
symptoms. No medications taken. No R/O ACS Crea 100.9 200.2 183.6 180.0  Alb
glargine
consult done. ALT 31.3 13.3 19.7
One week PTC, patient sought consult AST 23.2 11.8 10.4  Pro
5. Omeprazole 40 mg Na 128.4 127.1 128.3 129.9 132.5 126.6
at ER surgery due to gluteal abscess. calcitonin
Patient was given unrecalled TIV q24 K 4.5 4.3 3.8` 3.98 4.0 3.91
medication and was sent home. Cl 98.7 100.3 103.7 103.0 102.7 105.3  BNP
One day PTC, patient had persistent CBG while on NPO, then CBG Glu 18.04
vomiting of previously ingested food (4 TID when feeding TC 2.44
Give 1 vial of D5050 if CBG < 80  Repeat
episodes) with generalized body TG 1.30
weakness and loss of appetite, hence mg/dl CXR
VLDL 0.59
consult. Give insulin HR if CBG > to 180 TP 55.3
mg/dL  2D Echo
Albumin 26.5
Frequent bed turning with DS
Globulin 28.80
For transfer to ICU
A/G Ratio 0.92
VSq4  Chest CT
I and O q shift
UA 1/29 PBS 1/31 Spiral
Color Light Yellow RBC: Normocytic, normochromic
Trans Slightly Turbid WBC: Count within normal limits predominantly  D dimer
EC Few neutrophils
MT Few Platelet count: Markedly decreased  HAT
AU Occasional No blasts or immature forms seen Screening
WBC 10-15
RBC 2-3
Alb +1
Sugar Negative
SG 1.020
pH 6.0
Bacteria

BTRh B positive

Page 9 of 15
 URINE CS (1/31/19)
No microorganism seen
No growth after 2 days of incubation
FECALYSIS (1/15/19)
Color: brown
Consistency: Semi-formed
WBC: 1-2
RBC: 0-1
No ova seen, or parasite seen

404 FAMINIANO, CAROLINA CEREBRAL Update PDS CBC with PC 1/31 FOR
55/F INFARCTION, DASH diet WBC 6.8  BUA, FBS,
2018-061886 LACUNAR. PROBABLY IVF: PNSS 1L x 80cc/hr Lymphocytes 37.8 LP
1ST HD RMCA IN MID% 10.7
DOA: 2/2/2019 DISTRIBUTION, Aspirin 80mg/tab 1 tab Od Neutrophils 51.5  ESR
RIC: ATHEROTHROMBOTIC Atorvastatin 40mg/tab 1 tab RBC 3.98
CIC: NHSS=6; HCVD; S/P ODHS
HGB 10.9  CRP
CVD X2 W/ NOO Losartan 50 mg tab OD
HCT 35
CC: DIZZINESS and DYSARTHRIA RESIDUALS (OMMC Omeprazole 40mg cap OD
2016, 2018) Enalapril 5mg/tab 1 tab OD MCV 87.8  Plain
The patient is a known hypertensive Captopril 25mg/tab 1 tab SL prn MCH 27.3 Cranial CT
since 2017 with HBP”: 180/100 and Chlorhexidine gargle TID MCHC 31.1
Scan
UBP: 130/90. The patient is not RDW 12.7
diabetic. The patient complies to Moderate to high back rest Platelet 285
FOLLOW UP
medication of Losartan and I and O shift
Amlodipine. The patient has 2 VSq4 Clin Chem 1/31
 UA result
episodes of CVD one on 2017 and BUN 3.92
2018 Crea 119.7
ALT 33.6
On theday of consult, the patient had a AST 28.7
sudden emotional rush in which she Na 138.3
felt angry and instantly which led to K 3.7
stiffening of the tongue and joint. The Cl 104.9
patient di not have any changes in
sensorium and no seizure activity. The CT Scan of the Head Impression
patient also had weakness of the left - Normal non-enhanced CT scan of the breain
hand and left leg which prompted - Conchae bullosa
consult.

