Plan of the mandatory laboratory and instrumental examination

1. Blood investigations (Full blood test)

2. Blood glucose

3. Biochemical tests (C-peactive protein and immunologic tests, ALT,AST, total billirubin, urea, creatinine)

4. Coagulation tests

5. Urinalyses.

6. Glucose in daily urine.

7. Feces investigation

8. ECG

9. X-ray examination.

10. Bacteriologic blood investigations

11. Sputum examination: general, cultural, cytological.

12. Pulse oximetry or arterial blood gas measurement

13. Spirometry or lung function test

Results of the laboratory and instrumental examinations

Pulseoximetry 25MAR2009: Sa O₂ 90%.

X-ray examination 25MAR2009:

There is intensive and homogeneous infiltration of the lower lobe of the right lung.

Bacteriologic blood investigations 25MAR2009:

Any pathogens have not founded.

Full blood test 25MAR2009:

RBC- 4,5x10^I2/L

Hemoglobin – 140 g/L

WBC – 15,6x19²/L

Neutrophils segmented – 65%

Netrophils band – 17%

Lymphocytes – 12%

Monocytes – 6%

ESR – 60 mm/hour

Blood glucose 25MAR2009: 5,5 mmol/L

Biochemical tests 26MAR2009:

C-peactive protein – positive (++++)

Total bilirubin – 18,5 mcmol/L

Conjugated – 5,5 mcmol/L

Unconjugated – 13 mcmol/L

ALT -0,55 mmol/L*h

AST – 0,45 mmol/L*h

Urea – 8,9 mmol/L

Cretinine – 0,080 mmol/L

Coagulation tests 26MAR2009:

Protrombin time (PT) – 25 sec

Fibrinogen (A), plasma – 7,0 g/L

Fibrinogen (B) – positive (+++)

fibrinolysis time – 4 hours and 15 min

Urinalyses 26MAR2009:

Quantity- 100 ml

Specific gravity – 1022

pH – acid

Color –Yellow

Transparence – clear

Protein – 0,66 g/L

Urinary squamous epithelium – 4-6 cells/field of vision

Leucocytes – 8-10 cells/field of vision

Erythrocytes – 1-2 cells/fild of vision

Cristals - Oxalates

Glucose in daily urine 26MAR2009:

Daily dieresis – 1,2 L

Glocose - negative

Feces investigation 26MAR2009: worm’s eggs are absent.

ECG 26MAR2009:

Cardiac rhythm is sinus and regular. Heart rate is 100 in a min, sinus tachycardia. Position of the Electric Heart Axis is normal. Diffuse changes of myocardium.

General sputum examination 26MAR2009:

Amount – 20 ml

Character – mucopurulent

Color – yellow-greenish

Consistency – tenacious

Odor – odorless

Microscopy:

Squamous epithelium – 6-8 cells/field of vision,

Leucocytes – 50-80 cell/field of vision

Alveolar macrophages – 5-6 cells/field of vision

Erythrocytes – absent

Tuberculosis mycobacteria – absent.

Cultural sputum examination 29MAR2009:

S.pneumoniae 10 ⁷bacteria in 1 ml of sputum

Sensitive to claritromycin, amoxicillin, cefotaxim, levofloxacin, moxifloxacin.

Spirometry 29MAR2009:

FVC – 60% from predicted value

FEV1 – 70% from predicted value

FEV1/FVC = 101%

Moderate restrictive disorder of the lung function

Found and form clinical diagnosis according to classification.

The patient’s symptoms: a moderate stabbing, chest pain in the right side without irradiation that increases due to cough and deep breathing, mixed dyspnea which increase due to physical exertion, a permanent cough with purulent sputum without smell; the moderate severe general condition, pale cyanotic wet and hot skin, flash on the right cheek, lagging right part of the chest from the left one, tachypnea (36 per min), participating accessory muscles (neck, back and nose muscles) in breathing by visual inspection, amplifying vocal fremitus over the right lung, painful point along the right axillary line from 4^th till 7^th intercostals spaces, the positive Potenzher’s sign of the right side by palpation; dull sound over the right lung, upward shift of the right lower border of the lung, limiting excursion of the right lungs edge by percussion; the pathological bronchial breathing is heard over the right lung by auscultation allow suggesting the syndrome of the consolidation of the lung tissue. The syndrome has been confirmed by X-ray examination: intensive and homogeneous infiltration of the lower lobe of the right lung.

The patient’s symptoms: mixed dyspnea which increase due to physical exertion, the moderate severe general condition, pale cyanotic skin, tachypnea (36 per min), participating accessory muscles (neck, back and nose muscles) in breathing by visual inspection, tachycardia by examination of the cardiovascular system allow suggesting the syndrome of the severe respiratory failure. The syndrome has been confirmed by pulseoximetry: Sa O₂ 90%.

The patient symptoms: light headache, malaise, fever with body temperature 38,0-38,8 °C during a day, and chill which developed during a couple of days; the moderate severe general condition, body temperature 38,2°C pale cyanotic wet and hot skin by visual inspection are the symptoms and signs of the acute inflammation. The syndrome has been confirmed by full blood test – leucocytosis (15,6x19²/L), increased band neutrophils (17%), ESR (60 mm/hour), C-reactive protein (++++), fibrinogen A (7,0g/L) and B (+++), protein in urine (0,66 g/L), tachycardia by ECG.

Sputum examination has revealed bacterial character of inflammation of the respiratory system and founded pathogen – S.pneumoniae in diagnostically significant concentration.

Taking into account all received data of examination clinical diagnosis is

The community-acquired pneumococcal pneumonia of the lower lobe of the right lung IV group. Severe respiratory failure.

SUPPLEMENTS

LABORATORY REFERENCE RANGE VALUES, ADULT

НОРМАЛЬНЫЕ ЛАБОРА ТОРНЫЕ И ИНСТРУМЕНТАЛЬНЫЕ ПОКАЗАТЕЛИ У ВЗРОСЛЫХ CELL COUNTS * ОБЩИЙ АНАЛИЗ КРОВИ

Tests	Показатели	Reference range values
Red blood cells (RBC) Male Female	Эритроциты Мужчины Женщины	4,0-5,1x10I2/L 3,7- 4,7 xl012/L
Hemoglobin (Hb) Male Female	Гемоглобин Мужчины Женщины	130-160 g/L 120-140 g/L
Mean corpuscular Hemoglobin concentration (MCHC) Substance concentration Fe	Средняя концентрация гемоглобина в эритроците Концентрация железа	330-370 g/L 20-23 mmol/L
Mean corpuscular volume (MCV) Erythrocyte volume	Средний объем клетки Средний объем эритроцита	76-100fL
Color index	Цветной показатель	0,82-1,05
Reticulocyte count	Ретикулоциты	10-75 x10/L (0,2-1,2%)
Platelet count	Тромбоциты	180-320 x109/L
Leucocyte count	Лейкоциты	4,0- 9,0 x109/L
Basophils	Базофилы	0-1%
Eosinophils	Эозинофилы	0-5%
Myelocytes	Миелоциты	0%

Neutrophils Band Segmented	Нейтрофилы палочкоядерные сегментоядерные	1-6% 45-70%
Lymphocytes	Лимфоциты	18-38%
Monocytes	Моноциты	2-9%
Erythrocyte sedimentation rate (ESR) - Panchenko Male Female	Скорость оседания эритроцитов (СОЭ) по Панченко Мужчины Женщины	1-10 мм/ч 2-15 мм/ч
Hematocrit Male Female	Гематокрит Мужчины Женщины	42-52% 37-47%

* Test values are method dependent