Age: 61.0
Sex: F
Vaccine: COVID19
Symptoms: Nucleated red cells, Oxygen saturation, PCO2 normal, Platelet count normal, Red blood cell count decreased
Clinical narrative: (D.O.)  PHYSICIAN (D.O.) Specialty:  Emergency Medicine ED Provider Notes     Signed  Signed     I received sign-out from Dr..   Patient is a 64 Y female who presented with below cc/mdm/workup/disposition.      ED Course as of 11/13/23 1605 Mon Nov 13, 2023 0812 64 yo F originally presented for concern for constipation, CT scan showed likely constipation without signs of obstruction.  Labs with leukocytosis of uncertain etiology.  While here patient was noted to be hypoxic, placed on oxygen.  Also had some intermittent tachycardia.  Recently was COVID-positive and also had recent hip surgery.  Chest x-ray, EKG and other labs ordered.  HBS consulted for evaluation. Will follow up UA, trop, bnp, Lactic and repeat Chem. On 6l now. Lasix being given  0911 K: 5.2 Improved, per previous physician she spectated was most likely hemolyzed and will not be giving calcium or other treatments for hyperkalemia at this time. 1009 BNP(!): 2,527 Suspect CHF exacerbation cause of shortness of breath      BP 154/76  | Pulse 86  | Temp 98.2 °F (36.8 °C)  | Resp 20  | Ht 1.626 m (5' 4")  | Wt 72 kg (158 lb 11.7 oz)  | LMP 10/20/2007  | SpO2 (!) 84%  | Breastfeeding No  | BMI 27.25 kg/m²         Results for orders placed or performed during the hospital encounter of 11/13/23 CHEM 7 (NA, K, CL, CO2, BUN, GLUC, CR) Result Value Ref Range   Sodium 137 135 - 145 mEq/L   Potassium 6.1 (AA) 3.5 - 5.3 mEq/L   Chloride 102 100 - 111 mEq/L   CO2 25 24 - 33 mEq/L   Anion gap, ser/plas 10 5 - 16 mEq/L   BUN 46 (H) 7 - 27 mg/dL   GLUCOSE, RANDOM 264 (H) 60 - 159 mg/dL   Creatinine 1.61 (H) <=1.11 mg/dL   Estimated Glomerular Filtration Rate 36 (L) >=60 mL/min/1.73 m2 AST Result Value Ref Range   AST 35 10 - 40 U/L ALT Result Value Ref Range   ALT 13 0 - 41 U/L BILIRUBIN, TOTAL Result Value Ref Range   Bilirubin, total 0.7 0.2 - 1.2 mg/dL ALKALINE PHOSPHATASE Result Value Ref Range   ALKALINE PHOSPHATASE 93 37 - 117 U/L LIPASE Result Value Ref Range   Lipase 22 <=90 U/L CBC W AUTOMATED DIFFERENTIAL Result Value Ref Range   WBC COUNT 17.5 (H) 3.7 - 11.1 K/uL   Red blood cells count 3.44 (L) 3.60 - 5.70 M/uL   Hgb 10.1 (L) 11.5 - 15.0 g/dL   Hematocrit 33.0 (L) 34.0 - 46.0 %   MCV 96 80 - 100 fL   RDW, RBC 15.2 12.0 - 16.5 %   Platelets count 369 140 - 400 K/uL   RBC's, nucleated 0 <=0 /100WC   Differential panel AUTO DIF   WBC AUTO DIFF Result Value Ref Range   Neutrophils, Automated Count 14.2 (H) 1.8 - 7.9 K/uL   Lymphocytes, Automated Count 1.7 0.9 - 3.2 K/uL   Monocytes, Automated Count 1.3 (H) 0.3 - 0.9 K/uL   Eosinophils, Automated Count 0.0 0.0 - 0.4 K/uL   Basophils, Automated Count 0.0 0.0 - 0.1 K/uL   Immature Granulocytes, Automated Count 0.2 (H) 0.0 - 0.1 K/uL   Neutrophils %, Automated count 81 %   