DUTY REPORT JUNE 26TH 2013

MARDIAS ANJAS,MALE, 65 YO , MW16

Cc : Epigastric pain since 4 days ago Present illness history : Epigastric pain since 4 days ago,no refer, Heartburn since 4 days ago Nausea (+), vomit (+) since 2 days ago, twice, 1 spoonfull, consist of food and water consumed Hip cup since 2 days ago Decreased of apetite and no drink since 1 days ago Volume of Mixturation was decreased since 1 day ago,Volume Fever (-)

- Cough (-) - Defecation Normal - Patient has been hospitalize 1 month ago with diagnose Broncopneumonia and Hip cup
Physical examination : Consc : CMC BP : 120/80 mmHg HR : 88x/ RR : 20x/ T : 37 C Eye : Conjuctiva not anemic,sclera not icterus Lung : vesiculer, rales (-/-), Whezzing (-/-) Heart : ictus was palpable 1 finger medial of LMCS RIC V Abdomen: Liver and spleen werent palpable, tenderness on epigatric, bowel sound (+) Ext : Fisiology reflex :(+)/(+) Normal Pathology reflex:(-)/(-) Normal Edem (-)/(-)

Laboratorium Hb : 13,1 gr/dl Leu : 7700/mm3 Ht : 39% Trombosit : 216.000/mm3 Na : 138 mmol/L K : 3,6 mmol/L Cl : 109 mmol/L GDS : 105 mg/dl Ureum : 31 mg/dl Creatinin : 1,6 mg/dl Protein Urin : ( )

WD : Gastroesophageal Reflux Disease DD/ Peptic Ulcer AKI rifle R cb pre renal cb dehydration

Th : Rest/ Gastric diet II IVFD NaCl 0,9 % 8 hours/ kolf Inj.Omeprazole 1x1 (IV) Domperidon 3x10 mg Sukralfat Syr 3xCth II Fluid Balance

Suggestion Urinalyse Ureum, creatinin evaluation/3 days Gastroscopy

1.Herawati, 63 yo, female, FW 15 (dr.Riko) Cc: Nausea and Vomit since 5 days ago Present illness history: - Nausea and vomit since 5 days ago,frequency 3 time/days,volume 1 glass/x vomit - Epigastrium pain since 5 days ago - Decrease of apetite since 5 days ago - Fever since 3 days ago, continue,no sweat,no tremble - Pain of joint and muscle since 3 days ago - Headache since 3 days

Bleeding of Gum was denied - Defecation and mixturation usuall - History of DM from since 15 years ago,reguler control, consumpt insulin - History of Hipertension from since 15 years ago,reguler control, consumpt drug (amlodipin 1x 5 mg,candesartan 1x16mg) Physical finding Sensorium:CMC VS: Blood Presure:110/80 mmHg Heart Rate:87x/i, Respiratory Rate:20x/i,Temperature: 370 C Ideal weight Body = 47,2 kg Body Mass Index =21,6 kg/mm2
-

- Skin : Rumple Leed (+), flushing (-) - Eye: anemic (-),sclera icterus (-) - Lung : vesicular, rales (-/-), whezing (-/-) - Heart: reguler, murmur (-) - Abdoment : Liver and spleen unpapable , pain on epigastrium - Extremity : Fisiology reflex :(+)/(+) Normal Pathology reflex:(-)/(-) Normal right left Sensibiltas + Normal + Normal Pulsation a.dorsalis pedis + Normal + Normal Pulsation a.tibialis posterior + Normal + Normal Pulsation a.poplitea + Normal + Normal Edem (-)/(-)

Laboratorium Hemoglobin:11,5 gr/dl Leucocyte: 4300/mm3 Hemotocrit : 35% Platelet: 103.ooo/mm3 GDS: 201gr/dlGDS 168 gr/dl Sodium : 126 mmol/dl Clorida: 97 mmol/l Kalium: 4 mmol/l Ur eum : 48 mg/dl Creatinin: 2 mg/dl

WD : - Acute Gastritis DD/ Fungsional dispepsia - Dengue Fever DD/idiophatic trobocitopenia purpura - Type 2 DM controlled insulin normoweight - Stage II hipertension cb essensial - AKI RIFLE R cb prerenal cb dehydration - Hyponatermia cb vomit Th/: - Rest/Gastric Diet III/Low salt Diet III/Diabetic Diet 1700 kkal - IVFD NaCl 0,9 % 6hours/kolf - Lansoprazole 1x30 mg - Domperidon 3 x 10 mg - Amlodipin 1x5 mg - Candesartan 1x 16 mg

- Paracetamol 3x500mg - sukralfat syrup 3xcthII - Novorapid 3x 6 IU - Levemir 1x10 IU - Fluid Balance
Plan/ Check Hb,Ht,Platelet/24 hours Renal function test,liver function test Lipid profile Check IgG,IgM antidengue Check Ureum,creatinin 1time/days Gastroscopy Opthalmology consultation Nutrition consultation

Itoloni Gulo , male,21 yo, hostalized with : (dr.RINI) Chief complain : Fever since 5 days ago.

