1

Mapping pasien dr. DS Sp.PD KGH dan dr. ABD Pt/aptt : 18.40/ 29
Sp.PD.,KGH Albumin: 3.10
Lantai 1 Ca:6.4
Gds : 86
————————————————————— Ur/cr: 216/21.50
AQSA 3 1B1 Na/k/cl : 135/3.4/106
Nama : ati binti aliasa
CM : 1-31-17-32 AQSA 3 1B3
TL : 08/06/1994 Nama : Aminah binti Ubit
TM : 27/08/2022 Cm : 1315620
Tl : 8/9/1957
Ass/ TM : 28/08/2022
1.CKD stage V dengan uremik syndrome
Ass/
2. Anemia berat HM ec PGK
1. CKD stg V dgn uremic syndrome
3. Pneumonia CAP 2. Anemia sedang NN ec dd PGK
4. HF stage C FC NYHA III-IV 3. Hipertensi terkontrol
5. Hipokalemia ringan 4. Hipoalbuminemia ec renal loss

Th/
Th/
Threeway
Threeway Bicnat 3x500mg
IV Ceftriaxsone 2 gr / 24jam N-asetylsistein 3x200mg
IV furosemide / 12 Jam Lenal ace 2x169mg
Lansoprozole 30 gr/ 24 jam iv
P/
Ca gluconas 1 g / 12 jam iv
Balance cairan/hr
Valsartan 160 gr /24 ja, po USG urologi
Amlodipine 10 g /24 jam po
Lenal ace 16 gr/ 12 jam po Lab 29/8/22
Bicnat 500 gr /8 jam po Urinalisa
Gabapenton 100gr/24jam po Positif keton
Positif +1 protein
Bisoprolol 1x5mg
Lab 28/8/2022
P/ Hb/Ht/T/L : 9,8/28/209/4,79
Balance cairan/hari MCV/MCH/MCHC : 84/29/35
HD rabu, sabtu Diftel : 2/0/1/81/5/11
HIV R1 : non reaktif
4jam, UF 1000 Anti HCV : negative
HBsAg: non reaktif
Urinalisis 30/8/2022 Albumin : 3,30
Warna: Kuning Ca : 7,2
GDS: 83
Kejernihan: keruh Ur/Cr : 165/9,80
Leukosit + Na/K/Cl : 135/5,10/115
Protein +2
Glukosa – AGD
pH/pCO2/pO2/HCO3 : 7,3/26,2/85/14
Keton - Total CO2 : 14,8
Nitrit - BE/Saturasi O2 : -9,9/95,7
Uro -
Bilirubin –
Darah + AQSA 3 2B2
Leukosit: 10-25 Nama : Nurepa binti Rusli Lukman
Eritrosit: 50-60 NRM : 1303132
Epitel 1-3 TL : 7/1/1990
TM : 23/08/2022
Lab 28/08/2022
Hb/Ht/L/T : 8,0/22/17,95/123 Ass/
1. SLE derajat berat dgn keterlibatan jantung dan ginjal
Mcv/mch/mchc : 71/26/36
2. Nefritis lupus
Diftel : 2/0/0/88/3/7
3. Efusi pericard
Ur/cr: 67/8,60
4. Chest pain ec dd 1) pericarditis 2) VAP
Na/k/cl : 139/3,30/110
Th/
Lab 27/08/2022 Bedrest
Hb/L/tr : 5.3/11.5/186 Diet jantung 1700kkal/hr
Mcv/mch/mchc : 73/26/36 Threeway
Diftel : 4/0/1/72/14/9 O2 2-4 Lpm
 2

