1. + AB 12 year old Male Cotabato Muslim Date of Admission: 8/20/2014 Transferred to Nephro service Chief complaint: polyuria

2. + History of Present Illness 2 years prior Noted to be able to drink 3 liters per day, with increased frequency of urination 3-4 times per night No dysuria, no hematuria No headache, vomiting, blurring of vision (+) episode of fall, not witnessed, 7 flight of stairs

3. + History of Present Illness 18 months prior Consulted with a private physician due to persistence of polyuria. KUB ultrasound requested showed hydronephrosis. Further consult with a urologist advised Urologist requested VUR and renal perfusion study done

4. + History of Present Illness 12 months prior (+)Consult at Davao Hospital done Repeat KUB UTZ, Renal perfusion study done: Spinal MRI: Normal

5. + History of Present Illness 4 months PTC Patient seen by pedia urologist Repeat KUB ultrasound, VCUG with normal results Advised consult with a nephrologist

6. + History of Present Illness 1 month prior Patient was seen at Nephro OPD Patient was prescribed with Hydrochlorthiazide

7. + Review of Systems No headache No vomiting No Cough No difficulty of breathing No chest pain No palpitations No dysuria, hematuria No abdominal pain

8. + Birth and Maternal History Born to a 39year old G5P5 5005, nonsmoker, non-alcoholic beverage drinker, with regular prenatal check-up at the Local Health Center since 3 months age of gestation (+) FeSO4, (-)MV/Folic Acid; No intake of teratogen, radiation exposure Born full term via NSD at home delivered by traditional birth attendant. (-)fetomaternal complications, no NBS, no HS, BW ?

9. + Immunization History c/o Local Health Center No booster

10. + Nutritional History Exclusively breastfed until 1 years old Complimentary feeding started 6 months old Currently not a picky eater

11. + Developmental History At par with age

12. + Past Medical History No allergies to food and medication No previous hospitalization No trauma

13. + Family History 56 messenger 51 year old housewife 22 19 (-) Bronchial asthma, PTB, kidney disease; (+) DM, HPN, 23 20

14. + Physical Examination Awake, weak-looking, ambulatory, coherent, not in cardiorespiratory distress BP 90/60, HR 108, RR 22, T 36.7, Wt 27.5 kg Ht 110 cm Anicteric sclera, pink palbebral conjunctiva no cervical lymphadenopathy

15. + Physical Examination Symmetric chest expansion, clear breath sounds Adynamic precordium, normal rate and regular rhythm, no murmur Flat abdomen, normoactive bowel sounds, no hepatosplenomegaly, no tenderness Full and equal pulses, no swelling, no joint deformities No nail changes

16. + Assessment t/c Nephrogenic Diabetes Insipidus probably secondary to Chronic Obstructive Uropathy Urinary Tract Infection

17. + S>O>P> Awake, comfortable, not in distress (-) retractions, clear breath sounds (-) murmur Soft abdomen, non tender Full and equal CBC Urinalysis Electrolytes BUN, Crea TPAG Urince culture Urine Na DFA D5 0.9 NaCl (mtn) Hydrochlorthiazide Cefuroxime (100) Insert Foley Catheter

18. + Hgb 115 Hct 0.33 Plt 366 Wbc 23.1 Seg.90 Lym 0.05 Mono 0.05 Randome Urine Na : 27 BUN 4.50 Crea 57 Na 132 K 2.70 Chl 82 Sosm: 276 Color: yellow Trans: turbid SG: 1.004 pH: 5.5 Glu: negative Prot: trace RBC: 17 WBC: 123 Leukocytes: +3 *Few yeast cells with budding

19. + S>4 rd HDO>P> Awake, not in distress (-) retractions, clear breath sounds (-) murmur Soft abdomen, non tender Full and equal pulses I: 7860 O: 10720 FB -2860 UO: 11.9 cc/kg/hr x32h Na 156 K 2.2 Chl 106 Ca 2.67 Na 129 K 1.7 Chl 82 Ca 2.10 USG: 1.003 RBS: 6.7 BUN: 2.6 Sosm: 315.6 d/c IV fluids d/c Hydrochlorthiazide Kalium durule Minirin trial TNaR= 243.8 D50.45 + 6mEqs KCL (KIR 0.3) Refer to ICU Hook to Cardiac Monitor For ECG