Present illness : - Fever (+) - Headache (+) - Jointpain (+) - Epigastric pain (+) - Vomite (+) -Nausea (+) Past illness history : -History of malaria (-) - History of hepatitis (-)
Family illness history: None of the family member get this disease. Social /occupational/ habituation / psichiatric : Patient is a student

Phisical Examination 1.Vital sign - General appearence: moderate - Level of conciousness : cmc - BP : 110/70 mmHg - Pulse rate : 75 x/minutes - RR : 20 x / minutes - body temperature : 37,9C 2.Skin : Flushing (+) 3.Eyes : conjunctiva anemic (-),sclera icteric H20 4.Neck : JVP 5 2 cmH20. Regional lymh node : none enlargement. Tyroid gland : none enlargement.

5. Chest Lung : inspection simetris Palpation fremitus normal percution sonor Auscultation Breath sound vesicular normal,rales -/- , 6. Heart , Inspection: Ictucordis anvisible Palpation : ictus cordis palpable 1 finger medial LMCS RIC V, Thrill (-) Percution : Heart border Left : 1 finger medial LMCS RIC V, Right: right sternalis line upper ; intercostal line II Auscultation : regular rhythm,M1>M2 P2<A2.

7. Abdominal : inspection: Not enlargement Palpation : Liver and spleen not palpable. Percution : thympany auscultation : bowel sound (+) N 8.Back : CVA pain (-) 9. Extremitas : -Physiological reflex (+) - Pathological reflex() - Soft sensibility (+) - Rough sensibility (+) - Oedem (-) Laboratorium Finding: a.Blood routine : Hb = 14 g/dl Ht = 42,1% leu = 1600/mm3 Thr =77.000/mm3

WD : - Dengue fever - Suspect malaria

DD

: - ITP

THY : - Rest / Gastric diet II - IVFD Ringer lactat 8 hour/kolf - lansoprazol 1x1 tab - Paracetamol 3 x 500 mg - Domperidone 3 x 1 tab.

Mawarni, female,54 yo, hostalized with : (dr.Yoga) Chief complain : Fatigue since 1 week ago Present illness : - Fatigue increase since 1 week ago - Patient has been known as diabetes since 6 years ago - Fever since 3 days ago - Cough since ys ago3 day ago - No breathlesness

Phisical Examination 1.Vital sign - General appearence: moderate - Level of conciousness : cmc - BP : 110/70 mmHg - Pulse rate : 84 x/minutes - RR : 20 x / minutes - body temperature : 37,2C 2.Skin : Normal 3.Eyes : conjunctiva not anemic, sclera not icteric 4.Neck : JVP 5 2 cmH20. Regional lymh node : none enlargement. Tyroid gland : none enlargement.

5. Chest Lung : inspection simetris right and left Palpation fremitus normal percution sonor Auscultation Breath sound bronchovesicular,rales +/+ in both of lung , wh -/6. Heart , Inspection: Ictucordis anvisible Palpation : ictus cordis palpable 1 finger medial LMCS RIC V, Thrill (-) Percution : Heart border Left : 1 finger medial LMCS RIC V, Right: right sternalis line upper ; intercostal line II Auscultation : regular rhythm,M1>M2 P2<A2.