405 MORA, WI-AR APLASTIC ANEMIA DAT CBC 1/28 1/30 For:
33/M S/P BONE MARROW Heplock WBC 2.7 2.0  Serum K
2018-055617 ASPIRATION correction
Lymphocyte 47.6 53.1
5TH HD TO CONSIDER HIGH Medications:
DOA: 1/28/19 OUTPUT CARDIAC Ca gluconate after 3 units BT Neutrophils 41.9 34.4
RBC 2.14 2.30  Secure 2
RIC: Dr. Osia FAILURE Folic acid + Vitamin B complex
CIC: JI Monreal tab OD Hgb 6.9 7.1 units of
FeSo4 tab OD Hct 21.6 22.3 PRBC
CC: For blood transfusion EPO 4000 unit SQ every 5 days
MCV 101.3 97.1
Omeprazole 40 mg TIV OD  Post BT
Patient is not known hypertensive nor prebreakfast MCH 32.2 30.9
CBC
diabetic. No history of MI or stroke. He MCHC 31.8 31.8
has good functional capacity. No noted CV 25.0 25.0
easy fatigability. No PND, orthopnea, Page 10 of 15
 or intermittent edema. Patient is Still for transfusion of 2 pRBC Platelet 26 24
diagnosied with Aplastic Anemia properly typed and crossmatched
(OMMC, 2018), maintained on Folic VSq4 Clinical Chemistry 1/30
acid + Vitamin B complex tab OD, WOF: Hypotension, desaturation, BUN 3.89
FeSo4 tab OD, with poor compliance to changes in sensorium Crea 86.2
EPO 4000 units every 5 days.
Na 141.5
K 3.2
Patient is apparently well, with regular
check up to Hematology Clinic at Cl 109.0
OMMC. He has no episodes of ALT 65.4
bleeding, generalized body weakness, AST 36.1
poor appetite, or loss of
consciousness. BTRH 1/14
On the day of consult, he was having O positive
his monthly check up at Hema clinic,
repeat CBC showed WBC of 2.7, Seg
of 41.9, Lymp of 47.6, RBC of 2.14,
HGb of 6.4, Hct of 21.6, platelet of 26.
He was also noted to be pale thus
advised admission for blood
transfusion.

409 NUEVAS, GUILLERMO (Q4) NSTE- ACS DAT with SAP 12/16 12/18 12/24 12/29 1/23 FOR
79/M HCVD NSR FC I Heplock CBC
2018- 074111 CAD, OLD WBC 15.8 10 9 8 18.3  CBC post-
36th HD ANTEROSEPTAL AND Medications: Lymphocyte 11.5 12.6 12.7 23.1 3.5 BT
DOA: 12/16/2018 INFERIOR WALL MI 1. Furosemide 40 mg tab BID
Mid 5.7 13.7 11.6 18.3 4.8
RIC: Dr. Osia COPD SUSPECT 2. Omeprazole 40 mg tab BID  Repeat
Neutrophils 82.8 73.7 75.7 91.7
CIC: JI Monreal T/C GOUTY ARTHRITIS 3. ASA 80 mg tab OD RBC 4.88 10.0 9.4 3.03 CXR
4. Metoprololsuccinate 97.5 mg Hgb 14.5 13.0 31.2 9.3 7.4
CC: Altered Sensorium
tab OD Hct 47.7 41.4 29.5 25.5  Stool
Patient is a known hypertensive, not 5. Rebamipide 100 mg tab TID MCV 84.1 antigen test
known diabetes, no noted history of MI 6. Facilitate K correction TIV x 6 MCH 24.5
nor stroke. cycles MCHC 29.1  Urea breath
He has good baseline functional 7. Combivent neb q8 CV 20.2 test
