Variable Laboratory reference range On presentation to 2nd hospital 10 hours after admission 24 hours after admission 35 hours after admission 48h after admission 84h after admission
WBC ( /uL) 3.31-10.31 12.55 10.21 8.95 8.59
Hemoglobin (g/dL) 14.2-18.2 13.4 12.6 11.8 12.2
MCV (fL) 83.8-96.6 87.1 86.9 85 86.8
Platelet ( /uL) 140-370 428 428 387 376
Sodium (mEq/L) 136-146 144 145 145 146 143 143
Potassium (mEq/L) 3.5-5.1 2.3 1.7 1.8 2.8 3.7 3.4
Chloride (mEq/L) 103-112 111 112 110 111 110 113
Bicarbonate (mEq/L) 19-32 17 19 24 23 23 19
Glucose (mg/dL) 68-123 120 98 91 75 82
Creatinine (mg/dL) 0.5-1.3 2.8 2.8 2.2 2.2 1.8 1.5
BUN (mg/dL) 5-22 13 12 10 8 6 6
Calcium (mg/dL) 8.3-10.1 9.1 8.9 8.0 7.7 7.6
Phosphorus (mg/dL) 2.5-4.5 1.4 1.6 2.1 1.6 2.4
Magnesium (mg/dL) 1.9-2.9 2.2 2.4
Plasma Osmolality (mOsm/kg) 301
Albumin (g/dL) 3.5-5 3.9 2.9 2.9
Total Bilirubin (mg/dL) 0-1.3 0.7
ALT (IU/L) 0-54 32
AST (IU/L) 4-38 38
Alkaline phosphatase (IU/L) 42-135 132
Lactic acid (mmol/L) 0.5-1.99 0.7
Creatine kinase (IU/L) 3-198 762 808 1059 12,685
Renin activity (ng/mL/hour) 0.6-4.3 2
Aldosterone (ng/dL) 4-21 <4
TSH (mIU/L) 0.35-5.5 0.235 0.805
Free T4 (ng/dL) 0.89-1.76 0.56 0.62
Free T3 (pg/mL) 2.77-5.27 11 7.2
Vitamin B12 (pg/mL) 211-911 246
Methylmalonic acid (0.40 umol/L) <0.4 1.85
25-hydroxy Vitamin D (ng/mL) 30-100 <12.8
Urine Sodium (mEq/L) 28
Urine Potassium (mEq/L) 6.7
Urine Chloride (mEq/L) <50
Urine Creatinine (mg/dL) 16
Urine Osmolality (mOsm/kg) 128
Transtubular Potassium Gradient (TTKG) 9
Potassium to creatinine ratio (mEq/g creatinine) 38.125
On Day 4, 24h urine potassium was 77mmol/day, 24h urine protein 1043 mg/day with urine volume 3,240mL On Day 4, 24h urine potassium was 77mmol/day, 24h urine protein 1043 mg/day with urine volume 3,240mL On Day 4, 24h urine potassium was 77mmol/day, 24h urine protein 1043 mg/day with urine volume 3,240mL On Day 4, 24h urine potassium was 77mmol/day, 24h urine protein 1043 mg/day with urine volume 3,240mL On Day 4, 24h urine potassium was 77mmol/day, 24h urine protein 1043 mg/day with urine volume 3,240mL On Day 4, 24h urine potassium was 77mmol/day, 24h urine protein 1043 mg/day with urine volume 3,240mL On Day 4, 24h urine potassium was 77mmol/day, 24h urine protein 1043 mg/day with urine volume 3,240mL On Day 4, 24h urine potassium was 77mmol/day, 24h urine protein 1043 mg/day with urine volume 3,240mL
CSF Studies CSF was clear showed WBC 2/microliter, RBC 1/microliter, IG G index 0.58, albumin 27.8mg/dL (reference range ≤27mg/dL), CSF serology was negative for infectious etiology, IgM West Nile negative, CSF VDRL negative. CSF Coccidiodes Ig G and IgM antobody negative. CSF entervirus PCR negativeCSF IGG index 0.58 (reference level <0.85), CSF albumin 27.8mg/dL (reference range <27mg/dL). CSF culture was negative for growth in both the CSF taps. CSF cytology negative for malignany. Serum/Plasma studies Hepatitis A antibody positive, serology for hepatitis B and Hepatitis C were negative. HIV viral load undetectable. PCR for serm sample was negative for CMV, gonococci, chlamydia. Serology for Lymes, Babesia, Erlichia and Anaplasma were negative. CD4 count was 441 cells/mm3, serum cryptoccocal antigen negative Renal biopsy Renal Biopsy showed acute tubular necrosis with no evidence of immune complex glomerulonephritis or focal segmental glomerulosclerosis. The necrotic debris did not stain for myoglobin. Electron microscopy showed well preserved foot processes of visceral epithelial cells, glomerular basement membranes were slightly thickened, no electron dense deposit in mesangium. Tubular epithelial cells showed prominent vacuolization. CSF Studies CSF was clear showed WBC 2/microliter, RBC 1/microliter, IG G index 0.58, albumin 27.8mg/dL (reference range ≤27mg/dL), CSF serology was negative for infectious etiology, IgM West Nile negative, CSF VDRL negative. CSF Coccidiodes Ig G and IgM antobody negative. CSF entervirus PCR negativeCSF IGG index 0.58 (reference level <0.85), CSF albumin 27.8mg/dL (reference range <27mg/dL). CSF culture was negative for growth in both the CSF taps. CSF cytology negative for malignany. Serum/Plasma studies