Lymphocytes %, Automated count 10 %   Monocytes %, Automated Count 7 %   Eosinophils %, Automated Count 0 %   Basophils %, Automated Count 0 %   Immature Granulocytes %, Automated Count 1 % ABG W CALCULATED O2 SAT Result Value Ref Range   pH, arterial blood 7.40 7.35 - 7.45   CO2, partial pressure, arterial 38 35 - 45 mmHg   Oxygen, partial pressure, arterial blood 60 (L) 80 - 95 mmHg   Hco3, whole blood 23.7 23.0 - 28.0 mmol/L   Base excess, whole blood -0.8 -2.4 - 2.3 mmol/L   O2 saturation, arterial blood 90.0 (L) 95.0 - 99.0 %   PH CORRECTED, ARTERIAL BLOOD 7.40 7.35 - 7.45   PCO2 CORRECTED, ARTERIAL BLOOD 38 35 - 45 mmHg   pO2 adjust to pt's actual temp, partial press, Bld-a, Qn 59 (L) 80 - 95 mmHg   Body temperature 98.2 (L) 98.6 - 98.6 DegF   Oxygen rate, ventilator 2.0 L/min LACTIC ACID Result Value Ref Range   Lactate, ser/plas 1.6 0.5 - 1.9 mmol/L CHEM 7 (NA, K, CL, CO2, BUN, GLUC, CR) Result Value Ref Range   Sodium 137 135 - 145 mEq/L   Potassium 5.2 3.5 - 5.3 mEq/L   Chloride 101 100 - 111 mEq/L   CO2 22 (L) 24 - 33 mEq/L   Anion gap, ser/plas 14 5 - 16 mEq/L   BUN 45 (H) 7 - 27 mg/dL   GLUCOSE, RANDOM 277 (H) 60 - 159 mg/dL   Creatinine 1.66 (H) <=1.11 mg/dL   Estimated Glomerular Filtration Rate 34 (L) >=60 mL/min/1.73 m2 B-TYPE NATRIURETIC PEPTIDE (BNP) Result Value Ref Range   B type natriuretic protein 2,527 (H) <=100 pg/mL TROPONIN I, HIGH SENSITIVITY Result Value Ref Range   TROPONIN I, HIGH SENSITIVITY 26 (H) <=12 ng/L TROPONIN I, HIGH SENSITIVITY Result Value Ref Range   TROPONIN I, HIGH SENSITIVITY 31 (H) <=12 ng/L   TROPONIN I, HIGH SENSITIVITY, DELTA VALUE 5 ng/L   TROPONIN I, HIGH SENSITIVITY DELTA TIME 265 minute(s) URINALYSIS, AUTOMATED Result Value Ref Range   Glucose, UA 150 (A) <=49 mg/dL   Bilirubin, UA NEGATIVE NEGATIVE mg/dL   Ketones, UA NEGATIVE <=4 mg/dL   Specific gravity, UA 1.008 1.001 - 1.035   Hemoglobin,ur,ql MODERATE (A) NEGATIVE mg/dL   pH, UA 6.0 4.5 - 8.0   Protein, UA NEGATIVE <=29 mg/dL   Urobilinogen, UA <2.0 0.0 - 2.0 mg/dL   Nitrite, UA NEGATIVE NEGATIVE mg/dL   LEUKOCYTE ESTERASE, UA MODERATE (A) NEGATIVE Leu/ul   Appearance, urine CLEAR CLEAR   Color, urine YELLOW YELLOW   Specimen source CLEAN   URINALYSIS, MICROSCOPY Result Value Ref Range   MICROSCOPIC EXAM, URINE COMPLETE     WBC, urine 2 0 - 5 /HPF   RBC, urine 15 (H) 0 - 3 /HPF   Bacteria, urine HPF 1+ (A) NONE /HPF   Squamous cells count, ur sed, Qn None Seen 0 - 2 /LPF   Admitted to HBS in stable condition             Note Details  Author (D.O.) File Time 11/13/2023  4:06 PM Author Type PHYSICIAN (D.O.) Status Signed Last Editor (D.O.) Specialty Emergency Medicine Hospital Acct #  Admit Date 11/13/2023  ED to Hosp-Admission (Current) on 11/13/2023  ED to Hosp-Admission (Current) on 11/13/2023   Detailed Report  Note shared with patient Care Timeline  11/13   Admitted from ED (Observation) 1201 11/15   Admitted 1214  Pt in House Bed