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What Do These Following Lab Reports Indicate?
Question: Hi, This is XXXX XXXXXXX & my query is about my daughter's mother in law, who is in ICU.
The factors which led her to hospital were high pus cells in urine: 32-35
Platlet count 118000 & lower Hb. Createnine : 4
I am uploading the relevant reports for 2D Echo & sonography.
She is in ICU since 22nd July. The doctor had admitted her in ward but later shifted her to ICU stating heart, Kidney & Lungs problem.
The hospital is like any other good hospital in Navi XXXXXXX The social issue is that hospitals do exploit patients by extending stay at ICU, stating serous issues etc.
The day she was shifted to ICU, the treating doctor says that she is critical & nothing can be said whether she will survive or not. I do talk to the doctor & every time he says that she is critical due to heart & not kidneys.
I asked the doctor a couple of days before "what parameters make heart critical" He said that there are 3 factors which makes heart critical. Water in the lungs, BP & Oxygen. They are daily removing water from the lungs.
I have myself seen BP as 139/55, which is now 135/65.
I am uploading the relevant reports for your examination & comments. My questions are as follows:
1. Is she really serious? Critical? This question comes as almost all hospitals make money when they know that the admission is cashless & if there is a heart problem.
2. Is water in the lungs be diagnosed as serious heart ailment? This is because there is no Lipid Profile done by the hospital. BUN was around 43.
Kindly respond as we are all worried about the patient & also do not want to get cheated for money chase by hospitals.
Regards
XXXX XXXXXXX
The factors which led her to hospital were high pus cells in urine: 32-35
Platlet count 118000 & lower Hb. Createnine : 4
I am uploading the relevant reports for 2D Echo & sonography.
She is in ICU since 22nd July. The doctor had admitted her in ward but later shifted her to ICU stating heart, Kidney & Lungs problem.
The hospital is like any other good hospital in Navi XXXXXXX The social issue is that hospitals do exploit patients by extending stay at ICU, stating serous issues etc.
The day she was shifted to ICU, the treating doctor says that she is critical & nothing can be said whether she will survive or not. I do talk to the doctor & every time he says that she is critical due to heart & not kidneys.
I asked the doctor a couple of days before "what parameters make heart critical" He said that there are 3 factors which makes heart critical. Water in the lungs, BP & Oxygen. They are daily removing water from the lungs.
I have myself seen BP as 139/55, which is now 135/65.
I am uploading the relevant reports for your examination & comments. My questions are as follows:
1. Is she really serious? Critical? This question comes as almost all hospitals make money when they know that the admission is cashless & if there is a heart problem.
2. Is water in the lungs be diagnosed as serious heart ailment? This is because there is no Lipid Profile done by the hospital. BUN was around 43.
Kindly respond as we are all worried about the patient & also do not want to get cheated for money chase by hospitals.
Regards
XXXX XXXXXXX
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello Dear XXXX!
I passed carefully through your daughter's mother in law medical history and also the uploaded medical reports and what could be confirmed by all this evidence are summarized as follows:
1- From abdominal ultrasound it is revealed that her kidneys are irregularly scarred and there is also a stone in the right kidney.
2- From complete blood count it is concluded neutrophilic leukocytosis (which means an increase in the white blood cells, mainly neutrophils).
All the above can be summarized as chronic kidney injuries (probably from a long history of kidney stones) actually aggravated by an acute urinary tract infection.
If persistent high body temperature and increased inflammation (excessive elevation of PCR) are not present, then severe urosepsis is excluded. So there are no kidney related reasons for this patient to stay in the ICU.
Now returning to our main point of interest, which are heart and lung issues, there are two key points to consider:
1- Decreased left ventricular ejection fraction (LVEF) at around 40-45 %.
2- Certain left ventricular segmental kinetics abnormalities.
You should discuss with her attending doctor what is her opinion on these two echocardiographic findings: are they new occurring abnormalities or they are more likely to be chronic?
Because new left ventricular wall motion abnormalities and decreased LVEF may be an expression of an acute coronary syndrome or a new cardiac implication of a severe generalized sepsis.
In such case ICU treatment is correct and medically justified.
Some lab tests would be helpful to clarify these alternatives:
1- Cardiac enzymes (CKMB, Troponin I). If they show a dynamic increased levels together with new ECG changes, then probably an acute coronary syndrome may be the reason of her aggravated conditions. You should know that when judging about cardiac enzymes, there is one point to consider: a decreased renal function, which seems to be chronic and probably ultimately further aggravated by the infection. A DECREASED RENAL FUNCTION MAY GIVE FALSELY ELEVATED CARDIAC ENZYMES. That is why it is important to check for cardiac enzyme trends rather than a single measurement.
2- BNP or NT-proBNP levels (natriuretic peptides), arterial blood gas (ABG) analysis and a chest X ray to confirm heart failure and lungs fluid retention. If recently increased natriuretic peptides (NT-Pro BNP); profound oxygen and carbon dioxide alteration on ABG analysis and pulmonary congestion on the chest X ray film are confirmed, then ICU stay is justified at some point (at least for a few days until the above mentioned parameters show a clear improvement).
3- PCR test to confirm severe systemic inflammation (and hence severe sepsis).
Because if no severe alterations are found on the suggested tests, that prolonged ICU stay (from 22 July) seems a bit exaggerated.