7. Abdominal : inspection: Not enlargement Palpation : Liver and spleen not palpable. Percution : thympany auscultation : bowel sound (+) N 8.Back : CVA pain (-) 9. Extremitas : -Physiological reflex (+) - Pathological reflex() - Soft sensibility (+) - Rough sensibility (+) - Oedem (-) Laboratorium Finding: a. Hb = 13,3 g/dl Ht = 41% Leu = 11400/mm3 Thr =384.000/mm3 BG = 478 mg/dl Keton = (-)

WD :

- Type 2 DM uncontrolled normoweight - Bronchopneumonia duplex (CAP)

THY : - Rest / DD 1900 kkal - Inj. Ceftriaxone 1 x 2 gr (iv) - Inj. Novorapid 3 x 10 unit - Ambroxol syrup 3 x cth II - NTR 3 x 1 tab

RINI, 37 YO,FEMALE, HCU

Cc : black mixturation since 3 days ago

Present illness history : Black mixturation since 3 days ago, pain when mixturation (-) Patient has been curretaged a momment before admission Pale since the last 3 days Fatigue since 3 days ago Fever (-), cough (-), breathlessness (-) Black stool (-)

Physical examination : Consc : CMC BP : 110/60 mmHg HR : 122x/ RR : 28x/ T : 36,5 C Eye : anemic (+) Lung : fremitus was normal, vesiculer, rales (-/-) Heart : ictus was palpable 1 finger medial of LMCS RIC V

abdomen : Inspection : no enlargement Palpation : liver and spleen werent palpable Percussion : tympani Auscultation : bowel sound (+) N

Extremities : Oedem (-/-)

Laboratorium Hb : 2,6 gr/dl Leu : 3040/mm3 Ht : 7% Trombosit : 261.000/mm3 Na : 140 mmol/L K : 3,8mmol/L GDS : 127 mg/dl Ureum : 57 mg/dl Creatinin : 1,3 mg/dl

WD : Severe anemia normocytic normochrome cb acute bleeding SIRS Complete abortion

Th ; rest/ soft diet/ O2 3 L/I IVFD NaCl 0,9 % 8 hrs/kolf ceftriaxon 1x 2g Ambroxol 3x1c PRC transfussion untill Hb>7 g% Fluid balance

P: blood culture Urine cultur Sputum culture BMP Obtetrics consultation

KARTI, FEMALE, 38 YO, FW 19

Cc : swelling at the left neck since 20 days ago

Present illness history : Swelling at the left neck since 20 days ago Fever (+), Swelling of both palpebra since 20 days ago Decreased of appetite to eat since 20 days ago Nausea (-), vomit (-) Mixturation was no complain Black stool (-)

Physical examination : General appearance : moderate Consc : CMC BP : 110/60 mmHg HR : 122x/ RR : 28x/ T : 36,5 C Eye : conjunctiva anemic (+), icterics of sclera (-) Neck : JVP 5-2 mmHg

Lung : Inspection : simetric Palpation : fremitus decreased in sinistra Percussion : dullness Auscultation: vesiculer, rales (-/-) Heart : inspection : ictus invisible Palpation : ictus was palpable 2 finger medial LMCS Percussion : heart border : left ; 2 finger medial of LMCS, right : LSD Auscultation : reguler rhythm

abdomen : Inspection : no enlargement Palpation : liver and spleen werent palpable Percussion : shifting dullness (+) Auscultation : bowel sound (+) N

Extremities :oedem (+/+)

Laboratorium Hb : 9,7 gr/dl Leu : 3900/mm3 Ht : 29% Trombosit : 53.000/mm3 MCH : 28 MCV : 83 MCHC : 33,7 Na : 136 mmol/dl K : 2,9 mmol/dl
Ureum Creatinin : 43 mg/dl : 0,6 mg/dl

Blood gass analyze : pH : 7,49 pCO2 : 35 pO2 : 61 HCO3: 25,9 Beecf : -2,6 SO2 : 92%

WD : Superior Vena cave syndrome Septic cb limphadenitis TB Conjunctivitis OD Pansitopenia cbHypoplasia anemia

Th : Rest / O2 2 liter/ ML TKTP IVFD nacl 0,9 % 6 hours /kolf Ceftriaxon 1x2 mg Ciprofloxacin inf 2x200 Furosemid 1x20 mg Transfusi albumin 20% 100 c KSR 1x1

P: rontgen thorak BAJAH

M.

