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Personal Data
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Ȉ This is a case of B.J 49 M who was admitted
on Aug. 14, 2010 due to hyperpigmented
rashes.
3 months PTA, patient was selling
vegetable in the traditional market. It was
noted in the 9th day with selling, patient
developed papular rashes at his right volar
arm which was spreading to the upper arm,
both upper extremities, the neck and face,
trunk and both lower extremities, itchy.
Patient sought consult to a dermatologist,
he was given baby soap, no improvement.
Ȉ He sought consult again at another
doctor, he was given predmizone 5mg 2-
1-2, ciprobay 800mg 1tab BID, and
another unrecalled meds (Godex).
Patient improved and after 2 weeks
predmizone was decreased to 1-1-1 for 2
weeks and stopped but patient still took
predmizone occasionally as needed.
Ȉ (+) swelling at the face and all off the
lesion became hyperpigmented and
nulded.
Ȉ Took aspirin for 3 weeks.
Ȉ BP: 130/90 HR: 84 RR: 22 T: 37.6

Ȉ Moist tongue
Ȉ (+) oral ulcer at palatal area
Ȉ no lymphodenopathy
Ȉ clear breath sounds
Ȉ rhythmic precordium, NRRR, no murmur
Ȉ flat abdomen
Ȉ (+) extremity edema
Ȉ Diagnosis: Generalized hyperpigmented
swelled skin
Ȉ A> Steven Johnson Syndrome r/o SLE
AKI to infection
III. History of Past Illness
Past Medical History
Ȉ (+) RA treated with
predmizone in 1998 Ȃlost to ff.
up
Ȉ (-) DM, ASTHMA. HPN
È iblings
had RHD, delivered
V IVIIES OF DVILY LIVING
V   
 
VV 
 V V  V V
 

-The patient drinks - the patient drinks - an increase in
  10-12 glasses of 4-5 glasses of fluid intake may
water a day and water a day and aid in elimination
drinks 2-3 cups of consumes 7500- of toxins/
coffee in the 8000ml or bacteria in the
morning before approximately 7.5- body.
working. 8L of IVF PNSS -when the patient
- The patient likes to within 9 days of had grade 2
eat vegetables, hospitalization. edema on both,
especially squash, patient decreased
fish, pork meat and oral fluid intake.
2 cups of rice every
meal.
V   
 
VV 
 V V  V V

Sometimes he eats -the patient is on -the patient is on


salty junk foods while hypoallergenic hypoallergenic
driving from soft diet, and eats soft diet to
Cabanatuan to only what is decrease risk of
Bulacan to deliver provided by the skin irritation
vegetables. hospital. from allergens
obtained from
food. Also, a soft
diet is provided
for persons who
have difficulty/
troubled
chewing.
V   
 
VV 
 V V  V V

 V
-The patient -The patient -the patient has



urinates 5-6 times urinates 3-4 darker and fewer
 V a day, which times a day, with urine output
approximately in an amount of when patient has
total amount of 450-600mL. the decreased oral
1500-1800 mL. the color is from dark fluid intake due
color is from yellow to yellow. to the presence of
yellow to light -the patient grade 2 edema on
yellow. defecates once to both ankles.
-the patient twice a day with -the patient has
defecates twice a little difficulty or slight difficulty/
day, without straining. The strain during
difficulty or characteristics of defecation
straining. The stool are formed, because of
characteristics of soft, cylindrical, decrease oral
stool are formed, and brown in fluid intake.
soft, cylindrical color.
and brown in color.
V   
 
VV 
 V V  V V



-the patient -the patient is able -the sleeping
  sleeps to sleep for 8 hours during
approximately 4 hours at night with hospitalization
hours every day short interruptions is increased
from the nursesǯ
with because
rounds.
approximately 30 according to
minutes every him, he has
nap especially lesser things to
when delivering do even when
the vegetables there were
from Cabanatuan short
to Bulacan. interruptions
due to nurses
entering the
room.
V   
 
