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HPI He started feeling short of breath while at dialysis and admits to several months of intermittent productive
cough and night sweats. He also noted that he felt feverish when his vitals were checked before hemodialysis.
He does use O2 at home but only PRN, he has not had to increase its use before presentation. Denies CP, N/V
but does have on/off diarrhea. (**Questionable compliance with home meds)
ROS
CONSTITUTIONAL: as per HPI
HEENT: Eyes: No diplopia or blurred vision.
ENT: No earache, sore throat or runny nose.
CARDIOVASCULAR: No chest pain, palpitations
RESPIRATORY: + cough, shortness of breath, No paroxysmal nocturnal dyspnea or orthopnea.
GASTROINTESTINAL: + diarrhea, No nausea, vomiting
GENITOURINARY: No dysuria, frequency or urgency.
SKIN: No change in skin, hair or nails.
NEUROLOGIC: + weakness, No paresthesias, fasciculations, seizures
PSYCHIATRIC: + Depression, hallucinations, no suicidal/ homicidal ideations
ENDOCRINE: No heat or cold intolerance, polyuria or polydipsia.
HEMATOLOGICAL: No easy bruising or bleeding.
Past surgical hx
Insert Dialysis catheters
Left AV graft placement 5/2/2012
Right brachiocephalic AV fistula placement 11/2012
Right basilic vein transposition 10/2013
Areteriovenous fistula branch ligation
Social History
Tobacco: Current 1ppd x 37 years
EtOH: None
Illicit drugs: Hx of marijuana use
Sexual activity: Several years abstinent
PE
Ht 5' 8" (1.727 m)
Wt 150 lb 9.2 oz (68.3 kg)
Temp(Src) 38.3 C (101 F) (Oral) BP 172/108
SpO2 95%
Ca 8.2
Tot Protein 6.1
Albumin 3.0
AST/ALT 35/13
Alk Phos 67
T Bili 0.9
Venous Lactate 1.1
Lactic Dehydrogenase 1697
Blood cultures No growth 2/2 x 5 days
CXR
IMPRESSION:
Bilateral lung opacities likely represent edema. Cannot exclude atypical pneumonia.
Clinical course
Patient meets SIRS criteria and was admitted with diagnosis of sepsis secondary to BL pneumonia
Admitting medications
Bactrim 600 mg IV q daily
Prednisone 40 mg PO BID -> taper
Levaquin 750 mg IV q daily
Cont. home meds as prescribed
Consults on admission
Nephrology for ESRD/ HD
Pulmonology for possible diagnostic broncoscopy
Results of Bronchoalveolar lavage
BAL R middle lobe PCR- negative for MAC
BAL AFB smear- negative
BAL legionalla- negative
BAL KOH prep- negative
BAL fungal culture- pending
Bronchial brush cultures- Rare Staphylococcus, coagulase negative
Viral culture- pending
Pneumocystis smear- POSITIVE