Age: 19.0
Sex: F
Vaccine: COVID19
Symptoms: Alanine aminotransferase normal, Albumin globulin ratio, Anion gap, Back pain, Bacterial test
Clinical narrative: UTI, Cystitis, Proteinuria, DVT  Admission Information  8/20/2021 through 8/21/2022  Hospital Course       19-year-old G1P000 at 31 weeks 4 days with EDD of 10/18/2022 presented to the emergency department for increased left low back pain, fatigue today and a home blood pressure of 162/96 when she was crying from pain.  Patient was diagnosed with acute cystitis with hematuria the previous day at her NST and started on nitrofurantoin.  Pregnancy has been complicated by hypertension developed at 30 weeks 2 days; started on propranolol and currently titrated to 40 mg 3 times daily.  Patient was seen by maternal-fetal medicine and placed on bedrest, biweekly NSTs and strict monitoring for blood pressures and weekly labs.  Patient was placed under observation initially to monitor for blood pressures, as she was unsure if she took her evening dose of Macrobid, did give her Rocephin in the evening.  Patient was given both oral potassium and magnesium as well as placed on very gentle lactated Ringer's. Patient's potassium the following morning was critical at 2.9; magnesium 1.3.  Patient had also been collected for 24-hour protein and brought which she had started from home, the test was completed while she was in the hospital.  Await those results.  Thankfully, her UA on admission did not show any proteinuria.  Hemoglobin when she came in was 11.2, dropped down to 9.6 the following morning; patient had no evidence of bleeding, therefore favor dehydration.  Recheck of potassium was 3.2.  We will give her her last dose of potassium and magnesium before she goes.  Patient has follow-up in clinic tomorrow.      Physical Exam  Vitals & Measurements  T: 36.7  °C (Oral)  TMIN: 36.7  °C (Oral)  TMAX: 36.8  °C (Oral)  HR: 88(Monitored)  RR: 18  BP: 128/79  SpO2: 100%  SpO2: 100%  HT: 178.000 cm  WT: 84.700 kg  WT: 81.650 kg  BMI: 86.05(Percentile)  BMI: 26.730  O2 Therapy: Room air      See last progress note  Medications   Inpatient  !-Zofran ODT, 4 mg= 1 tab(s), Oral, q6hr (interval), PRN, PMC  acetaminophen, 650 mg= 2 tab(s), Oral, q6hr (interval), PRN  acetaminophen-codeine, 1 tab(s), Oral, q4hr (interval), PRN  aspirin, 81 mg= 1 tab(s), Oral, Daily  Injectafer, 750 mg, IV Piggyback, Once, PMC  Injectafer, 750 mg, IV Piggyback, Once, PMC  LR- 1,000 mL, 1000 mL, IV  Macrobid, 100 mg= 1 cap(s), Oral, BID  magnesium oxide 400 mg oral tablet, 800 mg= 2 tab(s), Oral, BID, PMC  Milk of Magnesia, 2400 mg= 30 mL, Oral, Daily, PRN  morphine, 4 mg= 1 mL, IV Push, Once, PRN  morphine, 2 mg= 1 mL, IV Push, q4hr (interval), PRN  potassium chloride 10 mEq oral tablet, extended release, 30 mEq= 3 tab(s), Oral, BID, PMC  propranolol, 40 mg= 2 tab(s), Oral, TID, PMC  Sodium Chloride 0.9% 250 mL, 250 mL, IV  THP acetaminophen-codeine 300 mg-30 mg oral tablet, 1 EA, Oral, As Directed  Tylenol, 650 mg= 2 tab(s), Oral, q4hr (scheduled), PRN  Home  acetaminophen 325 mg oral tablet, 650 mg= 2 tab(s), Oral, q6hr (interval), PRN  acetaminophen-codeine, 1 tab(s), Oral, As Directed  aspirin 81 mg oral tablet, chewable, 81 mg, Oral, Daily, PMC  