VV 
 V V  V V

V 

-The patient -Not applicable -Not applicable
  delivers -The patientǯs form -The patient is on
vegetables from of exercise is complete bed rest
Cabanatuan, walking back and with bathroom
driving at 4 forth inside the privileges
oǯclock in the room for 30 because an
morning, arriving minutes. increase in
in Bulacan after -When awake, the activity may
42-48 hours. patient watches cause difficulty in
-The patientǯs television while breathing and
form of exercise is lying on bed. exposure outside
walking from their the room may
house to the increase risk for
market for 30 skin infection.
minutes.
-The patient reads
newspaper every
day.
V   
 
VV 
 V V  V V

 V

-Patient takes -The patient -Providing
 V
complete bath takes partial complete

once a day bath everyday bath
and brushes with the aid increases
his teeth three from his wife risk for pain
times a day. and brushes in patientǯs
his teeth once skin.
a day.
c  
V g st 17, 2010

VITV IGN
T: 36.5 C RR: 19 cpm BW: 63 kg
PR: 80 bpm BP: 120/80mmHg Height: 5¶3´
BMI: 24.6

  

The patient is conscio s and weak-looking. He was


lying flat on bed, wearing an ID band, a shirt made of
polyester material and knee-length cotton shorts, with
IVF attached to left hand.
BODY TECHNIQU NORMV VCTUV FINDING VNVY I
PVRT E FINDING
IN Inspection Uniform kin is dry with -Idiopathic cell death ca ses epidermis to
brownish color; flaking and scaling; separate from dermis.
no skin lesions skin not niform in -impaired balance of concentration and
sho ld be color; skin moves vol me of body fl id can ca se dryness or
present; warm back slowly poor tiss e perf sion or poor skin t rgor
s rface which also affects wo nd healing.
temperat re
-the gaps between the cells of the vessel
with grade II edema wall open p then permeability to water is
on both ankles. increased first, b t as the gaps increase in
size permeability to protein, s ch as alb min,
also increases, ca sing edema.

NVI Inspection Nail s rface is Capillary refill less Normal


smooth and flat; than 3 seconds; no
c rved; no presence of finger
brittle edges. cl bbing

HEVD Inspection/ Normocephalic Ro nded, smooth, Normal


VND Palpation & symmetric, niform consistency;
FVCE smooth sk ll symmetrical facial
conto r movements.
-Hair is thin, scalp
with flaking and
scaling
BODY PVRT TECHNIQUE NORMV FINDING VCTUV FINDING VNVY I
EYE & Inspection Eyebrows eq ally Eyebrows symmetrically Normal
VI ION distrib ted & symmetrical, distrib ted; eyelashes c rled
no discharges slightly o tward; white sclera;
symmetric eye movements
with briskly reactive p pils; Idiopathic cell death
no discharge. ca ses epidermis to
-Eyelids with flaking and separate from dermis
scaling.

EVR & Inspection Ear sho ld be Normoset ears; pinna recoils Normal
HEVRING proportionally set to the easily after it is folded; dry
head; recoils easily when cer men; brownish in color;
folded & perceives so nd responds to perceived so nd
clearly & eq ally on both & verbal commands. Idiopathic cell death
ears. -Presence of skin lesions ca ses epidermis to
s ch as flaking. separate from dermis

NO E & Inspection Moist, pink to d ll red ymmetric; non-tender Normal


INU E m cosa; patent w/o sin ses; no discharge
lesions & discharge present.
BODY PVRT TECHNIQUE NORMV FINDING VCTUV FINDING VNVY I
MOUTH & Inspection ips sho ld be symmetric, ymmetrical movement of Normal
ORO- pink, moist; symmetrical lips and tong e; intact hard
PHVRYNX movement of lips & and soft palate Darkening of lips and
tong e; no lesion & -ips have lcers; slightly staining of teeth
inflammation dark in color (dark brown); res lts from cigarette
with yellowish stained teeth. smoking.