So, to conclude, and make it more clear and short for you, I would summarize as follows:
Ask her attending doctor on the following issues:
a) Is the patient suffering for an acute coronary syndrome complicated by acute heart failure (and if Yes, which are her underlying tests results that confirm such an alternative? As for the latest copy of cardiac enzymes results, ECG, BNP or NT-proBNP, ABG analysis, chest X ray film).
b) Is the patient suffering from severe complicated sepsis (persistent high body temperature, excessive PCR increase; multi-organ dysfunctions?
c) Is her blood pressure maintained without support or is controlled using positive inotropic drugs (such as dobutamine, dopamine, norepinephrine, etc.). And which is her current therapy?
If all the above points (a, b and c) have a negative answer (No!), then probably such a prolonged ICU stay is a bit exaggerated.
Nevertheless, I could not speculate on such a matter, as I have not all the above mentioned tests results available for me to review and give a thorough and more precise professional opinion. I am an intensivist cardiologist (ICCU) and I know that there are several unexpected situations which could prolonge ICU stay, so without a clear and full evidence of the above mentioned tests would be a bit difficult to conclude on the medical justification of ICU stay.
I would be glad to review all the above mentioned tests for a direct review. IF you can provide and upload them here, I would be ready to give a precise opinion on your relative's medical conditions.
Hope to have been helpful to you!
In case of any further uncertainties, feel free to ask me again.
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello Dear XXXX!
I passed carefully through your daughter's mother in law medical history and also the uploaded medical reports and what could be confirmed by all this evidence are summarized as follows:
1- From abdominal ultrasound it is revealed that her kidneys are irregularly scarred and there is also a stone in the right kidney.
2- From complete blood count it is concluded neutrophilic leukocytosis (which means an increase in the white blood cells, mainly neutrophils).
All the above can be summarized as chronic kidney injuries (probably from a long history of kidney stones) actually aggravated by an acute urinary tract infection.
If persistent high body temperature and increased inflammation (excessive elevation of PCR) are not present, then severe urosepsis is excluded. So there are no kidney related reasons for this patient to stay in the ICU.
Now returning to our main point of interest, which are heart and lung issues, there are two key points to consider:
1- Decreased left ventricular ejection fraction (LVEF) at around 40-45 %.
2- Certain left ventricular segmental kinetics abnormalities.
You should discuss with her attending doctor what is her opinion on these two echocardiographic findings: are they new occurring abnormalities or they are more likely to be chronic?
Because new left ventricular wall motion abnormalities and decreased LVEF may be an expression of an acute coronary syndrome or a new cardiac implication of a severe generalized sepsis.
In such case ICU treatment is correct and medically justified.
Some lab tests would be helpful to clarify these alternatives:
1- Cardiac enzymes (CKMB, Troponin I). If they show a dynamic increased levels together with new ECG changes, then probably an acute coronary syndrome may be the reason of her aggravated conditions. You should know that when judging about cardiac enzymes, there is one point to consider: a decreased renal function, which seems to be chronic and probably ultimately further aggravated by the infection. A DECREASED RENAL FUNCTION MAY GIVE FALSELY ELEVATED CARDIAC ENZYMES. That is why it is important to check for cardiac enzyme trends rather than a single measurement.
2- BNP or NT-proBNP levels (natriuretic peptides), arterial blood gas (ABG) analysis and a chest X ray to confirm heart failure and lungs fluid retention. If recently increased natriuretic peptides (NT-Pro BNP); profound oxygen and carbon dioxide alteration on ABG analysis and pulmonary congestion on the chest X ray film are confirmed, then ICU stay is justified at some point (at least for a few days until the above mentioned parameters show a clear improvement).
3- PCR test to confirm severe systemic inflammation (and hence severe sepsis).
Because if no severe alterations are found on the suggested tests, that prolonged ICU stay (from 22 July) seems a bit exaggerated.
So, to conclude, and make it more clear and short for you, I would summarize as follows:
Ask her attending doctor on the following issues:
a) Is the patient suffering for an acute coronary syndrome complicated by acute heart failure (and if Yes, which are her underlying tests results that confirm such an alternative? As for the latest copy of cardiac enzymes results, ECG, BNP or NT-proBNP, ABG analysis, chest X ray film).
b) Is the patient suffering from severe complicated sepsis (persistent high body temperature, excessive PCR increase; multi-organ dysfunctions?
c) Is her blood pressure maintained without support or is controlled using positive inotropic drugs (such as dobutamine, dopamine, norepinephrine, etc.). And which is her current therapy?
If all the above points (a, b and c) have a negative answer (No!), then probably such a prolonged ICU stay is a bit exaggerated.
Nevertheless, I could not speculate on such a matter, as I have not all the above mentioned tests results available for me to review and give a thorough and more precise professional opinion. I am an intensivist cardiologist (ICCU) and I know that there are several unexpected situations which could prolonge ICU stay, so without a clear and full evidence of the above mentioned tests would be a bit difficult to conclude on the medical justification of ICU stay.
I would be glad to review all the above mentioned tests for a direct review. IF you can provide and upload them here, I would be ready to give a precise opinion on your relative's medical conditions.
Hope to have been helpful to you!
In case of any further uncertainties, feel free to ask me again.
Kind regards,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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