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Patient Timeline

Clinical Summary & Daily Progress

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

2026-01-25

Risks to Watch

  • 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

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

2026-01-26

Risks 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

2026-01-27

Risks 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

2026-01-28

Risks 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

2026-01-29

Risks 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