NEC Inspection/ M scles are symmetrical; Neck m scles are eq al in Normal


Palpation lymph nodes not palpable; size; coordinated and
able to move head in a f ll smooth movements witho t
range motion w/o discomfort; No palpable
discomfort lymph nodes

THORVX & Inspection/ F ll & symmetric chest VP to lateral diameter ratio Normal
UNG Palpation/ expansion; normal in of thorax is 1:2; f ll &
V sc ltation shape; bilateral symmetry symmetric chest expansion;
of vocal fremit s; VP to no adventitio s breath
lateral diameter ratio of so nds are a sc ltated; no
thorax is 1:2; slightly visible s perficial veins; no
elliptical in shape; masses or tenderness.
s perficial veins are not
visible; no masses & -Presence of skin lesions
tenderness; no s ch as scaling; areas of Idiopathic cell death
adventitio s breath so nd hyperthermia ca ses epidermis to
sho ld be a sc ltated. separate from dermis
BODY PVRT TECHNIQUE NORMV FINDING VCTUV FINDING VNVY I
CVRDIO- Inspection/ No p lsations visible in No lifts & heaves are palpated; Normal
VV CUVR Palpation/ aortic, p lmonic & j g lar veins not distended; ign of veno s
& V sc ltation tric spid areas; no lifts symmetric p lse vol mes on p lse or arterial
PERIPHERV & heaves palpated; sites; capillary refill of <3 seconds ins fficiency.
- -Mild edema; skin is shiny and waxy
VV CUVR with red ced hair and lceration.
Y TEM

VBDOMEN Inspection/ Flat & slightly ro nded ymmetrical movements by Normal


Palpation/ abdominal conto r; respiration; no tenderness present;
V sc ltation bilaterally symmetrical; flat and slightly ro nded abdomen.
niform in color & Presence of rash, scaling and flaking
pigmentation; no br its
or friction r b
a sc ltated
BODY PVRT TECHNIQUE NORMV FINDING VCTUV FINDING VNVY I
MU CUO- Inspection M scles on both sides No tremors and contract res; no Normal
EETV of the body are deformities and no tenderness,
Y TEM symmetrical; extremities swelling and crepitation; m scles
proportional to body size are symmetrical.
& shape; walks
smoothly; m scle
strength allows for
complete, vol ntary joint
ROM against gravity &
moderate resistance

NEURO- Inspection OC=14-15 OC=15 Normal


OGIC Patient is relaxed and Patient is groomed and dressed
Y TEM well- groomed & appropriate to dress; responsive to
dressed appropriate to q estions and commands; answers
age; oriented to time, both q estions correctly; steady gait
place and persons; with slightly bent post re; exhibits
immediately responds to appropriate facial expressions;
q estions & commands spontaneo s coherent speech;
coherently; facial follows verbal commands.
expressions appropriate
to content of
conversation.
 The SKIN is the largest organ in the human
body.
 For the average adult human, the skin has a
surface area of between 1.5-2.0 square
meters (16.1-21.5 sq ft.), most of it is
between 2Ȃ3 mm (0.10 inch) thick. The
average square inch (6.5 cm²) of skin holds
650 sweat glands, 20 blood vessels, 60,000
melanocytes, and more than a thousand
nerve endings.
 The skin is the outer covering of the body.
 Human skin is not unlike that of most other
mammals except that it is not protected by a
pelt and appears hairless though in fact nearly
all human skin is covered with hair follicles.
 Because it interfaces with the environment,
skin plays a key role in protecting (the body)
against pathogens and excessive water loss. Its
other functions are insulation, temperature
regulation, sensation, synthesis of vitamin D,
and the protection of vitamin B folates.
Severely damaged skin will try to heal by
forming scar tissue. This is often discoloured
and depigmented.
 Skin has mesodermal cells, pigmentation, or
melanin, provided by melanocytes, which absorb
some of the potentially dangerous ultraviolet
radiation (UV) in sunlight.
 It also contains DNA-repair enzymes that help
reverse UV damage, and people who lack the genes
for these enzymes suffer high rates of skin cancer.
One form predominantly produced by UV light,
malignant melanoma, is particularly invasive,
causing it to spread quickly, and can often be
deadly.
 Human skin pigmentation varies among
populations in a striking manner. This has led to the
classification of people on the basis of skin color.
 The epidermis, which
provides
waterproofing and
serves as a barrier to
infection;
 The dermis, which
serves as a location
for the appendages of
skin; and
 The hypodermis
(subcutaneous
adipose layer).
 Epidermis, "epi" coming
from the Greek meaning
"over" or "upon", is the
outermost layer of the
skin.
 It forms the waterproof,
protective wrap over the
body's surface and is
made up of stratified
squamous epithelium
with an underlying basal
lamina.
The epidermis contains no blood
vessels, and is nourished by
diffusion from the dermis.
The main type of cells which
makeup the epidermis are
keratinocytes, melanocytes,
Langerhans cells and Merkels
cells. The epidermis helps the
skin to regulate body
temperature.
  