SYAFII, MALE, 75 YO, HCU

Cc : reddish mixturation since 2 days ago

Present illness history; Reddish mixturation since 2 days ago Fever (+) History of haemodyalize (+)

Physical examination : General appearance : moderate Consc : CMC BP : 110/60 mmHg HR : 108x/ RR : 36x/ T : 36,8 C Eye : conjunctiva anemic (-), icterics of sclera (-) Neck : JVP 5-2 mmHg

Lung : Inspection : simetric Palpation : fremitus normal Percussion : sonor Auscultation: vesiculer, rales (-/-) Heart : inspection : ictus was invisible Palpation : ictus was palpable 1 finger medial LMCS Percussion: heart border : left ; 1 finger medial of LMCS, right : LSD Auscultation : reguler rhythm

abdomen : Inspection : no enlargement Palpation : liver and spleen werent palpable Percussion : shifting dullness (+) Auscultation : bowel sound (+) N

Extremities : Oedem (-/-)

Laboratorium : Hb Leu Ht Trombosit Na K GDS Ureum Creatinin : 9,6 gr/dl : 18.500/mm3 : 30% : 253.000/mm3 : 130 mmol/L : 3,5mmol/L : 112 mg/dl : 82 mg/dl : 3,6mg/dl

WD : Uroseptis AKI rifle F cb prerenal Mild anemia normocytic normochrome cb acute bleeding

Th : Rest/ O2 2 l/i/ soft diet IVFD NACL 0,9 % 6 hrs/ kolf Ceftriaxon 1x2 gr Paractamol 4x500 mg Fluid balance

P; urine culture Rontgen thorak BMP Renal usg

YUNIUS, 73 YO , MALE, MW 11

Cc : black vomit since 12 hours ago

Present illness history: Black vomit since 12 hrs ago, no fresh blood Fever (-) Caugh (+) History of consuming OAT (+) for 6 month Decrease of appetite to eat no complain of mixturation No black stool

Physical examination : General appearance : moderate Consc : CMC BP : 120/70 mmHg HR : 112x/ RR : 24x/ T : 36,3 C Eye : conjunctiva anemic (-), icterics of sclera (-) Neck : JVP 5-2 mmHg

Lung : Inspection : simetric Palpation : fremitus normal Percussion : sonor Auscultation: bronchovesiculer, rales (+/+) Heart : inspection : ictus was invisible Palpation : ictus was palpable 1 finger medial LMCS Percussion: heart border : left ; 1 finger medial of LMCS, right : LSD Auscultation : reguler rhythm

abdomen : Inspection : no enlargement Palpation : liver and spleen werent palpable Percussion : tympani Auscultation : bowel sound (+) N

Extremities : Oedem (-/-)

Laboratorium : Hb Leu Ht Trombosit Na K GDS Ureum Creatinin : 10,9 gr/dl : 17.500/mm3 : 33% : 430.000/mm3 : 111 mmol/L : 4,9mmol/L : 194 mg/dl : 51 mg/dl : 1,2mg/dl

Blood gass analyze : pH : 7,54 pCO2 : 24 pO2 : 128 HCO3: 20,5 Beecf : -2,0 SO2 : 99%

WD : Hematemesis cb peptic ulcer Hyponatremia cb low intake Duplex Bronchopneumonia

Th : Rest/ O2 2 l/I / drain NGT/fasting 8 hrs Correction NaCl 3 % 12 hrs /kolf (II) continue with NaCl 0,9 % 12 hrs/kolf Ceftriaxon injection 1x2 gr Prosogan 1x1 amp Ca gluconas 1 amp (extra) Ambroxol syr 3x1 C Drip prosogan 2 amp in 500cc Nacl 0,9% for 6 hrs Fluid balance

P; urine culture Renal USG

SYAFRIZAL ,56 YO, MALE MW 11

Cc : breathlessness since 2 days ago

Present illness history : Breathlessness since 2 days ago due to activity History of heart disease since 4 years ago, has no control in the last 1 month. Swelling of both foot since a week ago, increase when having activity History of hypertension (+),routinely consume ramipril since 4 years ago

Physical examination : General appearance : moderate Consc : CMC BP : 110/60 mmHg HR : 130x/ RR : 22x/ T : 37 C Eye : conjunctiva anemic (-), icterics of sclera (-) Neck : JVP 5+5 mmHg

Lung : Inspection : simetric Palpation : fremitus decreased in sinistra Percussion : dullness Auscultation: vesiculer, rales (-/-)

Heart : inspection :ictus cordis visible 2 finger lateral LMCS, at ICS V Palpation :ictus cordis palpable2 finger lateral LMCS Percussion:heart border :
left ;at LAAS Rigth: 1 finger lateral LSD

Auscultation : irreguler rhythm , S1 and S2 was difficult to evaluate

abdomen : Inspection : no enlargement Palpation : liver and spleen werent palpable Percussion : tympani Auscultation : bowel sound (+) N

Extremities : Oedem (-/-)