capacity, noted only with occasional 8. Chlorhexidine gargle Platelet 391 292 288 281 216
joint pains on right hip and knee
9. FeSO4tab OD  Rpt serum
allegedly due to arthritis. No easy Clinical Chemistry 1/15 1/23 1/28 1/30
fatigability, no dyspnea, no PND/ 10. Folic acid OD K post
BUN 7.42 8.49 8.28 5.35
orthopnea, no intermittent bipedal 11. Atorvastatin 40 mg tab OD Crea 100.9 89.7 84.6 57.8 correction
edema. 12. Formeterol + Na 128.4 21.8 141
Beclomethasone 100/6 K 4.5 18.0 2.5  2D echo
Patient generally dwells on the street. MDI BID Cl 98.7 141.1 99.3
No other complains until few minutes 13. NAC 600 mg tab BID ALT 31.3 3.1 18.3
prior to consult, when he was seen by AST 23.2 105.2 22.4
a bystander drowsy with difficulty in
VSq4
ambulation. He was then immediately
I and O qshift BTRH 1/21 B Positive
brought in for consult.
Refer
Page 11 of 15
410 PARAGAS, ADELINA NSTE-ACS (TIMI 3) Healthy heart diet CBC with PC 1/22 1/25 1/26 1/29 FOR
76/F CAD, old inferior wall WBC 11.2 6.1 4.8 9.5
2018-011114 MI, anterior and inferior Heplock Neutrophils 81.5 74.3 64 61.5  Repeat
11th HD wall ischemia, RSR I CXR
DOA: 1/22/19 HCVD, LVH 1) Piperacillin + Tazobactam Lymphocytes 11.9 19.2 20.1 23.5
s/p CVD with no 4.5mg TIV q8 Monocytes 6.6 6.5 15.9 15.0  Plain
CC: chest pain residuals, MRS = D 2) Azithromycin 500mg/tab OD Eosinophils - - Cranial CT
(OMMC, 2017)> for 1 more dose Basophils - - Scan
She was previously admitted at our 3) NAC 600mg/tab + 100cc RBC 5.05 3.80 3.50 3.63
institution as a case of CVD infarction, water ODHS HGB 15.0 10.7 9.5 10  Mg
HCVD, LVH, NSR I, with good 4) Salbutamol+Ipratropium neb
HCT 44.3 33.2 30.5 31.3
compliance to Atorvastatin 40mg, PRN for dyspnea  PT/INR
Amlodipine 10mg, and Enalapril 10mg. 5) Hold > ASA 80mg/tab OD MCV 87.8 87.3 87.2 86.4
6) Clopidogrel 75mg/tab OD MCH 29.8 28.3 27.3 27.5  2D Echo
She has a good baseline functional 7) Atorvastatin 80mg ODHS MCHC 33.9 32.4 31.3 31.8 with DS
capacity with no edema, orthopnea or 8) Omeprazole 40mg/tab OD RDW 11.9 11.8 12.4 12.4
easy fatigability. She also denies 9) Metoprolol 100mg/tab BID Platelet 279 197 179 421
dyspnea on exertion or paroxysmal 10) ISMN 30mg/tab OD
nocturnal dyspnea. 11) ISDN 5mg/tab PRN for chest
pain
2 days PTC, the patient had a sudden 12) Enalapril 5mg/tab OD
onset of chest heaviness, radiating to 13) Lactulose 30cc OD
the back, associated with DOB, VAS
7/10, and lasted for >30 mins.
Symptoms resolved spontaneously.
She denied having diaphoresis, fever, URINALYSIS 1/20
cough, colds or cyanosis. No consult Color Yellow
done. No medications taken. Transparency Clear