Hepatitis A antibody positive, serology for hepatitis B and Hepatitis C were negative. HIV viral load undetectable. PCR for serm sample was negative for CMV, gonococci, chlamydia. Serology for Lymes, Babesia, Erlichia and Anaplasma were negative. CD4 count was 441 cells/mm3, serum cryptoccocal antigen negative Renal biopsy Renal Biopsy showed acute tubular necrosis with no evidence of immune complex glomerulonephritis or focal segmental glomerulosclerosis. The necrotic debris did not stain for myoglobin. Electron microscopy showed well preserved foot processes of visceral epithelial cells, glomerular basement membranes were slightly thickened, no electron dense deposit in mesangium. Tubular epithelial cells showed prominent vacuolization. CSF Studies CSF was clear showed WBC 2/microliter, RBC 1/microliter, IG G index 0.58, albumin 27.8mg/dL (reference range ≤27mg/dL), CSF serology was negative for infectious etiology, IgM West Nile negative, CSF VDRL negative. CSF Coccidiodes Ig G and IgM antobody negative. CSF entervirus PCR negativeCSF IGG index 0.58 (reference level <0.85), CSF albumin 27.8mg/dL (reference range <27mg/dL). CSF culture was negative for growth in both the CSF taps. CSF cytology negative for malignany. Serum/Plasma studies Hepatitis A antibody positive, serology for hepatitis B and Hepatitis C were negative. HIV viral load undetectable. PCR for serm sample was negative for CMV, gonococci, chlamydia. Serology for Lymes, Babesia, Erlichia and Anaplasma were negative. CD4 count was 441 cells/mm3, serum cryptoccocal antigen negative Renal biopsy Renal Biopsy showed acute tubular necrosis with no evidence of immune complex glomerulonephritis or focal segmental glomerulosclerosis. The necrotic debris did not stain for myoglobin. Electron microscopy showed well preserved foot processes of visceral epithelial cells, glomerular basement membranes were slightly thickened, no electron dense deposit in mesangium. Tubular epithelial cells showed prominent vacuolization. CSF Studies CSF was clear showed WBC 2/microliter, RBC 1/microliter, IG G index 0.58, albumin 27.8mg/dL (reference range ≤27mg/dL), CSF serology was negative for infectious etiology, IgM West Nile negative, CSF VDRL negative. CSF Coccidiodes Ig G and IgM antobody negative. CSF entervirus PCR negativeCSF IGG index 0.58 (reference level <0.85), CSF albumin 27.8mg/dL (reference range <27mg/dL). CSF culture was negative for growth in both the CSF taps. CSF cytology negative for malignany. Serum/Plasma studies Hepatitis A antibody positive, serology for hepatitis B and Hepatitis C were negative. HIV viral load undetectable. PCR for serm sample was negative for CMV, gonococci, chlamydia. Serology for Lymes, Babesia, Erlichia and Anaplasma were negative. CD4 count was 441 cells/mm3, serum cryptoccocal antigen negative Renal biopsy Renal Biopsy showed acute tubular necrosis with no evidence of immune complex glomerulonephritis or focal segmental glomerulosclerosis. The necrotic debris did not stain for myoglobin. Electron microscopy showed well preserved foot processes of visceral epithelial cells, glomerular basement membranes were slightly thickened, no electron dense deposit in mesangium. Tubular epithelial cells showed prominent vacuolization. CSF Studies CSF was clear showed WBC 2/microliter, RBC 1/microliter, IG G index 0.58, albumin 27.8mg/dL (reference range ≤27mg/dL), CSF serology was negative for infectious etiology, IgM West Nile negative, CSF VDRL negative. CSF Coccidiodes Ig G and IgM antobody negative. CSF entervirus PCR negativeCSF IGG index 0.58 (reference level <0.85), CSF albumin 27.8mg/dL (reference range <27mg/dL). CSF culture was negative for growth in both the CSF taps. CSF cytology negative for malignany. Serum/Plasma studies Hepatitis A antibody positive, serology for hepatitis B and Hepatitis C were negative. HIV viral load undetectable. PCR for serm sample was negative for CMV, gonococci, chlamydia. Serology for Lymes, Babesia, Erlichia and Anaplasma were negative. CD4 count was 441 cells/mm3, serum cryptoccocal antigen negative Renal biopsy Renal Biopsy showed acute tubular necrosis with