tokens: 493597270 CMC 86164445 3/17/1998 12:00:00 AM ACUTE LEUKEMIA Signed DIS Admission Date : 03/17/1998 Report Status : Signed Discharge Date : 04/12/1998 HISTORY OF PRESENT ILLNESS : The patient is a 68 year old with acute leukemia . The patient was in her usual state of health until about three weeks prior to admission when she began to notice increased weakness and bruising . She presented to a Wood Emergency Department six days prior to admission . Platelets were 9,000 , hemoglobin 9.5 , temperature was 100.4 . The patient had a smear there consistent with ALL . The patient was transferred to Norri Hospital . REVIEW OF SYSTEMS : No headache , no nausea , vomiting or diarrhea . Some shortness of breath with allergies , particularly cats . No chest pain . The patient had been doing aerobics three times a week until a couple of weeks before admission . PAST MEDICAL HISTORY : The patient &apos;s past medical history is significant for allergies , depression and anxiety , pleural thickening / asbestosis , chronic left bundle branch block , tonsillectomy , adenoidectomy , vein stripping ( 1968 ) , left wrist fracture ( 1994 ) , and hypercholesterolemia . ALLERGIES : The patient &apos;s allergies include a questionable penicillin reaction ; however , the patient tolerated Ampicillin well . The patient does not recollect what her reaction to penicillin was . The patient also had a history of platelet reaction . FAMILY HISTORY : The patient &apos;s family history was significant for a brother with colon cancer . SOCIAL HISTORY : The patient lives with her husband and she has three children . PHYSICAL EXAMINATION : The patient &apos;s physical examination revealed a well-developed , well-nourished white female in no apparent distress . Vital signs : Temperature 98.2 , blood pressure 134/80 , respiratory rate 22 , pulse 102 . HEENT examination was normocephalic and atraumatic . Cranial nerves II-XII were grossly intact . There was decreased hearing bilaterally . The oropharynx was within normal limits with fillings and a partial upper plate . The neck had a full range of motion , no lymphadenopathy . The chest exam was clear to auscultation . Cardiac exam revealed an S1 and an S2 and a diffuse 2/6 systolic murmur . The abdomen was soft , nontender and nondistended with no guarding and no hepatosplenomegaly . Bowel sounds were present . The skin examination revealed the right breast had a dark two centimeter ecchymosis and the left medial thigh had two pale blue two centimeter macules . LABORATORY DATA : Admitting labs were : Sodium 138 , potassium 4.2 , chloride 98 , BUN 21 , creatinine 0.7 , glucose 117 , white blood cell count 13,200 , hematocrit 22.5 , platelet count 40,000 . AST 29 , ALK 151 , total bilirubin 0.2 , total protein 7.2 , albumin 4.3 , globulins 2.9 , calcium 8.9 . PT 12.8 , PTT 19.1 . Peripheral smear revealed blasts of 62% . HOSPITAL COURSE : A Hickman catheter was placed and the patient was begun on chemotherapy . The regimen included cyclophosphamide , daunorubicin , prednisone , Vincristine and PEG-asparaginase . The patient tolerated the chemotherapy regimen well . The patient began neutropenic on day five of induction . The patient &apos;s liver function tests began to rise and she began to experience pulmonary symptoms including increased crackles . The patient began to spike and a blood culture grew out Staphylococcusaureus . The patient was begun on Gentamicin , Vancomycin and Piperacillin , which was changed to Gentamicin and Ceftazidime . The patient continued to spike and was enrolled in a randomized trial , the patient was randomized to AmBisome antifungal treatment . An abdominal MRI was performed to assess continued elevated liver enzymes ; however , the MRI was negative . The patient was begun on Nafcillin due to continued spiking . The patient began to experience urinary retention and was straight catheterized . Thepatient developed a possible drug rash and Nafcillin was changed to Ancef . The patient became constipated ; this resolved with laxatives . The patient improved significantly and was thought to be ready for discharge by the 11th of April . She will follow up with her primary oncologists , Dr A and Dr Dark , at IVMC , after her discharge . DISCHARGE MEDICATIONS : The patient &apos;s discharge medications include the following : 1) Albuterol inhaler two puffs q.i.d. p.r.n. breathing difficulties . 2) Calcium gluconate 1000 mg p.o. q day . 3) Cefazolin one gram IV q.8h. x 13days . 4) Colace 100 mg p.o. b.i.d. 5) Lasix 40 mg p.o. q day . 6) Lactulose 30 milliliters p.o. q.2h. p.r.n. constipation . 7) Magnesium hydroxide 30 milliliters p.o. q day . 8) Miracle Creamtopical q day p.r.n. skin irritation . 9) Sarna topical b.i.d. p.r.n. itching . 10) Senna tablets , two tablets p.o. b.i.d. 11) Simethicone 80 mg p.o. q.i.d. p.r.n. gas pain . 12) Citrucel one tablespoon p.o. q day . 13) K-Dur 10 mEq x three , p.o. b.i.d. 14) Zoloft 25 mg p.o. q day . 15) Peridex 30 cc p.o. b.i.d. x 14 days . 16) Robituss in AC five to ten milliliters p.o. q.h.s. p.r.n. cough . Dictated By : AZEL HIBBSKAYS , M.D. CF66 Attending : TELSHEY K. SWATLLEEBTIK , M.D. NJ38 ME089/6922 Batch : 43792 Index No. CHDNIR25 OK D : 05/13/98 T : 05/13/98