- Respiratory compromise from right >> left pleural effusion; empyema on CT differential
- Post-large-volume paracentesis physiology (7 L) -> hypotension/electrolyte shifts
- Decompensated cirrhosis with portal hypertension and large-volume ascites
- Hyponatremia and low albumin; mild normocytic anemia
Patient
Sofia Lopez
Patient ID
PAT-1000
Admit Date
2026-01-25
Service Line
Cardiac Care
Code Status
DNR/DNI
Baseline ECG
SR - QTc 389
Destination
Lafayette General Medical Center
Payor
Blue Cross Blue Shield LA
Next-24h Watchlist (today)
Respiratory load unchanged; airway/SpO2 watch
Electrolyte swings post-taps (Na 134, Mg 1.6)
Anemia Hgb 8.6; bleeding precautions
Cholestatic marker rising: ALP 219 (up from 181)
Glycemic safety: ACC 90-99 with basal on; prandial insulin often held
Day 1 - Admission
2026-01-25Risks to Watch
Timeline (concise)
- Paracentesis performed (~7 L removed); transudate; SAAG > 1.1; SBP ruled out
- Ceftriaxone started (empiric for pleural process)
- Baseline ECG: Sinus rhythm; QTc 389 ms
- Labs: Na 132, Alb 2.8; ALP 234
Recovery Metrics
SpO2
~98% RA
BP
~130/60
Fluid Status
-7 L
Albumin
2.8
Hgb
mid-8s
Day 2
2026-01-26Risks to Watch
- Ongoing effusion burden; R > L
- Monitor for post-paracentesis hypotension/HRS
- Anemia/coagulation monitoring
Timeline (concise)
- IR & GI following; plan for thoracentesis
- Lasix administered; diuretic plan on board
- Vitals overall stable; patient reports less abdominal pressure
Improvement Indicators
- Symptoms: abdominal pressure improved
- Hemodynamics stable on room air
Recovery Metrics
Respiratory
Diminished R base
BP
~130/60
Albumin Trend
2.8->2.4->2.2
Hgb
~8.4
Day 3
2026-01-27Risks to Watch
- High risk of rapid deterioration (post-tap hypotension, HRS, HE, bleeding)
- Large pleural effusion persists; thoracentesis attempted but non-yielding
- Electrolyte risk: Mg 1.5; Na 133
- DNR/DNI in effect; ensure banner
Timeline (concise)
- Thoracentesis attempted under US guidance -> no fluid obtained
- Paracentesis performed (~4 L removed)
- Antibiotics changed/started: Unasyn 3 g IV q6h (start 18:00)
- Mg repletion ordered/administered
- Palliative meeting; DNR/DNI documented
Deterioration Indicators
- Pleural effusion unchanged (thoracentesis non-yielding)
- Electrolytes borderline (Na 133, Mg 1.5)
Improvement Indicators
- Volume offload via paracentesis (~4 L)
New Today
- Unasyn initiated; ceftriaxone de-emphasized
- DNR/DNI established
- Non-yielding thoracentesis indicates likely loculated effusion
Recovery Metrics
SpO2
>93% RA
MAP Target
>=65
Fluid Removed
~4 L
ALP
181
Albumin
2.1
Hgb
8.1
WBC
4.2
Day 4
2026-01-28Risks to Watch
- Respiratory load unchanged; continue monitoring
- Electrolyte borderline (Na 133, Mg 1.5)
- Anemia Hgb 8.1; bleeding precautions
- ALP 181; monitor for cholestatic trend
Timeline (concise)
- Unasyn doses continued q6h; DOT day 2
- Lactulose daily; rifaximin 550 mg BID continues
- Vitals stable overnight; no significant events
- I&O: In 1200 mL, Out 1100 mL, Net +100 mL
- Labs: Na 133, Mg 1.5, ALP 181, Hgb 8.1
Improvement Indicators
- Hemodynamics stable
- No acute events overnight
New Today
- Unasyn DOT day 2
- Plan to increase lactulose to BID tomorrow if needed
Recovery Metrics
SpO2
94-95% RA
Hemodynamics
Stable
Net Fluid
+100 mL
ALP
181
Hgb
8.1
Glycemic
ACC 95-105
Day 5 - Today
2026-01-29Risks to Watch
- Respiratory load unchanged; airway/SpO2 watch
- Electrolyte swings post-taps (Na 134, Mg 1.6)
- Anemia Hgb 8.6; bleeding precautions
- Cholestatic marker rising: ALP 219 (up from 181)
- Glycemic safety: ACC 90-99 with basal on; prandial insulin often held
Timeline (concise)
- Unasyn on-time doses: 00:24, 06:28; next due 12:00
- Lactulose increased to 30 mL PO BID; rifaximin 550 mg BID continues
- Overnight vitals: DBP low event 58 at 03:00; SBP 130-135->127; SpO2 95-96%
- I&O prev 24 h: In 1466 mL, Out 900 mL, Net +566 mL
- Labs 04:25: Na 134, K 4.6, Mg 1.6, Cr 1.10, Alb 2.21, ALP 219, AST/ALT 24/17, WBC 4.34, Hgb 8.6, Plt 169
Deterioration Indicators
- ALP 181->219 (cholestatic trend)
- Hemodynamics: DBP low event (58) at 03:00
- Net positive balance (+566 mL) over previous 24 h
Improvement Indicators
- Electrolytes: Na 133->134; Mg 1.5->1.6
- Hematology: Hgb 8.1->8.6
New Today
- Lactulose stepped up to BID
- Unasyn doses on time; DOT day 3 visible
Recovery Metrics
SpO2
95-96% RA
Hemodynamics
1 DBP-low event
Net Fluid
+566 mL
ALP
219 (rising)
HE Regimen
Lactulose BID + Rifaximin BID
Glycemic
ACC 90-99
Since Admission - Procedures
| Date/Time | Event | Notes |
|---|---|---|
| 2026-01-25 ~14:00 | Paracentesis - 7 L removed (transudate; SAAG >1.1; SBP ruled out) | approximate time |
| 2026-01-27 (time n/a) | Thoracentesis attempt - no fluid obtained (likely loculated) | |
| 2026-01-27 (time n/a) | Paracentesis - ~4 L removed |
Since Admission - Labs
| Date/Time | Panel | Highlights |
|---|---|---|
| 2026-01-29 04:25 | BMP/CBC/LFT | Na 134, K 4.6, Mg 1.6, Cr 1.10, Alb 2.21, ALP 219, AST/ALT 24/17, WBC 4.34, Hgb 8.6, Plt 169 |
| 2026-01-28 04:25 | BMP/CBC/LFT | Na 133, Mg 1.5, ALP 181, Hgb 8.1 |
| 2026-01-27 (time n/a) | BMP | Na 133, Mg 1.5 |
Medication Summary (since admission)
Ceftriaxone
Empiric initiation on 01/25 (pleural process)
Ampicillin/sulbactam (Unasyn) 3 g IV q6h
Started 01/27; on-time overnight doses 00:24 & 06:28 on 01/29
Furosemide (Lasix) 40 mg IVP
01/26 16:47
Spironolactone 100 mg PO daily
On board since admission
Lactulose 30 mL PO
Escalated to BID on 01/29; HE prevention
Rifaximin 550 mg PO BID
Continued
Insulin glargine (Lantus) 25 U HS
~22:30 on 01/26 and 22:50 on 01/27
Insulin aspart (Novolog) prandial
Frequently held as 'not indicated' per ACC
Magnesium sulfate IV
Repletion events on 01/27
Albumin replacement
After large-volume paracentesis