Deepest layer- single row of
cells (AKA: stratum
germinativum)
Combination of merkel cells,
melanocytes, keratinocytes
& stem cells that divide
repeatedly
Scattered protein that forms
keratin higher up
   !"#
8 to 10 cell layers
Melanin taken in by
phagocytosis from nearby
melanocytes
  "#
3 - 5 layers of flat dying cells (apoptosis)
Ä#$%!" &"' ()#"* #!" #
Ä!"+
Contain granules that release lipids that repels
water
  )!,
"% !" $!)Ä Ä!": palms, fingers, & soles
3 - 5 layers of clear, flat, dead cells
Dead keratinocytes w/ lots of keratin
  #"
25 to 30 layers of flat dead cells Ȃ lots of
keratin and surrounded by lipids
Continuously shed
 The dermis is the layer of skin
beneath the epidermis that
consists of connective tissue
and cushions the body from
stress and strain.
 The dermis is tightly
connected to the epidermis by
abasement membrane. It also
harbours many
Mechanoreceptor/nerve
endings that provide the sense
of touch and heat.
DERMIS
 It contains the hair follicles, sweat glands,
sebaceous glands, apocrine glands, lymphatic
vessels and blood vessels. The blood vessels in
the dermis provide nourishment and waste
removal from its own cells as well as from the
Stratum basale of the epidermis.
 The dermis is structurally divided into two
areas: a superficial area adjacent to the
epidermis, called the  !%
&!#", and a
deep thicker area known as the !)