Laboratorium Hb : 17,6 gr/dl Leu : 10900/mm3 Ht : 53,5% Trombosit : 236.000/mm3 Na : 140 mmol/L K : 3,8mmol/L GDS : 124 mg/dl Ureum : 78 mg/dl Creatinin : 2,1 mg/dl

Blood gass analyze : pH : 7,48 pCO2 : 29 pO2 : 141.000/mm3 HCO3: 215 Beecf : -1,9 SO2 : 99%

WD : CHF Fc III LVH RVH AF rapid respon rhythm cb CAD Congestive hepatopathy AKI rifle I cb pre renal cb cardiac output cb AF

Th : Rest/ O2 2L/i / DJ III IVFD nal 0,9 % 12 hrs /kolf Digoxin 1x0,5 mg next to 1x 0,25 mg Lansoprazol 1x30 mg Inj. Furosemid 1x40 mg-next to 1x20 mg Ascardia 1x80 mg Fluid balance

P: rontgen thorak Echocardiography

MASRIZAL, 75 YO, MALE , MW 11

Cc : diarrhea since 5 days ago

Present illness history ; Diarrhea since 5 days ago, 10 times a day, about glass consist of fluid, no blood, no mucous Fever (-) since 5 days ago, continously, no chill, no sweat Cough (+) since 5 days ago, mucous (+), blood (-) Breathlessness since 5 days ago, do not due to activity

Physical examination : General appearance : moderate Consc : CMC BP : 130/60 mmHg HR : 96x/ RR : 22x/ T : 37,8 C Eye : conjunctiva anemic (-), icterics of sclera (-) Neck : JVP 5-2 mmHg

Lung : Inspection : barrel chest, ICS is wider Palpation : fremitus decreased sinistra et dextra Percussion : hypersonor Auscultation: bronchovesicular, rales (+/+) Heart : inspection :ictus cordis invisible Palpation :ictus cordis palpable1 finger medial LMCS Percussion:heart border :

left ;at 1 medial LMCS Rigth: LSD

Auscultation : irreguler rhythm

abdomen : Inspection : no enlargement Palpation : liver and spleen werent palpable Percussion : tympani Auscultation : bowel sound (+) N

Extremities : Oedem (-/-)

Laboratorium Hb : 13,6 gr/dl Leu :26900/mm3 Ht : 40% Trombosit : 326.000/mm3 Na : 138 mmol/L K : 3,9mmol/L GDS : 124 mg/dl Ureum : 59 mg/dl Creatinin : 0,9 mg/dl

WD : acute gastroenteritis koleriform type with mild dehydration Stable COPD bronchopneumonia

Th ; Rest/ O2 2 L/ i/ low fiber diet IVFD NaCl 0,9%-- > loading 1 kolf then 8 hours/kolf Lasidofil 2x1 tab Salbutamol3x2 mg Ceftriaxon 1x2 gr Azitromicin 1x500 mg Oralit sachet 3x1sch Pct 3x500 mg Fluid balance

P: Feses culture Expertise rontgen thorak

HERMAN, 70 YO, MALE, MW 08

Cc ; increasing of Chest pain since a day ago

Present illness history: Increasing of Chest pain since a day ago, reffered to the back and arm, firstly complain since 5 days ago, twice a day,the duration about 2 minutes but lately it becomes 20 minutes Nausea (-), vomit (-) Breathlessness (+) do not due to activity Mixturation was no complain

Physical examination : General appearance : moderate Consc : CMC BP : 120/70 mmHg HR : 84x/ RR : 28x/ T : 36,4 C Eye : conjunctiva anemic (-), icterics of sclera (-) Neck : JVP 5-2 mmHg

Lung : Inspection : simetric Palpation : fremitus normal Percussion : sonor Auscultation: vesiculer, rales (-/-) Heart : inspection :ictus cordis was invisible Palpation :ictus cordis palpable 1 finger medial LMCS Percussion:heart border :

left ;1 finger medial LMCS Right: LSD

Auscultation : reguler rhythm

abdomen : Inspection : no enlargement Palpation : liver and spleen werent palpable Percussion : tympani Auscultation : bowel sound (+) N

Extremities : Oedem (-/-)

Laboratorium Hb : 5,9 gr/dl Leu :10000/mm3 Ht : 18% Trombosit : 369.000/mm3 Na : 132 mmol/L K : 3,9mmol/L GDS : 160 mg/dl Ureum : 98 mg/dl Creatinin : 2 mg/dl

