1. COURSE IN THE WARDS

2. 12/24/10UnitReference values Hgb97g/L94 – 112 RBC3.49x 10 12 /L- Hct0.290.28 – 0.35 MCV83.00U3U3 84 – 95 MCH27.80pg- MCHC33.40g/dL28.3-31.8 RDW20.4011.6 – 14.6 MPV7.90fL7.4 – 10.4 Platelet20x 10 9 / L150 – 450 WBC34x 10 9 / L4.50 – 10.0 Neutrophils0.030.50 – 0.70 Metamyelocytes0.02 Bands-0.00 – 0.05 Segmenters0.010.50 – 0.70 Lymphocytes0.630.20 – 0.40 Monocytes0.00 – 0.07 Eosinophils-0.00 – 0.05 Basophils-0.00 – 0.01 Reticulocyte-10^35-15 Blast0.32 Myelocytes0.02 UPON ADMISSION

3. Leukocytes(+)RBCs>100/hpfMucus Threads + ColorAmberErythrocytes(+)Pus cell2-4/hpfAmorphous Crystals (-) TransparencyTurbidBilirubin(-)Yeast Cell(-)Uric Acid Crystals (-) pH5.0Nitrite(-)Squamous cells (-)Ca Oxalate Crystals (-) Specific Gravity 1.025Ketones(+)Renal cell(-)A. Phosphate Crystals (-) Albumin+ ++UrobilinogennormalTransitiona l Epithelial C. (-)Triple Phosphate (-) Sugar(-)Casts present(-)Bacteria+ (-) URINALYSIS

4. Reference range Creatinine0.380.31-0.48 mg/dL

5. Platelet concentrate transfusion 2U Prednisone 10mg/5ml, 7ml TID after meals Lactulose 10 ml ODHS Patient developed abdominal pain. - Omeprazole 10mg/SIVP QD

6. 2 nd HOSPITAL DAY Patient had 3 episodes of vomiting of previously ingested food. Cefuroxime 500mg/IV q8 was given.

7. 3 RD HOSPITAL DAY Patient was given Salbutamol 2mg/5ml syrup, 4 ml q8 due to persistence of cough.

8. 4 TH HOSPITAL DAY Patient was transfused with 2 units of type specific platelet concentrate. Gum bleeding (+) for blood clots - Tranexamic acid 250mg/tab diluted in 250ml cold water, gargled TID. Left ear pain (+)impacted cerumen on both ears. - Baby oil was instilled on both ears, 2-3 drops for 3 x a day.

9. 5 TH HOSPITAL DAY Persistence of fever (T 39.5-40.5) - Cefuroxime was shifted to Ceftazidime 500mg/IV infusion over 30 minutes q8. - Amikacin 80mg/SIVP q8 was also given. Blood culture and sensitivity was requested Transfuse with 240ml of properly typed and crossmatched packed RBCs

10. 12/24/1012/28/10Unit Hgb9764g/L94 – 112 RBC3.492.28x 10 12 /L- Hct0.290.180.28 – 0.35 MCV83.0079.90U3U3 84 – 95 MCH27.8028.10pg- MCHC33.4035.20g/dL28.3-31.8 RDW20.4020.5011.6 – 14.6 MPV7.909.50fL7.4 – 10.4 Platelet2017x 10 9 / L150 – 450 WBC340.50x 10 9 / L4.50 – 10.0 Neutrophils0.030.090.50 – 0.70 Metamyelocytes0.02 Bands-0.00 – 0.05 Segmenters0.010.50 – 0.70 Lymphocytes0.630.890.20 – 0.40 Monocytes0.010.00 – 0.07 Eosinophils-0.010.00 – 0.05 Basophils-0.00 – 0.01 Reticulocyte-10^35-15 Blast0.32 Myelocytes0.02

11. 6 TH HOSPITAL DAY Patient had increased appetite and was less irritable. Still complained of left ear pain experienced productive cough.

12. 7 TH HOSPITAL DAY Transfused 2 units of type specific platelet concentrate.

13. 12/24/1012/28/1012/31/10Unit Hgb976485g/L94 – 112 RBC3.492.283.25x 10 12 /L- Hct0.290.180.250.28 – 0.35 MCV83.0079.9078.20U3U3 84 – 95 MCH27.8028.1026.10pg- MCHC33.4035.2033.40g/dL28.3-31.8 RDW20.4020.5017.9011.6 – 14.6 MPV7.909.508.90fL7.4 – 10.4 Platelet201720x 10 9 / L150 – 450 WBC340.500.60x 10 9 / L4.50 – 10.0 Neutrophils0.030.090.100.50 – 0.70 Metamyelocytes0.02- Bands--0.00 – 0.05 Segmenters0.010.100.50 – 0.70 Lymphocytes0.630.890.900.20 – 0.40 Monocytes0.01-0.00 – 0.07 Eosinophils-0.01-0.00 – 0.05 Basophils--0.00 – 0.01 Reticulocyte-10^35-15 Blast0.32 Myelocytes0.02

14. Referred to ENT Assessment : Impacted cerumen, AU t/c post auricular cellulitis. Otosol drops 3gtts q8 hours AU

15. 9 TH HOSPITAL DAY Referred to Ophthalmology Assessment: Subconjunctival Hemorrhage, OS Periorbital Hematoma, OU Advised to apply cold compress 15 mins TID x 48 hrs on both eyes then warm compress thereafter

16. Fluconazole was started Dosage: 200mg/capsule, 1 capsule as loading dose Then ½ capsule OD as maintenance dose to begin 24 hrs after. LOADING DOSE= 12mg/kg BW = 12mg x 16 kg = 192g MAINTENANCE DOSE = 6mg/kg BW = 6mgx 16 kg = 96g

17. 10 TH HOSPITAL DAY Transfused with 2 units of type specific platelet concentrate.

18. 12/24/1012/28/1012/31/1001/02/2011Unit Hgb97648575g/L94 – 112 RBC3.492.283.252.83x 10 12 /L- Hct0.290.180.250.220.28 – 0.35 MCV83.0079.9078.2078.10U3U3 84 – 95 MCH27.8028.1026.1026.60pg- MCHC33.4035.2033.4034.10g/dL28.3-31.8 RDW20.4020.5017.9017.1011.6 – 14.6 MPV7.909.508.909.30fL7.4 – 10.4 Platelet20172019x 10 9 / L150 – 450 WBC340.500.600.80x 10 9 / L4.50 – 10.0 Neutrophils0.030.090.100.260.50 – 0.70 Metamyelocytes0.02-- Bands---0.00 – 0.05 Segmenters0.010.100.260.50 – 0.70 Lymphocytes0.630.890.900.740.20 – 0.40 Monocytes0.01--0.00 – 0.07 Eosinophils-0.01--0.00 – 0.05 Basophils---0.00 – 0.01 Reticulocyte-10^35-15 Blast0.32 Myelocytes0.02

19. 11 TH HOSPITAL DAY BLOOD CULTURE AND SENSITIVITY BACTEC 9120 (AEROBIC) SPECIMEN: BLOOD WITH ARD FINAL REPORT: No growth after 5 days incubation

20. 12 TH HOSPITAL DAY Aural irrigation done, AU Findings: (+) Perforated TM, hyperemic TM, AS Impression : COM, AS, Active Suggest to start Chloramphenicol otic drops 2 gtts TID x 7 days Referred to Pedia-Nutrition