nitrofurantoin  ondansetron 8 mg oral tablet, 8 mg= 1 tab(s), Oral, q8hr (interval), PRN  potassium chloride 10 mEq oral tablet, extended release, 20 mEq= 2 tab(s), Oral, BID, PMC  propranolol 10 mg oral tablet, 30 mg, Oral, TID, 3 refills  Tylenol 325 mg oral capsule, 650 mg, Oral, q4hr (scheduled), PRN, PMC  Tylenol 325 mg oral capsule, 650 mg, Oral, q4hr (scheduled), PRN  Procedure/Surgical History  ?Rotator cuff repair (2020) ?Cholecystectomy  Social History    Electronic Cigarette/Vaping   Electronic Cigarette Use: Never.   Sexual   Identifies as female Gender Identity:.   Tobacco   Never (less than 100 in lifetime) Tobacco Use:.  Lab Results        Test Name  Test Result  Date/Time        Sodium Level 136 mEq/L 08/21/2022 17:09         Sodium Level 138 mEq/L 08/21/2022 06:33        Sodium Level 138 mEq/L 08/20/2022 20:00         Potassium Level 3.2 mEq/L (Low) 08/21/2022 17:09         Potassium Level 2.9 mEq/L (Critical) 08/21/2022 06:33         Potassium Level 3.0 mEq/L (Low) 08/20/2022 20:00         Chloride Level 102 mEq/L 08/21/2022 17:09         Chloride Level 103 mEq/L 08/21/2022 06:33          Chloride Level 102 mEq/L 08/20/2022 20:00         CO2 26 mmol/L 08/21/2022 17:09         CO2 26 mmol/L 08/21/2022 06:33         CO2 20 mmol/L (Low) 08/20/2022 20:00         Anion Gap 12 mmol/L 08/21/2022 17:09         Anion Gap 12 mmol/L 08/21/2022 06:33         Anion Gap 18 mmol/L 08/20/2022 20:00         Glucose Level 99 mg/dL 08/21/2022 17:09         Glucose Level 90 mg/dL 08/21/2022 06:33          Glucose Level 116 mg/dL (High) 08/20/2022 20:00          BUN 6 mg/dL (Low) 08/21/2022 17:09          BUN 4 mg/dL (Low) 08/21/2022 06:33          BUN 5 mg/dL (Low) 08/20/2022 20:00         Creatinine Level 0.5 mg/dL 08/21/2022 17:09         Creatinine Level 0.5 mg/dL 08/21/2022 06:33          Creatinine Level 0.6 mg/dL 08/20/2022 20:00          BUN/Creat Ratio 12 08/21/2022 17:09         BUN/Creat Ratio 8 08/21/2022 06:33         BUN/Creat Ratio 8 08/20/2022 20:00        GFR AA 191 08/21/2022 17:09        GFR AA 187 08/21/2022 06:33         GFR AA 159 08/20/2022 20:00         GFR Non AA 158 08/21/2022 17:09          GFR Non AA 155 08/21/2022 06:33          GFR Non AA 132 08/20/2022 20:00          Calcium Level 8.6 mg/dL 08/21/2022 17:09          Calcium Level 8.3 mg/dL 08/21/2022 06:33          Calcium Level 8.6 mg/dL 08/20/2022 20:00          Magnesium 1.3 mg/dL (Low) 08/21/2022 06:33          Bili Total 0.4 mg/dL 08/21/2022 17:09          Bili Total 0.5 mg/dL 08/21/2022 06:33          Bili Total 0.4 mg/dL 08/20/2022 20:00          Alk Phos 140 unit/L 08/21/2022 17:09         Alk Phos 128 unit/L 08/21/2022 06:33          Alk Phos 142 unit/L 08/20/2022 20:00          ALT/SGPT 12 unit/L 08/21/2022 17:09         ALT/SGPT 12 unit/L 08/21/2022 06:33         ALT/SGPT 14 unit/L 08/20/2022 20:00         Protein Total 6.7 g/dL (%) 08/21/2022 17:09         Protein Total 6.3 g/dL (%) (Low) 08/21/2022 06:33         Protein Total 7.1 g/dL (%) 08/20/2022 20:00         Albumin Level 2.4 g/dL (%) (Low) 08/21/2022 17:09         Albumin Level 2.3 g/dL (%) (Low) 08/21/2022 06:33         Albumin Level 2.7 g/dL (%) (Low) 08/20/2022 20:00         Globulin 4.3 gm/dL (High) 