WD : nonstemi antero lateral Th ; Rest /heart diet II/ O2 3 L/I IVFD NaCl 0,9 % 12 hrs/ kolf Loading clopidogrel 300mg continue with 1x75 mg Loading ascardia 160 mg continue with 1x80 mg Heparin drips bolus 4000u continue with drip 1 cc of heparin in 50 cc Nacl 0,9 % start in 7,2 cc/hr( in syringe pump) cek aptt each 6 hours : APTT , <40: increase 1,2 cc 40-49 increase 0,6cc 50-70 fix dose 71-95 decrease 1,2 cc >95 stop ISDN 3x5 mg Bisoprolol 1x2,5 mg Inj prosogan 2x1 amp Sucralfat syr : 3x1 C Fluid balance

YUSNIAR,FEMALE, 54 YO , FW !@

Cc : palpitation on chest since 1 day ago

Present illness history : palpitation on chest since 1 day ago, like burn,referred to right hand Nausea (+), vomit (-) since 1 day ago Decrease of appetite to eat Dizziness (+) since 1 day ago

Physical examination : Consc : CMC BP : 130/90 mmHg HR : 72x/ RR : 24x/ T : 37,2 C Eye : anemic (-), icterus (-) Lung : vesiculer, rales (-/-) Heart : ictus was palpable 1 finger medial of LMCS RIC V Abdomen: Liver and spleen werent palpable, peristaltik was normal Ext : fisiology reflec +/+ (Normal) pathology reflec -/- (Normal) Edema (-/-)

Laboratorium Hb : 14,7 gr/dl EKG :VES bigemini Leu : 8800/mm3 Ht : 44% Trombosit : 327.000/mm3 Na : 139 mmol/L K : 2,8 mmol/L Cl : 102 mmol/L GDS : 145 mg/dl Ureum : 14 mg/dl Creatinin : 0,9 mg/dl

WD : VES bigemini cb imbalance eletrolyte Chronock gatritis

Th : Rest/ Heart diet II/gatric Diet II/O2 3L/minute IVFD NaCl 0,9% 8 hours/ kolf Corection KCL 40 meq in 200 cc NaCl 0,9% Sukralfat syrup 3xcth I Omeprazole 1x1

P: Check profile lipid Echocardigrafi Gastroscopy EKG evaluation

ALEX JENDRA, 46 YO,MALE, MW

Cc : Redness mixturation since 5 days ago

Present illness history : Redness mixturation since 5 days ago, history of mixturation with stone (-) Pain of waist right and left since 3 months ago Nausea since 1 week ago Breathleness since 1 days ago Decrease of apetite since patient was sick Fever (-) Patients has been nefrostomi in Emergengy room

Physical examination : Consc : CMC BP : 140/70 mmHg HR : 102x/ RR : 22x/ T : 36,7 C Eye : anemic (+) icterus (-) Lung : vesiculer, rales (-/-) Heart : ictus was palpable 1 finger medial of LMCS RIC V Abdomen: Liver and spleen werent palpable, peristaltik normal Ext : fisiology reflec +/+ (Normal) pathology reflec -/- (Normal) edema (-/-)

Laboratorium Hb : 9,1 gr/dl Leu : 18400/mm3 Ht : 28% Trombosit : 488.000/mm3 Na : 125 mmol/L K : 3,8mmol/L Ureum : 336 mg/dl Creatinin : 17,9 mg/dl

Blood gass analyze : pH : 7,33 pCO2 : 21 pO2 : 101 HCO3: 11,1 Beecf : -14,8 SO2 : 97%

WD : Stage V CKD cb PNC with metabolic acidose post Nefrostomi bilateral Th ; rest/ low salt diet II/ low protein 36 gr IVFD Eastprimer : D10% =1:1 >12 hrs/kolf ceftriaxon 1x 2g Domperidon 3x10mg Bicarbonat Natrium 3x500mg Folic acid 1x 5 mg Candesartan 1x 8 mg Meylon correction 150 meq in 150 cc NaCl 0,9% fast drip Fluid balance

Plan/ Preperation to Hemodialysis

MUSLIH, 52 YO, MALE,MW 25

WD : Decrease of consciousness cb KAD Sepsis cb abses a/r poplitea dextra Mild anemia Aki rifle R cb pre renal cb dehydration

Th ; Rest/ O2 2 L/i/ fluid diet1900kkal IVFD 0,9% 6 hrs /kolf Bolus insulin 10 u Drip insulin 10 u in 500 cc NaCl 0,9% microdrip start from 15 drops