20. + S>4 th HDO>P> Awake, not in distress (-) retractions, clear breath sounds (-) murmur Soft abdomen, non tender I: 1910 O: 1900 FB: +10 UO: 8.5 cc/kg UO: 0.7cc/kg x8h Na 129 K 1.7 Chl 82 Ca 2.10 Na 128 K 2.60 Chl 85 Ca 2.05 Central Line Insertion 10mEqs KCL Cefu D2+2 Amik D1 D5LRS + 6mEqs KCl Cranial MRI Hold Minirin for now

21. + S>5 rd HDO>P> Awake, not in distress (-) retractions, clear breath sounds (-) murmur Soft abdomen, non tender Full and equal I: 3745 O: 5375 FB -1630 UO: 11.9cc/kg 18h Na 130 K 3.2 Chl 91 Ca 2.09 BUN 2.2 Crea 43 RBS 6.3 sOs 268.5 UCS: Pseudomonas Aeurginosa 80, 000 col/ml PLRS + 6mEqs KCl Kalium Durule Cefuroxime Ceftazidime Replace loses in excess of 115ml of urine (4cc/kg) w/ PLRS

22. + S>6 rd HDO>P> Awake, comfortable, not in distress C (-) retractions, clear breath sounds (-) murmur Soft abdomen, non tender Full and equal pulses I: 12197 O: 15680 UO: 24cc/kg Na 130 K 3.5 Chl 95 Ca 2.19 d/c urine volume/volume replacement for Minirin ENDO: Central DI unlikely May not give Minirin Resume HCTZ

23. + S>7 th HDO>P> Awake, not in distress (-) retractions, clear breath sounds (-) murmur Soft abdomen, non tender Full and equal pulses I: 5420 O: 7810 FB: -2390 UO: 12.2cc/kg Na 136 K 4.1 Chl 94 Ca 2.46 d/c kalium durule For repeat UCS

24. + S>9 th HDO>P> Awake, not in distress (-) retractions, clear breath sounds (-) murmur Soft abdomen, non tender Full and equal pulses I: 4420 O: 4090 FB +330 UO: 6.95cc/kg Na 136 K 3.5 Chl 88 Ca 2.42 BUN 3.4 RBS 5.3 Na 134 k 3.40 Chl 88 Ca 2.37 BUN 4.4 RBS 6.5 Repeat UCS: Candida species 100,000 col/ml Minirin tablet High Potassium diet Fluconazole tab

25. + S>10 th HDO>P> Awake, not in distress CR 92 RR 20 T 36.6 (-) retractions, clear breath sounds (-) murmur Soft abdomen, non tender Full and equal pulses 24hrs post MINIRIN I: 8400 O: 8760 FB: -360 UO: 14.31cc/kg Pre minirin Na 136 Sp gr: 1.004 Post minirin Na 134 Sp gr: 1.003 Monitor I and O accurately Start HCTZ

26. + S>12 th HDO>P> Awake, not in distress CR 92 RR 20 T 36.6 (-) retractions, clear breath sounds (-) murmur Soft abdomen, non tender Full and equal pulses I: 4150 O:2490 FB:1660 UO: 3.9cc/kg KUB UTZ: Hydronephrosis, bilateral more on the left Cystitis with urine sediments Continue HCTZ Fluco D2/7 Ceftaz D8+2 Ciprofloxacin (oral)

27. + S>14 th HDO>P> Awake, comfortable No febrile episodes (-) retractions Clear breath sounds Full equal pulses I: 2700 O: 3860 FB -1160 UO: 6.12cc/kg Transfer to Nephro service Continue HCTZ Continue Cipro

28. + 16 th Hospital Day Discharged with Hydrochlorthiazide and Kalium durule; Ciprofloxacin and Fluconazole to complete for 2 more days Follow-up at Nephro service