eae Laboratory Values on Admission: BUN 13, creatinine 1.3, sugar 98, amylase 46, cholesterol 116, electrolytes normal, calcium, magnesium and phosphate normal, alkaline phosphatase $0, total protein 8.5, albumin 4,1, total bilirubin 0.1, SCPT, SCOT and LDY all normal, uric acid 5.8, While being treated with cytosine arabinoside the SCPT and SCOT rose out of the normal range and in the one week prior to death he had billrubin elevations to as high as 6 as well, There was never any evidence of disseminated intra- ee vascular coagulation on twice weekly coagulation screening tests, Problem No, 2 - Thyrold Status: Clinically, the patient vas euthyroid. Thyroxine level was 3.7, hospital stay he was concinued on L-thyroxine, 0.3 mg. daily, Throughout his Problem No. 5 - Oticis Media: The patient was treated with oxacillin and gentamicin followed by ampicillin for g@ total of seven days with resolucion of his lefe otitis, Problem No. 6 - Perlodonsircis: The dental consultant recommended managing his molar periodontitis with frequent local lavage, which was done under his supervision, The initial inflammation resolved after several days, buc during the last three weeks of his hospitalization he had severe peridontal inflammarion, worse on the right. In addition, a right subauricular swelling appeared late in the second hospital week and persisced until the time of death. Ear, nose and throat consultant thought this represented parotitis, but reactive adenopathy from the periodontitis could not be excluded. During the last three weeks of hospital- ization he was on nearly concinual antibiotic treatment with oxacillin and gentamicin or keflin and gentamicin. On November 8 Proteus mirabilis and Pasteurella milticida were cultured from the blood. These organisms had previously been cyltured from the mouth as well, and a likely source of sepsis was hia perfodontitis, He continued to be febrile throughout the rest of the hospical course, buc subsequent blood cultures were sterile, Problem No. 7 ~ Pneumonitis: On November 7 the patient had gram-negative sepsis; on November 8 he complained of a brassy cough; on Nevember 9 he was generally tachypneie and quite anxious, with cyanotic nail beds. Physical examination revealed right axillary rales and chest x-ray showed & patchy alveolar infiltrate in the right upper, middle and lower lobes. Arcerial oxygen saturation was 45 om. of mercury on room air and pCO, and 20 mom, of Mercury, Cultures of the scanty blood-tinged sputum grew only a few colonies of Klebsiella, Over che next two days he had increasingly severe respiratory distress with gradual opacification of both hemithoraces on chest x-ray. His sputum became frankly bloody. On November 12 he was intubated by the nasotracheal route and placed on a volume cycled respirator. He was begun on treatment empirically with pyrimethamine and sulfadiazine for the possibility of Pneumocyatis carinii pneumonitis, Management Clinical MCcORD Rongelap (54) 09-44-40 3 ( Wiwery ond Physical laeminesion Ph, wmmary -3THE CLINICAL CENTER MATIONAL INSTITUTES OF NEALTO - 144 - Narrative OD Comerisanan 0 Conrayation WULPPE ihes, $71) C1 Fethow-wp ‘