&!#"-
Ȉ The papillary region is
composed of loose areolar
connective tissue. It is named
for its fingerlike projections
called papil lae that extend
toward the epidermis. The
papillae provide the dermis
with a "bumpy" surface that
interdigitates with the
epidermis, strengthening the
connection between the two
layers of skin.
Papillary Region
Ȉ In the palms, fingers, soles, and toes, the
influence of the papillae projecting into the
epidermis forms contours in the skin's
surface. These are called friction ridges,
because they help the hand or foot to grasp
by increasing friction. Friction ridges occur
in patterns that are genetically and
epigenetically determined and are therefore
unique to the individual, making it possible
to use fingerprints or footprints as a means
of identification.
REI LVR REGION
 The reticular region lies deep in
the papillary region and is
usually much thicker. It is
composed of dense irregular
connective tissue, and receives
its name from the dense
concentration of collagenous,
elastic, and reticular fibres that
weave throughout it. These
protein fibres give the dermis
its properties of strength,
extensibility, and elasticity.
REI LVR REGION
 Also located within the
reticular region are the roots of
the hair, sebaceous glands,
sweat glands, receptors, nails,
and blood vessels.
 Tattoo ink is held in the dermis.
Stretch marks from pregnancy
are also located in the dermis.
Ȉ The hypodermis is not part of the
skin, and lies below the dermis.
Its purpose is to attach the skin
to underlying bone and muscle as
well as supplying it with blood
vessels and nerves. It consists of
loose connective tissue and
elastin. The main cell types are
fibroblasts, macrophages and
adipocytes (the hypodermis
contains 50% of body fat). Fat
serves as padding and insulation
for the body.
Ȉ Microorganisms
like Staphylococcus
epidermis colonize the skin surface.
The density of skin flora depends on
region of the skin. The disinfected
skin surface gets re-colonized from
bacteria residing in the deeper
areas of the hair follicle, gut and
urogenital openings.
FN IONS OF HE SKIN
 #)!#" - an anatomical barrier from
pathogens and damage between the
internal and external environment in bodily
defense. Langerhans cells in the skin are
part of the adaptive immune system.
 "!#" - contains a variety of nerve
endings that react to heat and cold, touch,
pressure, vibration, and tissue injury.
 #"#
#.
* #!#" - the skin provides
a relatively dry and semi-impermeable
FN IONS OF HE SKIN
 
&!#" - the skin contains a blood supply
far greater than its requirements which allows
precise control of energy loss by radiation,
convection and conduction. Dilated blood vessels
increase perfusion and heat loss, while constricted
vessels greatly reduce cutaneous blood flow and
conserve heat.
 V$!)
",
)#"!)!#" - others see our
skin and can assess our mood, physical state and
attractiveness.
 #&
",
%"$!/ acts as a storage center for
lipids and water, as well as a means of synthesis of
vitamin D by action of UV on certain parts of the skin.
FN IONS OF HE SKIN
 V0# !#" - Oxygen, nitrogen and carbon dioxide
can diffuse into the epidermis in small amounts,
some animals using their skin for their sole
respiration organ (contrary to popular belief,
however, humans do not absorb oxygen through
the skin). In addition, medicine can be administered
through the skin, by ointments or by means of
adhesive patch, such as the nicotine patch or
iontophoresis. The skin is an important site of
transport in many other organisms.
 