08/21/2022 17:09         Globulin 4.0 gm/dL (High) 08/21/2022 06:33         Globulin 4.4 gm/dL (High) 08/20/2022 20:00         A/G Ratio 1 08/21/2022 17:09         A/G Ratio 1 08/21/2022 06:33         A/G Ratio 1 08/20/2022 20:00         Ur Protein 9.2 mg/dL 08/20/2022 07:00         U24 Protein 92.0 mg/24hr 08/20/2022 07:00         TV Protein 1000 mL 08/20/2022 07:00          WBC 12.6 x10^3/mcL (High) 08/21/2022 06:33          WBC 13.7 x10^3/mcL (High) 08/20/2022 20:00          RBC 3.23 x10^6/mcL (Low) 08/21/2022 06:33          RBC 3.72 x10^6/mcL (Low) 08/20/2022 20:00          Hgb 9.6 g/dL (%) (Low) 08/21/2022 06:33          Hgb 11.2 g/dL (%) (Low) 08/20/2022 20:00          Hct 29 % (Low) 08/21/2022 06:33         Hct 33 % (Low) 08/20/2022 20:00         MCV 90 fL 08/21/2022 06:33          MCV 88 fL 08/20/2022 20:00         MCH 30 pg 08/21/2022 06:33         MCH 30 pg 08/20/2022 20:00         MCHC 33 g/dL (%) 08/21/2022 06:33         MCHC 34 g/dL (%) 08/20/2022 20:00         RDW 12.8 % 08/21/2022 06:33         RDW 12.6 % 08/20/2022 20:00         Platelet 265 x10^3/mcL 08/21/2022 06:33         Platelet 324 x10^3/mcL 08/20/2022 20:00         Auto Lymph % 14 % (High) 08/21/2022 06:33         Auto Lymph % 13 % (High) 08/20/2022 20:00         Auto Neut % 77 % (High) 08/21/2022 06:33          Auto Neut % 79 % (High) 08/20/2022 20:00         Auto Mono % 7 % 08/21/2022 06:33         Auto Mono % 6 % 08/20/2022 20:00         Auto Eos % 0 % 08/21/2022 06:33          Auto Eos % 0 % 08/20/2022 20:00          Auto Baso % 0 % 08/21/2022 06:33          Auto Baso % 0 % 08/20/2022 20:00         Neut Abs# 9.7 x10^3/mcL 08/21/2022 06:33          Neut Abs# 10.8 x10^3/mcL 08/20/2022 20:00          PT 8.6 second(s) (Low) 08/20/2022 20:00          INR 0.8 (Low) 08/20/2022 20:00          UA Color Yellow 08/20/2022 20:50         UA Clarity Cloudy 08/20/2022 20:50          UA Glucose Negative 08/20/2022 20:50         UA Ketones Negative 08/20/2022 20:50         UA Spec Grav 1.020 08/20/2022 20:50         UA Blood Trace-lysed 08/20/2022 20:50         UA pH 7.0 08/20/2022 20:50         UA Protein Negative 08/20/2022 20:50         UA Urobilinogen 0.2 08/20/2022 20:50         UA Nitrite Negative 08/20/2022 20:50         UA Leuk Est Large 08/20/2022 20:50         UA Bilirubin Negative SGHO 08/20/2022 20:50         Culture? No 08/20/2022 20:50         UA WBC 31-50 08/20/2022 20:50         UA RBC 0-2 08/20/2022 20:50          UA Bacteria Moderate 08/20/2022 20:50         UA Epithelials Moderate 08/20/2022 20:50        Discharge Plan        1. Hypokalemia E87.6    2. Hypertension in pregnancy O16.9    3. Proteinuria R80.9    4. Acute cystitis with hematuria N30.01    5. Back pain in pregnancy O99.891    6. Pregnant Z34.90    Orders:   Tylenol, 650 mg = 2 tab(s), Tab, Oral, q4hr (scheduled), PRN Pain/Fever, Routine, Start date 08/21/22 9:40:00, 08/21/22 9:40:00  Tylenol 325 mg oral capsule, ( 650 mg ), Oral, q4hr (scheduled), PRN PRN: Pain/Fever, 0 Refill(s), Cap  acetaminophen, 650 mg = 2 tab(s), Tab, Oral, q6hr (interval), PRN Pain/Fever, Routine, Start date 08/20/22 21:06:00, 08/20/22 21:06:00   acetaminophen 325 mg oral tablet, ( 650 mg ) 2 tab(s), Oral, q6hr (interval), PRN PRN: Pain/Fever, 0 