IV furosemide 20 /8jam IV Ondansetron 4 mg/12jam

CPG 1x75mg PO N-Asetil Cystein 3x200mg
Aspilet 1x80g PO Bicnat 3x500mg
HCQ 1x200g PO As. Folat 2x400mg
Atorvastatin 1x20mg
Amlodipin 1x10mg
Bisoprolol 1x2,5mg
Valsartan 1x80mg IV Furosemide 20 mg
Lenal ace 2x169mg
P/ Valsartan 1x160mg
Balance cairan/hr
USG Urologi P/
Balance cairan/hari
Lab 30/8/2022 USG urologi
HIV R1: non reaktif HD rabu-Sabtu
Lab 29/8/22
Hb/L/T: 9,6/10,91/546
Lab 31/8/2022
Diftel: 0/0/0/87/9/4 Hb/Ht/T/L : 9,6/28/372/16,30
Ur/cr: 219/7,60 MCV/MCH/MCHC : 78/27/34
Anti hcv negatif Diftel : 4/0/1/83/5/7
Hbsag non reaktif Ur/Cr : 24/2,70
Ca: 12,6
Lab 24/8/2022 Na/K/Cl : 138/3,90/109
Hb/Ht/T/L : 9,5/28/290/1,84
MCV/MCH/MCHC : 82/28/34 Lab 27/8/22
Diftel : 0/1/0/4/55/40
Hb/L/T: 8,5/32,07/373
CRP kualitatif : positif
Albumin : 2,63 MCV/MCH/MCHC: 75/ 26/35
Troponin T/CKMB : 0,08/50 Diftel:
Ca : 7,5 Ur/Cr: 72/3,90
Ur/Cr : 78/2,46 Na/K/Cl/Ca: 140/4,20/107/11,8
Na/K/Cl : 139/3,90/110
Lab 26/8/22
Urinalisis Hb/L/T : 8,5/32.07/373
Warna : kuning Diftel : 2/0/0/89/4/5
Kejernihan : keruh Ur/cr : 72/107
Berat jenis : 1,022
Na/K/Cl : 141/4.20/107
pH : 5,0
L/P/G/K : +/+3/-/+ Ca : 11.8
N/Uro/B/Dr : -/-/-/+ Albumin : 3
Leukosit : 25-50
Eritrosit : 80-100 Lab 24/8/22
Epitel : 5-10 H/L/T :6,3/55,56/738
Granular cast : + Mcv/mch/mchc:76/26/35
Hyalin cast : + RDW: 18,2
Bakteri : + Diftel: 0/0/0/95/2/3
AGDA
pH: 7,274
Aqsa 3 2B4 pCO2:17,70
Afrida Binti Muslim 34 TH pO2: 18
DPJP : dr. Mahriani Sylvawani, Sp.PD-KR HCO3: 12,9
Co2 total: 13,8
Ass/ SaO2: 22,3
1. CKD stage V dengan uremic syndrome Albumin: 3,10
2. ISK GDS: 94
3. Anemia berat hipokrom mikrositer ec dd PGK Pt/Aptt: 18,50/27,40
Ur/cr:251/11,40
Th/ Na/K/Cl/Ca:143/3,90/118/9
Bedrest Urinalisa: Leukosit (+), Protein (+), Darah (+), Sel ragi
O2 2-4 lpm nasal cannule (+), Bakteri (+)
Diet ginjal 1700 kkal + diet protein 0,6-0,8 HbsAg/Anti HCV: (-/-)
gr/hari
IV Meropenem 1gr/8jam AQSA 3 3B3
IV Lansoprazole 30g/24jam
 3

Nama : Rohani binti M. Yusuf 4. ISK

CM: 1312931 5. Hipertensi stage II
TL : 13/1/1955 Th/
TM : 29/8/2022 Bedrest
Diet ginjal 1700kkal/hari
Ass/ Threeway
1. CKD stg V dgn uremic syndrome ec dd Drip levofloxacin 500g/24jam
1) HN 2) PNC IV Omeprazole 40mg/12jam
2. Bisitopenia ec dd 1) related CKD 2)
Leukemia akut 3) MDS P/
3. Pneumonia geriatri Balance cairan/hari
4. Hiponatremia hipoosmolar hipovolemik USG Urologi (7/9/2022)
5. Hipertensi Stg I Cek asam urat, lipid profile