!") - The skin acts as a water
resistant barrier so essential nutrients aren't
washed out of the body
 Stevens-Johnson syndrome is an immune-
complexȂmediated hypersensitivity
disorder that may be caused by many drugs,
viral infections, and malignancies.
 Although not currently relevant to the
practice of emergency medicine, research
into the pathophysiology of SJS/TEN may
soon allow for the development of tests to
aid in the diagnosis as well as to identify
those at risk.
PVHOPHYSIOLOGY
 Pathologically, cell death results causing
separation of the epidermis from the dermis.
The death receptor, Fas, and its ligand, FasL,
have been linked to the process, as has TNF-
alpha. Researchers have found increased
soluble FasL levels in the sera of patients with
SJS/TEN before skin detachment or inset of
mucosal lesions.
 The  ) # (FasR) is a death receptor
on the surface of cells that leads to
programmed cell death (apoptosis).
PVHOPHYSIOLOGY
Ȉ #
")#!
.)# (, cachexin or cachectin
and formally known as " 2
 ) is a cytokine involved in
systemic inflammation and is a member of a group
of cytokines that stimulate the acute phase reaction.
Ȉ The primary role of TNF is in the regulation
of immune cells. TNF is able to induce apoptotic cell
death, to induce inflammation, and to
inhibit tumorigenesis and viral replication.
Dysregulation of TNF production has been
implicated in a variety of human diseases, as well
as cancer.
PVHOPHYSIOLOGY
 %#Ä!" (Greek 2 , cell; and 
, movement) are any of a
number of small proteins that are
secreted by specific cells of the
immune system and glial cells, which
carry signals locally between cells,
and thus have an effect on other
cells. They are a category of signaling
molecules that are used extensively
in cellular communication.
PVHOPHYSIOLOGY
 They are proteins ,peptides ,
or glycoproteins. The term cytokine
encompasses a large and diverse
family of polypeptide regulators that
are produced widely throughout the
body by cells of diverse embryological
origin.
 The term "cytokine" has been used to
refer to the immuno modulating
agents (interleukins, interferons, etc.).
 Stevens-Johnson syndrome is a rare, serious
disorder in which your skin and mucous
membranes react severely to a medication
or infection.
 Often, Stevens-Johnson syndrome begins
with flu-like symptoms, followed by a
painful red or purplish rash that spreads and
blisters, eventually causing the top layer of
your skin to die and shed.
SEVEN JONHSON SYDROME
(SJS)
Ȉ Stevens-Johnson syndrome is an emergency
medical condition that usually requires
hospitalization. Treatment focuses on eliminating
the underlying cause, controlling symptoms and
minimizing complications.
Ȉ Recovery after Stevens-Johnson syndrome can
take weeks to months, depending on the severity
of your condition. If your doctor determines that
your case of Stevens-Johnson syndrome was
caused by medication, you'll need to permanently
avoid the medication and all others related to it.
Ú The exact cause of Stevens-Johnson syndrome can't
always be identified. Usually, the condition is an allergic
reaction in response to medication, infection or illness.
 ,!)!#"
)
Medications are most often the cause of Stevens-
Johnson syndrome. Drugs commonly associated
with Stevens-Johnson syndrome include:
Anti-gout medications, such as allopurinol
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Sulfonamides and penicillins, which are used to
treat infections
Anticonvulsants, which are used to treat seizures
Ȉ ".)!#
)
Infections that can cause Stevens-Johnson
syndrome include:
Herpes (herpes simplex or herpes zoster)
Influenza
HIV
Diphtheria
Typhoid
Hepatitis
Ȉ $
)
In some cases, Stevens-Johnson syndrome may be
caused by physical stimuli, such as radiation
therapy or ultraviolet light.
SIGNS VND SYMPOMS:
Facial swelling
Tongue swelling
Hives
Skin pain
A red or purple skin rash that spreads
within hours to days
Blisters on your skin and mucous
membranes, especially in your mouth,
nose and eyes
Shedding (sloughing) of your skin
SIGNS VND SYMPOMS:
 If you have Stevens-Johnson
syndrome, several days before the
rash develops, you may experience:
Fever
Sore throat
Cough
Burning eyes
SIGNS VND SYMPOMS:
 Stevens-Johnson syndrome requires
immediate medical attention. Seek
emergency medical care if you experience
any of the following signs or symptoms:
Unexplained widespread skin pain
Facial swelling
Blisters on your skin and mucous
membranes
Hives
Tongue swelling
A red or purple skin rash that spreads
Shedding of your skin
Ȉ Stevens-Johnson syndrome is a rare and unpredictable
reaction. No test is available to help predict who is at greater
risk. Some factors, however, may increase your risk of
developing Stevens-Johnson syndrome:
 1!!"&
,!)
)#",!!#"- Viral infections,
diseases that decrease your immunity, human
immunodeficiency virus (HIV) and systemic lupus
erythematosus Ȅ a chronic inflammatory disease
Ȅ increase your risk of developing Stevens-
Johnson syndrome.
 "!)- Carrying a gene called HLA-B12 may
make you more susceptible to Stevens-Johnson
syndrome.
Ȉ Possible complications of Stevens-Johnson syndrome
include:
 )#",%
Ä!"
!".)!#"
()!!+- This acute
infection of your skin can lead to life-threatening
complications, including meningitis Ȅ an
infection of the membrane and fluid surrounding
your brain and spinal cord Ȅ and sepsis.
  !- Sepsis occurs when bacteria from a
massive infection enter your bloodstream and
spread throughout your body. Sepsis is a rapidly
progressing, life-threatening condition that can
cause shock and organ failure.
Ȉ %
#0- The rash caused by Stevens-
Johnson syndrome can lead to inflammation in
your eyes. In mild cases, this may cause
irritation and dry eyes. In severe cases, it can
lead to extensive tissue damage and scarring
within your eyes that can result in blindness.
Ȉ &
#
!""
#&"- Stevens-Johnson
syndrome can cause lesions of your internal
organs, which can result in inflammation of
your lungs (pneumonitis), heart (myocarditis),
kidney (nephritis) and liver (hepatitis).
OMPLI VIONS:
Ȉ ""
Ä!"
,&- When your
skin grows back following Stevens-
Johnson syndrome, it may have abnormal
bumps and coloring (pigmentation).
Scars may remain on your skin, as well.
Lasting skin problems may cause your
hair to fall out, and your fingernails and
toenails may not grow normally.
È  
     