Refill(s), Tab  acetaminophen-codeine, 1, tab(s), Tab, Oral, q4hr (interval), PRN, Pain - Mild, NOW, Start date 08/21/22 1:06:00, 08/21/22 1:06:00   acetaminophen-codeine, 1 tab(s), Oral, As Directed, 0 Refill(s), Tab  THP acetaminophen-codeine 300 mg-30 mg oral tablet, 1, EA, Tab, Oral, As Directed, Routine, Start date 08/21/22 18:21:00, Physician Stop, 08/21/22 18:21:00   aspirin, 81 mg = 1 tab(s), Tab-Chew, Oral, Daily, Routine, Start date 08/22/22 9:00:00, 08/21/22 9:40:00   LR- 1,000 mL, 1,000, mL, IV, Routine, Start date 08/20/22 21:51:00, 50 mL/hr, 20, hr, Total volume (mL): 1,000, 81.65 kg, 2.01, m2, 08/20/22 21:51:00  Milk of Magnesia, 30, mL, Susp, Oral, Daily, PRN, constipation, Routine, Start date 08/20/22 21:06:00, 08/20/22 21:06:00   magnesium oxide 400 mg oral tablet, 800 mg = 2 tab(s), Tab, Oral, BID, Routine, Start date 08/21/22 21:00:00, 08/21/22 10:00:00   morphine, 4 mg = 1 mL, Soln, IV Push, Once, PRN pain, Routine, Start date 08/20/22 21:06:00, Physician Stop, 08/20/22 21:06:00   morphine, 2 mg = 1 mL, Soln, IV Push, q4hr (interval), PRN pain, Routine, Start date 08/20/22 21:06:00, 08/20/22 21:06:00   Macrobid, 100 mg = 1 cap(s), Cap, Oral, BID, Antibiotic Indication Urinary Tract Infection, Routine, Start date 08/21/22 9:00:00, 2 day(s), Physician Stop, Stop date 08/23/22 8:59:00, 08/21/22 9:00:00   !-Zofran ODT, 4 mg = 1 tab(s), Tab-DIS, Oral, q6hr (interval), PRN Nausea, Routine, Start date 08/20/22 21:06:00, 08/20/22 21:06:00   potassium chloride 10 mEq oral tablet, extended release, ( 20 mEq ) 2 tab(s), Oral, BID, Instructions: PMC, # 120 tab(s), 0 Refill(s), Pharmacy: Tab-ER, 178, cm, 08/20/22 23:40:00, Height/Length Dosing, 81.65, kg, 08/20/22 20:44:00, Weight Dosing  potassium chloride 10 mEq oral tablet, extended release, 30 mEq = 3 tab(s), Tab-ER, Oral, BID, Routine, Start date 08/21/22 9:00:00, 08/20/22 21:06:00   propranolol, 40 mg = 2 tab(s), Tab, Oral, TID, Routine, Start date 08/21/22 9:00:00, 08/20/22 21:06:00   Sodium Chloride 0.9% 250 mL, 250, mL, IV, Routine, Start date 08/20/22 21:25:00, 10 mL/hr, 25, hr, Total volume (mL): 250, 81.65 kg, 2.01, m2, 08/20/22 21:25:00   96 Hour Admit Notification, 08/20/22 21:06:00, I certify that this patient can reasonably be expected to be discharged or transferred within 96 hours of admission.  Aqua K Pads, 08/20/22 22:17:00, Constant order, Standard Precautions  Bedrest, 08/20/22 21:06:00, Constant order, Standard Precautions  Comprehensive Metabolic Panel Standard, Blood, Expedite collect, 08/21/22 7:00:00, Once, Stop date 08/21/22 7:00:00, Lab Collect  Comprehensive Metabolic Panel Standard, Blood, Stat collect, 08/20/22 19:50:00, Once, Stop date 08/20/22 19:51:00, Lab Collect  Comprehensive Metabolic Panel Standard, Blood, Timed Study collect, 08/21/22 17:00:00, Once, Stop date 08/21/22 17:00:00, Lab Collect  Diet Order, 08/20/22 21:06:00, Regular, Nursing Isolation Status: Standard Precautions, Constant Indicator  Fetal Heart Monitor, 08/20/22 21:06:00, Standard Precautions  Incentive Spirometry, 08/20/22 21:06:00, MTuWThF, Walk, No, No, Standard Precautions, RT to evaluate and instruct patient on use of incentive spirometer, -1, -1, 08/22/22 9:00:00  Incentive Spirometry Nursing, 08/20/22 21:06:00, TID, Have pt. complete every hour while awake. Document in requisite form or data View.  