no evidence of immune complex glomerulonephritis or focal segmental glomerulosclerosis. The necrotic debris did not stain for myoglobin. Electron microscopy showed well preserved foot processes of visceral epithelial cells, glomerular basement membranes were slightly thickened, no electron dense deposit in mesangium. Tubular epithelial cells showed prominent vacuolization. CSF Studies CSF was clear showed WBC 2/microliter, RBC 1/microliter, IG G index 0.58, albumin 27.8mg/dL (reference range ≤27mg/dL), CSF serology was negative for infectious etiology, IgM West Nile negative, CSF VDRL negative. CSF Coccidiodes Ig G and IgM antobody negative. CSF entervirus PCR negativeCSF IGG index 0.58 (reference level <0.85), CSF albumin 27.8mg/dL (reference range <27mg/dL). CSF culture was negative for growth in both the CSF taps. CSF cytology negative for malignany. Serum/Plasma studies Hepatitis A antibody positive, serology for hepatitis B and Hepatitis C were negative. HIV viral load undetectable. PCR for serm sample was negative for CMV, gonococci, chlamydia. Serology for Lymes, Babesia, Erlichia and Anaplasma were negative. CD4 count was 441 cells/mm3, serum cryptoccocal antigen negative Renal biopsy Renal Biopsy showed acute tubular necrosis with no evidence of immune complex glomerulonephritis or focal segmental glomerulosclerosis. The necrotic debris did not stain for myoglobin. Electron microscopy showed well preserved foot processes of visceral epithelial cells, glomerular basement membranes were slightly thickened, no electron dense deposit in mesangium. Tubular epithelial cells showed prominent vacuolization. CSF Studies CSF was clear showed WBC 2/microliter, RBC 1/microliter, IG G index 0.58, albumin 27.8mg/dL (reference range ≤27mg/dL), CSF serology was negative for infectious etiology, IgM West Nile negative, CSF VDRL negative. CSF Coccidiodes Ig G and IgM antobody negative. CSF entervirus PCR negativeCSF IGG index 0.58 (reference level <0.85), CSF albumin 27.8mg/dL (reference range <27mg/dL). CSF culture was negative for growth in both the CSF taps. CSF cytology negative for malignany. Serum/Plasma studies Hepatitis A antibody positive, serology for hepatitis B and Hepatitis C were negative. HIV viral load undetectable. PCR for serm sample was negative for CMV, gonococci, chlamydia. Serology for Lymes, Babesia, Erlichia and Anaplasma were negative. CD4 count was 441 cells/mm3, serum cryptoccocal antigen negative Renal biopsy Renal Biopsy showed acute tubular necrosis with no evidence of immune complex glomerulonephritis or focal segmental glomerulosclerosis. The necrotic debris did not stain for myoglobin. Electron microscopy showed well preserved foot processes of visceral epithelial cells, glomerular basement membranes were slightly thickened, no electron dense deposit in mesangium. Tubular epithelial cells showed prominent vacuolization. CSF Studies CSF was clear showed WBC 2/microliter, RBC 1/microliter, IG G index 0.58, albumin 27.8mg/dL (reference range ≤27mg/dL), CSF serology was negative for infectious etiology, IgM West Nile negative, CSF VDRL negative. CSF Coccidiodes Ig G and IgM antobody negative. CSF entervirus PCR negativeCSF IGG index 0.58 (reference level <0.85), CSF albumin 27.8mg/dL (reference range <27mg/dL). CSF culture was negative for growth in both the CSF taps. CSF cytology negative for malignany. Serum/Plasma studies Hepatitis A antibody positive, serology for hepatitis B and Hepatitis C were negative. HIV viral load undetectable. PCR for serm sample was negative for CMV, gonococci, chlamydia. Serology for Lymes, Babesia, Erlichia and Anaplasma were negative. CD4 count was 441 cells/mm3, serum cryptoccocal antigen negative Renal biopsy Renal Biopsy showed acute tubular necrosis with no evidence of immune complex glomerulonephritis or focal segmental glomerulosclerosis. The necrotic debris did not stain for myoglobin. Electron microscopy showed well preserved foot processes of visceral epithelial cells, glomerular basement membranes were slightly thickened, no electron dense deposit in mesangium. Tubular epithelial cells showed prominent vacuolization.