   
   
 
  
  



       

   
  
 


 

    

  
 
 
Ȉ Stevens-Johnson syndrome requires hospitalization,
often in an intensive care unit or burn unit.
Ȉ # !"&
,!)!#"
)
The first and most important step in
treating Stevens-Johnson syndrome is to
discontinue any medications that may be
causing it. Because it's difficult to
determine exactly which drug may be
causing the problem, your doctor may
recommend that you stop taking all
nonessential medications.
Ȉ  #!*
)
Currently there are no standard recommendations for
treating Stevens-Johnson syndrome. Supportive care
you're likely to receive while hospitalized includes:
 !,
 )"- Because skin loss can result in
significant loss of fluid from your body, replacing
fluids is an important part of treatment. You may
receive fluids and nutrients through a tube placed
through your nose and into your stomach
(nasogastric tube).
 Ä!"
"!"&- Cool, wet compresses will help
soothe blisters while they heal. Your health care
team may gently remove any dead skin, and then
place a dressing with a topical anesthetic over the
affected areas, if needed.
È Medications commonly used in the
treatment of Stevens-Johnson
syndrome include:
 Pain medication to reduce discomfort
 Antihistamines to relieve itching
 Antibiotics to control infection, when
needed
 Topical steroids to reduce skin
inflammation
Ȉ In addition, you may receive one of the following types
of medications that are currently being studied in the
treatment of Stevens-Johnson syndrome:
 Intravenous corticosteroids. These drugs may
lessen the severity of your symptoms and
shorten your recovery time if started within a
day or two of when symptoms first appear.
 Immunoglobulin intravenous (IGIV). This
medication contains antibodies that may help
your immune system halt the process of
Stevens-Johnson syndrome.
 Ä!"
&.!"&
If a large area of your body is affected,
skin grafting Ȅ removing skin from one
area of your body and attaching it to
another Ȅ may be necessary to help
you heal. This treatment is only rarely
required.
 If the underlying cause of Stevens-
Johnson syndrome can be eliminated
and the skin reaction stopped, your
skin may begin to grow again within
several days. In severe cases, full
recovery may take several months.
Ȉ It's difficult to prevent an initial attack of Stevens-
Johnson syndrome because you don't know what
will trigger it. However, if you had Stevens-Johnson
syndrome once, and your doctor determined that it
was caused by medication, be sure to avoid that
medication and others in the same class to prevent
another attack. If the herpes virus caused your
reaction, you may need to take daily antiviral
medications to prevent a recurrence.
Ȉ A recurrence of Stevens-Johnson syndrome is
usually more severe than the first episode and, in
many cases, it can be fatal.
Patient: Buan, Juanito C. Date/time Performed: 08/14/10 11:25 am
Ward/Rm No. OP Requesting Doctor: Cosico, Lyndon A. M.D
File no: U-10-3136 Age: 44 yrs. old and 5 mos.