Notify Provider Vital Signs, 08/20/22 21:06:00, T > 101  Place in Observation, 08/20/22 21:06:00, Med/Surg, hypertension in pregnancy, Anticipated LOS 1 midnight or less  Resuscitation Status, 08/20/22 21:06:00, Full Resuscitation, Constant Order  Saline Lock with Standard Flushes, 08/20/22 21:00:00, q24hr (interval), Standard Precautions  Vital Signs, 08/20/22 21:06:00, q4hr (scheduled), Standard Precautions  Weight, 08/20/22 21:06:00, qAM (scheduled), Standard Precautions  All Diagnoses This Visit   Hypokalemia  Hypertension in pregnancy  Proteinuria  Acute cystitis with hematuria  Back pain in pregnancy  Pregnant  Patient Discharge Condition  Improved  Discharge Disposition  Home to self cares  Patient Education   Hypokalemia  Follow Up        With  When  Contact Information        In 1 day 08/22/2022  Additional Instructions: Keep our appt       Medication Reconciliation   New Prescription  acetaminophen-codeine1 tab(s) Oral As Directed.    Changed  acetaminophen (acetaminophen 325 mg oral tablet)2 tab(s) Oral every 6 hours as needed Pain/Fever.    acetaminophen (Tylenol 325 mg oral capsule)650 Milligram Oral Every 4 hours as needed Pain/Fever.    acetaminophen (Tylenol 325 mg oral capsule)650 Milligram Oral Every 4 hours as needed Pain/Fever. PMC.    potassium chloride (potassium chloride 10 mEq oral tablet, extended release)2 tab(s) Oral 2 times a day. PMC. Refills: 0.    Unchanged  aspirin (aspirin 81 mg oral tablet, chewable)81 Milligram Oral Daily. PMC. Refills: 0.    nitrofurantoin    ondansetron (ondansetron 8 mg oral tablet)1 tab(s) Oral every 8 hours as needed nausea/vomiting.    propranolol (propranolol 10 mg oral tablet)30 Milligram Oral 3 times a day. Refills: 3.  Images   None  Professional Services/Counseling  Total time spent on discharge: 45 minutes    Signature Line [Electronically Signed by: 08/21/2022 18:27] ________________________________________ DO  Reason For Exam left calf pain & swelling  US LE Veins Duplex Lt EXAM:  DUPLEX ULTRASOUND LEFT LOWER EXTREMITY DEEP VEINS  DATE:  08/24/2022  1:30PM    TECHNIQUE:  Left leg venous duplex Doppler ultrasound. Multiple real-time grayscale transverse and longitudinal ultrasound images were performed, with application of color/power and spectral Doppler technique including color Doppler flow, spectral waveform analysis and compression.  COMPARISON:  None.  CLINICAL INDICATION: Left leg swelling, patient 33 weeks pregnant.  FINDINGS:  Occlusive DVT is demonstrated within the left leg extending through the distal external iliac vein, common femoral vein, greater saphenous vein, superficial femoral vein, popliteal vein, posterior tibialis, and peroneal veins.  Minimal blood flow is demonstrated within the peroneal veins.  No real-time demonstration of significant edema, or any focal fluid collection.  IMPRESSION: Significant clot burden/DVT extending throughout the left leg, from the level of the distal external iliac vein through the peroneal veins.    Signature Line ***** Final *****  Dictated by:    MD Dictated: 08/24/22 4:48  Signed (Electronic Signature):  MD       08/24/22 4:47 pm