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Department of Pathology
(March 24 – 31, 2018)
Alinsugay, Amytess
Landero, Jaime Vinc Angelo
Singco, Shera Efraim
Yrauda, Noreen Joyce
General Data
• M.A., 14 year old female, child, from Basak, Mandaue, Cebu, born on
February 23, 2003, was admitted for the first time at VSMMC last
January 16, 2018 due to fever
Prenatal History
• Maternal age 20 years old
• No maternal illnesses
Natal History
• Birth rank 1/1
• Born live term, female neonate delivered via NSD with good cry, BW 3,600gm
with good cry at VSMMC
Post-extubation
HR: 125
RR: 32
O2Sat:95 – 96%
CBC – Mar 19
WBC 7.87
RBC 3.09
Hgb 88
Hct 0.25
Platelet 135
Neutrophil 92.4
Lymphocyte 6.2
Monocyte 1.3
Eosinophil 0.0
Basophil 0.1
CBC – March 21
WBC 7.87
RBC 3.09
Hgb 88
Hct 0.25
Platelet 135
Neutrophil 92.4
Lymphocyte 6.2
Monocyte 1.3
Eosinophil 0.0
Basophil 0.1
Hospital Week 9 (Mar 19 – Mar 25, 2018)
S O A P
Mar22 • T/C Antibiotic- • Labs: ABG POC stat;
(+) watery-stools, Associated Diarrhea Stool Exam; Stool C/S;
yellowish, non-foul with Mild Dehydration S. Electrolytes stat
smelling • O2 via face mask @
10LPM
• High-back rest
• Cotrimoxazole 1tab
BID per NGT
• Start Probiotics
Hospital Week 9 (Mar 19 – Mar 25, 2018)
S O A P
Mar23 unresponsive • T/C Systemic Lupus • CPR started
Mother refused Vital Signs Erythematosus • Manual ambubagging
intubation HR: 59 • Hospital Acquired • Suction secretions PRN
(+) copious oral secretions O2Sat: 39% Infection • Epinephrine 1amp
(+) desaturations • T/C Rapidly Progressive IVTT
Glomerulonephritis
(+) CP arrest • MR mild, TR mild,
prob. sec. to SLE
carditis
Hospital Week 9 (Mar 19 – Mar 25, 2018)
S O A P
Mar 24 Vital Signs • T/C Systemic Lupus • CPR started
(+) pooling of secretions HR: 59 Erythematosus • Manual ambubagging
O2Sat: 64% • Hospital Acquired • Suction secretions PRN
Infection • Epinephrine drip
(+) decreased air entry • T/C Rapidly Progressive • Dobutamine drip
Glomerulonephritis • Patient revived
• MR mild, TR mild, • For stat HD
prob. sec. to SLE • Repeat blood C/S
carditis
Hospital Week 9 (Mar 19 – Mar 25, 2018)
S O A P
Mar 25: (+) referred for GCS: 5 • T/C Systemic Lupus • CPR started
bradycardia; (+) coffee- Erythematosus • Epinephrine 1ml X
ground NGT drain; Vital Signs • Hospital Acquired 1dose q3mins
HR: 40’s -> 130’s Infection • Resume epinephrine
O2sat: 30% • T/C Rapidly Progressive drip
Glomerulonephritis • Continue Dobutamine
- Pupils 3mm, isocoric, • MR mild, TR mild, drip
sluggish prob. sec. to SLE • Manual ambubagging
carditis • For stat HD
Hgt: 59 mg/dl • Given NaHCO3 50mcg
+ equal amount of
D5W to run over
30mins X 2cycles; to
give 2nd cycle after
30mins
Hospital Week 9 (Mar 19 – Mar 25, 2018)
S O A P
Mar25 6:25pm HR: 0 • T/C Systemic Lupus • Pronounced clinically
(+) fixed dilated pupils Erythematosus dead
(-) respiration • Hospital Acquired • Family consented for
Infection autopsy
• T/C Rapidly Progressive
Glomerulonephritis
• MR mild, TR mild,
prob. sec. to SLE
carditis
CBC – March 24 March 24
WBC 5.4 Creatinine 3.26 0.66 – 1.09mg/dl
RBC 1.8 BUN 64.69 7.87 – 21.90mg/dl
Hgb 51
March 24
Hct 0.157
Sodium 148.2
Platelet 83
Potassium 3.98
Neutrophil 80.7
Chloride 111.0
Lymphocyte 17.4
Ionized Calcium 1.07
Monocyte 1.7
Eosinophil 0.2
Culture and Susceptibility Result
Basophil 0.0
Final Report: No important enteropathogen isolated
Fecalysis – March 24
Color Yellow
Consistency Mucoid
RBC 2-4
Differential Diagnoses
Fever x x x x
Headache x x
Rash x x x x
Abdominal Pain x x
Vomiting x x
Arthritis x x x
Carditis x x
Subcutaneous Nodules x x
Chorea x x
hepatomegaly x x
splenomegaly x x
serositis x x
edema x
seizure x
thrombocytopenia x
leukopenia x
valvular involvement x x
nephritis x x x
Impression
1. Multiple Organ Failure secondary to Septic Shock
secondary to Multiple Opportunistic Infections (A. baumanii,
K. pneumoniae, E. faecium, C. laurentii, B. cepacia)
2. Systemic Lupus Erythematosus
3. T/C Immunocompromised State
4. S/P Intubation
5. S/P Arrest x12
Mechanism of Organ Damage
Right Lung
Heart
Kidneys
Kidneys
Stomach
Pancreas
Liver
Appendix
Provisionary Anatomic Findings:
1. Brain
• Grossly unremarkable
2. Heart
• Left Ventricular Hypertrophy
• Ventricular Septum (3cm)
• Left Ventricular Wall (1.5cm)
• Pericardial Fluid (75ml)
3. Lungs
• Pulmonary Congestion, Bilateral
• Multiple yellow to green solid nodules (0.5 to 2cm in diameter), bilateral
Provisionary Anatomic Findings:
4. Abdomen
• Peritoneal Fluid (400ml)
• Hepatomegaly (1950 grams)
• Splenomegaly (200 grams)
• Grossly unremarkable: Stomach, Pancreas, Small and Large Intestines,
Appendix
5. Kidney
• Grossly enlarged (400 grams), Bilateral
• End