“Coughing Up Blood” part 2

Patient is intubated for airway protection. She is also resuscitated with 2 liters of IV crystalloid fluids. Initial workup elicits the following: Lab WBC 10.2 (normal differential), Hgb 11.4, Plt 190K Na+ 136, K+ 4.0, Cl– 110, HCO3– 24, BUN 52, Cr 2.6, Glucose 112 AST: 27, ALT 25, Total Bilirubin 0.2, Albumin 3.2 ABG:Continue reading ““Coughing Up Blood” part 2″

“Coughing Up Blood” part 3

This patient has two separate problems: Hemoptysis (with likely Diffuse Alveolar Hemorrhage) and Acute Kidney Injury (with likely glomerulonephritis as evidenced by urinalysis findings) in the setting of elevated inflammatory markers. Diffuse Alveolar Hemorrhage Diagnosed by bronchoscopic alveolar lavage (BAL) obtaining sequential 5mL aliquots that show increasing RBCs Differential Diagnosis: Pulmonary capillaritis Vasculitis Anti-GBM diseaseContinue reading ““Coughing Up Blood” part 3″

Viral Hepatitis

Hepatitis A Virus (HAV) Transmission: Fecal-oral Presentation: Febrile illness, nausea/vomiting, diarrhea, anorexia, abdominal distension, rarely causes fulminant liver disease Diagnosis: Hepatitis A Virus IgM Management: Conservative management Hepatitis B Virus (HBV) Transmission: Blood, sex, vertical (mother-to-baby) Presentation Acute: Similarly to Hepatitis A: Febrile illness, nausea/vomiting, diarrhea, abdominal pain. Rarely, jaundice and fulminant liver disease. Chronic:Continue reading “Viral Hepatitis”

“My blood pressure is high” continued

This young male with difficult-to-control hypertension on maximum-dose therapy of two antihypertensives requires a workup for secondary hypertension. Labs WBC 6,400, Hgb 13.6, Plt 245,000 Na+ 146, K+ 2.8, Cl– 110, HCO3– 30, BUN 27, Creatinine 0.8, Calcium 8.5 TSH: 2.4 8 AM Plasma Aldosterone Concentration (PAC): 22 ng/dL; Plasma Renin Activity (PRA): 0.6 ng/mLContinue reading ““My blood pressure is high” continued”

Lumbar Puncture Interpretation

Meningitis Routine Laboratory Results Specific Markers PCR May vary from center to center, but generally will detect E. coli, H. influenzae, N. meningitidis, Listeria monocytogenes, Streptococcus agalactiae, Streptococcus pneumoniae, CMV, Enterovirus, HSV 1/2, HHV-6, Human parechovirus, VZV, and Cryptococcus neoformans/gattii ADA (Adenosine Deaminase) Sensitivity and specificity for tuberculous meningitis varies depending cutoff level, however, approachesContinue reading “Lumbar Puncture Interpretation”