Th/ Lab 1/9/2022

Bedrest HIV R1: Non reaktif
Threeway
Diet MII 1700 kkal/hari Lab 31/8/2022
IVFD Nacl 0,9% 20 tpm Hb/Ht/T/L : 5,0/14/127/7,60
PO Valsartan 1x80 mg MCV/MCH/MCHC : 92/31/33
Ceftriaxone 2gr/24 jam Diftel : 1/0/0/77/16/6
Lansoprazole 30mg/24 jam PT/APTT: 15,60/29,60
Valsartan 80mg/24 jam Anti hcv: -
Asam folat 1 tab/12 jam Hbsag: non reaktif
Amlodipine 10 mg/24 jam Albumin: 4,00
Lenal ace 2x169mg Ca: 6,8
Fluimucil 200mg/8 jam GDS: 132
Ur/Cr : 239/11,00
P/ Na/K/Cl :142/5,40/115
Urinalisa
Cek asam urat, HBsAg, Anti HCV AQSA 3 5B5
USG urologi Nama: Cut Astri Erlisa
SWAB PCR CM: 1315875
Balance cairan/hari TL: 20/02/1988
TM: 31/8/2022
Lab 30/8/2022
Hb/Ht/T/L : 6,3/18/16/18,22 Ass/
MCV/MCH/MCHC : 82/28/34 1. CKD st. V e.c dd :
Diftel : 1/1/0/32/23/43 PNC
GDS: 170
HN
Ur/Cr : 131/8,80
Na/K/Cl : 130/4,90/97 2. Anemia Berat HM e.c Penyakit Kronis
3. Hipertensi st. I
4. Hiperkalemia ringan
Lab 29/08/2022
Hb/L/T : 6,3/18,22/16 Th/
MCV/MCH/MCHC: 82/28/34 Bed rest
Diftel: 1/10/32/23/43 O2 4 LPM via Nasal Canul
Na/K/Cl: 130/4,90/97 Diet GInjal 1700 kkal/ hari
Ur/Cr: 131/8,80 iv. Furosemide 20 mg/ 8 jam
GDS: 170 iv. Ceftriaxone 2gr/ 24 jam
iv. Ca. Gluconas 1 gr/ 12 jam
AQSA 3 4B3 Domperidone 3x10 mg
Nama : Surati binti Wiryodikmoro Amlodipine 1x 10 mg
CM: 1258762 Kalitake sach 3x1
Bicnat 3x 500 mg
TL : 31/12/1966
As. Folat 2x 0,4 mg
TM : 31/8/2022 Fluimicyl 3x 200 mg

Ass/ P/
1. CKD stg V dgn uremic syndrome Urinalisa
2. Anemia berat NN ec dd PGK USG urologi
3. Hipocalsemia berat Balance cairan/hari
 4

Nama : Sartimah binti Saroni

Cm : 1202387
Lab 30/8/22 Tl : 3/6/1962
TM : 28/08/2022
Hb/L/T : 7,2/5,89/265
Mcv/mch : 67/24 Ass/
Diftel : 0/0/0/94/5/1 1. CKD stg V on HD regular
Na/K/Cl : 142/3,6/106 2. Anemia berat NN ec PGK
Ca: 5,9 3. Ulkus diabetic a/r pedis bilateral
4. DM tipe 2 NW
5. Hipoalbuminemia berat
Anti HCV = negative 6. Hipokalsemia
HbsAg= non reaktif
HIV R1 = non reactive Th/
O2 2-4
AGD Diet ginjal 1700kkal/hr
PH = 7,337 IVFD Nacl 0,9% 10 tpm
Clindamisin 3x300g
PCO2 = 23,20 Drip albumin
PO2 = 49 Atorvastatin 1x20g
HCO3 = 12,6 Asam folat 2x400mg
CO2 = 13,3 Lenal ace 2x169mg
BE = -11,0
P/
SaO2 = 82,7
Balance cairan/hr
HD senin kamis, UF 1000, 3jam
Albumin = 3,30
KGDS = 165 mg/dl Lab 28/8/2022
Ur/Cr = 279/ 23,00 Hb/L/T : 4,8/4,81/141
MCV/MCH : 82/26
Diftel : 1/0/0/67/24/8
AQSA 3 6B1 Albumin : 2,3
Nama: Jahura Ur/Cr : 127/8,5
CM: 1315388 Na/K/Cl/Ca : 137/4,4/112/7,7
TL: 31/12/1944 PT/APTT/D-dimer : 1,26/1,1/2950
TM: 26/8/2022
————————————————————
Ass/
1. CKD Stage V dengan uremic syndrome ec dd PGOI Aqsha 2 K3B1
2. Anemia sedang ec PGK Faris Munandar
3. Pneumonia (HAP) CM: 1119339
Th/ TL: 13/5/1998
Bedrest TM : 19/8/2022
Diet ginjal 1700 kkal/hari+protein 1,2 gr/kgbb/h
HMY Ass/
IV Ceftriaxone 2gr/24 jam
IV Omeprazole 40 mg/24 jam 1. Anemia berat HM ec dd Penyakit kronik
IV metokloperamid 5 mg/8jam 2. Ca rectum menginfiltrasi buli
PU Lenel ACE 1x 3. AKI Stage III
PO as Folat 3x 50 mg
Transfusi PRC 2 KOF on HD, target HB>9 gr/dl.
4. Psmbb ec related ca recti
HD rabu-sabtu 5. hidronefrosis bilateral
P/
Balance cairan/hari Th/
Pantau hemodinamik
Bicnat 3x500
Lab 30/8/22 N-asetylsistein 3x200mg
PT/APTT: 13,20/26,00
Allopurinol 1x100g
Lab 25/08/22
Hb/L/T: 8,4/15,84/94
MCV/MCH/MCHC; 85/31/37 P/
Diftel: 1/0/0/82/10/7
HIV R1; Non reaktif Ct Scan Abdomen NK (kontras bila Ur/Cr perbaikan)
Anti HCV: Negatif
HbsAg: Non reaktif
Albumin: 3,60 Lab 30/8/2022
Ca: 9,8
GDS: 68 H/L/T 9,9/8,97/519
Ur/Cr: 169/15
MCV/MCH/MCHC 80/26/33
Diftel 1/0/0/83/10/6
AQSA 3 6B4
Ur/Cr 57/3,25
 5