Result: Kidneys and Urinary Bladder


The Kidney are normal position and shape with
echogenic parenchymae with loss of the normal
cortico- medullary demarcation. The right kidney
measures 9.81 x 4.1 cm (length x AP diameter),
cortical thickness of 0.8 cm. The left measures 10.0
x 5.5 cm (length x AP diameter), cortical thickness
of 1.2 cm
Multiple small lithiases line in calyceal walls of both
kidneys. These range n size from 0.4 cm to 0.6 cm.
At least 3 cortical cysts are seen measuring 0.94 cm,
1.9 cm (lower) and 1.1 cm (upper). No hydronephrosis
demonstrated.
The urinary bladder is normal on shape and wall
thickness with a volume of 122 cc. The walls are midly
thickened (0.53 cm) and irregular. No lithiasis or mass
demonstrated. Post voiding volume is 77.9 cc.
Impression:
Bilateral Renal Parenchymal disease with
Multiple small Calyceal Lithiases.
Cortical Cysts, left kidney
Cystitis
Patient Name: B an, J anito ab # 28235 ample ID: 45
Vge: 44 pecimen: ser m
Ward: VP Physician: Dr. Tan Melendrez
Date: V g st 15, 2010

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#! 5.0 mmol/L 3.50-5.10 5.60 mmol/L 3.50-5.10 NORMAL
Comment
Patient Name: B an, J anito ab # 28158 ample ID: 5
Vge: 44 pecimen: ser m
Ward: VP Physician: Dr. Tan Melendrez
Date: V g st 15,2010
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ab # 28183
ample ID: 26

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ab #27996
ample ID: 100
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V T H- / 15-37 128 / 15.00- sign of serio s
(Vspartate 128 37.00 liver damage
Vmino
transferase)

VT H-70 30-65 70 / 30-65 sign of serio s


(Vlanine liver damage
transaminase
)
odi m - mmol 136- 132.0 mmol 136- both sodi m and
132 / 145 0 / 145 water content in
the body
increase, b t
water gain is
greater (EDEMV)
Potassi m H- mmol 3.50- 6.10 mmol 3.50-
6.1 / 5.10 / 5.10
Patient Name: B an, J anito ab # 27996-128
Vge: 44
Ward: ER Physician: Dr. B dhi
Date: V g st 14, 2010
ES RESL NI REFEREN E

Ä )% 3.10 10^q/L 5.0-10.0

%$ )% 2.49 10^q/L M:4.6-6.2


F:4.2-5.4

 & 0!" 7.1 g/dL M:12.0-17.0


F:11.0-15.0

  )! 21.00 M:40.0-54.00


F:37.0-47.0
HEMVOLOGY
ES RESL NI REFEREN E

$#0#)% 210 10^q/L 150-450


% $#)% 32.6 % 20.0-40.0
#"#)% 7.9 % 0.0-7.0
"#)% 59.5 % 50.0-70.0
Result Vnalysis

Ä )% L-3.10

E   )   L- .

 & 0!" L-7.1

 )! L- 1.00


Normal Findings Result Vnalysis

$#0#)% 210 Ê


#"#)% H-7.9

% $#)% 32.6 Ê


"#)% 59.5 Ê



Name: B an, J anito ab # 27996-82
Vge: 44 Encoded by: JRN
Ward: ER Req esting Physician: Dr. B dhi
Date Req ested: V g st 14, 2010
Res lt Date: V g st 14, 2010

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Color: Light Yellow Albumin: ++++
Reaction: 6.0 Sugar: NEGATIVE
Transparency: Slightly Turbid Chloride:
Quantity: 20 mL Calcium:
Specific Gravity: 1.015 Acetone:
RINVLYSIS
$
'
Bence Jones Protein

V/  !)#)# !)


V  Pus Cells: innumerable/HPF
Amorphous Po4/ Red Blood Cells:8-10/ HPF
Urates: FEW Epithelial Cells: Rare
Bacteria: FEW