Few hrs PTA, the patient had Epithelial Cells Few

recurrence of this heaviness, non- Mucus Thread Occ
radiating to the left arm. Amorphous Occ
Urate
Amorphous
Phosphate
WBC 0-1
RBC 5-8
Albumin Negativ
e
Sugar Negativ
e
Specific Gravity 1.020
pH 6.5
Bacteria
Page 12 of 15
 Yeast
Clin 1/21 1/22 1/28 1/29 1/30
Chem
BUN 4.30 6.11 5.56
CREA 101.4 87.5 86.2
ALT 22.4
AST 24.9
Na 140.8 140.8 131.7 134.4
K 4.15 4.2 4.7 3.96
Cl 105.9 105.9 97.8 100.2
Ca 2.12
Mg 0.76
Trop I 28.60
Albumin 42

Sputum GS/CS (1/28/2019)

A. Microscopy
EC: +++
Pus Cells: ++
Gram Positive cocci in pairs: ++
Gram Positive cocci in single: +
Gram Positive Bacilli: +
B. Culture
Moderate growth of Diphtheroids
Most probably contaminants

411 LEGAZPI, LITO (Q4) PLEURAL EFFUSION Regular Diet 1/31 FOR
69/M LEFT PROB ONSS 1L X 80CC/hour CBC
2018-056623 SECONDARY TO: 1) TB, WBC 16.6  Repeat
2nd H.D. 2) PARAPNEUMONIA, 3) Tx: Lymphocyte 7.1 CXR PA/L
DOA:1/31/2019 R/O MALIGNANCY 1. Piperacillin-
Mid 5.6
RIC: Dr. Osia PTB CATEGORY I, Tazobactam 4.5 g  Refer back
Neutrophils .87.3
CIC: Maramot CLINICALLY TIV q8 to Surgery
DIAGNOSED RBC 5.30 for CTT
CC:DOB Hgb 14.0 insertion
2. Azithromycin 500 mg Hct 44.8
Px is not hypertensive and not diabetic. tab OD MCV 84.5  Refer to
Patient was previously admitted last MCH 26.4 TBDOTS
July 2018 in this institution as a case of 3. HRZE tabs 3 tabs MCHC 31.2 (2/4/2019)
pleural effusion left probably secondary OD CV 13.8
to tuberculosis treatment started but Platelet 359
was not able to finish his medications 4. Vitamin B complex  PF, CS
for 3 weeks.
TAB OD
The patient has a fair baseline
functional capacity in which the patient Page 13 of 15
 is able to do his daily activities of living 5. Omeprazole 40mg Clinical Chemistry 1/31 2/1
with ease. With 2 pillow orthopnea, no TIV OD PLEURAL FLUID Analysis (1/31/19) BUN 3.01
exertional dyspnea, no easy fatigability. Qualitative Examination: Crea 89.4
6. Combivent Nebule Color: Dark brown Na 138.3
5 days PTC, the patient developed Transparency: Turbid K 4.1
Q8 and PRN for
productive coughing and dyspnea. RBC: 29, 920 Cl 102.6
There was no associated fever, chest dyspnea WBC: 930 ALT 42.3
pain, chest heaviness, the patient did PMN: 98% AST 52.5
not took any medication as of the VSQ4 Lymphocytes: 2%
Glu 5.92
moment and no intervention was done.
TC 4.40
Glucose: 2.1 mmol/L
On the interval, the px experienced TG 1.23
Total Protein: 118.23 g/L
worsening of the dyspneic episode and LDH: 5688 IU/L VLDL 0.56
coughing. Patient then had no
medications taken. Patient was Chest CT Scan Impression
described to have increased effort in - Consider left lower lobe mass or consolidation, neoplastic versus infectious. Histopathologic correlation is
breathing. Persistence of the suggested
symptoms prompted consult. - Multiple bilateral pulmonary nodules
- Pleural effusion, left
- Mild pleural thickening, left
- Prominent sized mediastinal and axillary lymph nodes
- Atherosclerosis
- Thoracic spondylosis
- Small hiatal hernia

410 LACERONA, PATROCINA (Q4) Non ST Elevated Heart Healthy Diet 1/30 1/30 Clinical 1/30 2/3 FOR
89/F Myocardial Infarction, Heplock CBC Chemistry
2019-006635 Coronary Artery WBC 15.4 15.1 BUN 5.41 7.04  BUA
Disease, Old Anteriror Therapeutics: Lymphocyte 3.5 5.3 Crea 89.5 67.3
DOA: 1/30/19 wall MI, Atrial 1. Aspirin 80 mg/tab 1 tab OD Na 138.7 134.4  Ca, Mg
Mid 9.1 9.9
Fibrillation in Moderate 2. Clopidogrel 75 mg/tab OD K 3.5 3.1
Neutrophils 87.4 84.8
Ventricular Response, 3. Enoxaparin 0.6 SC OD Cl 103.4 98.8  2D Echo
RBC 3.32 3.19
This is a case of a 89/F from SAB, Hypertensive 4. Captopril 25 mg/tab q6h ALT 32.1 with DS
Manila who came in due to difficulty of Cardiovascular Disease, 5. Atorvastatin 40 mg/tab 1 Hgb 9.6 9.5
Hct 30.6 30.4 AST 53.8
breathing. Left Ventricular tab OD  Coronary
MCV 95.1 95.3 Glu 4.30
Hypertrophy, 6. Metorprolol 50 mg/tab 1 Angiogram
MCH 29.8 29.7 TC 3.38
Patient allegedly has no known co- Community Acquired tab q6h
morbidities, and is currently not on any Pneumonia- Moderate 7. Omeprazole 40 mg TIV OD MCHC 31.4 31.2 TG 1.29  CBC
maintenance medications Risk, To consider 8. Rivaroxaban 2.5mg 1 tab CV 13.5 13.9 VLDL 0.59
Seborrheic Dermatitis BID Platelet 276 265 Troponin I 2.600 ng/ml  12L ECG
She has poor baseline functional 9. Lactulose 30 cc ODHS 1/30 OD
capacity mostly spending her time in
bed requiring assistance on her ADLs.

Few minutes prior to consult, patient

was seen by her relatives in respiratory URINALYSIS 1/20
distress with note of difficulty of Color Yellow
breathing. No fist clenching, no loss of Transparency Turbid
consciousness. Patient was
immediately brought to our institution. Epithelial Cells Few
Mucus Thread Few

Page 14 of 15
Amorphous Few
Urate
Amorphous
Phosphate
WBC 0-1
RBC Many
Albumin Negativ
e
Sugar Negativ
e
Specific Gravity 1.030
pH 6.5
Bacteria
Yeast

Page 15 of 15