Ur/Cr : 52/2,30

Lab 25/8/2022 Lab 30/8/2022

H/L/T 10,1/7,78/649 Hb/ht/E/L/T : 9,4/30/4,6/6,59/340
MCV/MCH/MCHC : 64/20/31
MCV/MCH/MCHC 77/26/34
Difftel : 13/0/0/68/11/8
Diftel 0/0/0/84/10/6 Feritin : 15,83
Anti HCV Negatif Fe : 25
Ur/Cr 66/3,5 TIBC : 311
Lab 22/8/22 Lab 29/8/2022
Hb/L/T : 7.8/15.73/716 Hb/ht/E/L/T : 6,9/23/3,6/360/6,38
Mcv/MCH : 76/25 MCV/MCH/MCHC : 63/19/30
Diftel : 0/0/1/88/5/6 Difftel : 13/1/0/65/14/7
Ca : 8.8 Ur/cr : 50/2,16
Ur/Cr : 56/3.60 Asam urat : 8,4
Na/K/Cl : 139/3.60/117
AQSA 2 4B3
Nama: Jabaruddin bin m.sufi
Lab 21/08/22
TL : 01/07/19/75
Hb/L/T : 6.4/13.7/ 866
CM : 1315586
Mcv/MCH : 79/15
TM : 27/08/2022
Diftel : 1/0/0/70/13/8
Ur/Cr : 53/3.5 Ass/
Na/K/Cl : 140/3.8/115 1. ckd stage V dengan uremic syndrome
2. anemia sedang ec PGK
AQSA 2 4B1
3. post nefrostomi
Nama: Ridwan bin Abdullah
4. hepatitis b kronik
TL : 08/06/1968
CM: 1315264
Th/
TM : 26/08/2022
Bedrest
Ass/ Threeway
1. Anemia berat HM (perbaikan) ec dd Diet ginjal 1700 kkal/hari +
-defisiensi Fe Protein 0,8 g / kgbb/hari
-perdarahan kronik Iv omeprazole 40 mg/2 jam
- penyakit kronik Iv furosemide 2 mg/12 jam
2. PSMBA ec dd
Iv levofloxacin 50 mg/24 jam
1. Gastropati NSAID
2. Ulkus gaster Iv ceftrixon 2 g/24 jam
3. Ulkus duodenum Po asam folat 2x400 mg
3. Gout artritis dengan multiple tophus Biconat 3x50 g
4. Hipokalsemia
5.AKI stage II dd HN P/
Balance cairan/hari
Th/
Bedrest
Diet MII 1700 kkal/hari rendah protein Lab 30/8/2022
IVFD NaCL 0,9% 20 tpm Na/K/Cl/Ca: 144/2,50/103/7,3
IV Lansoprazole 30 mg/12 jam Ur/Cr: 121/7,70
PO Sukralfat syr 3 x CII Asam urat: 7,9
Lactulac syr 3 x c ii
Urinalisis
P/
Tranfusi PRC s/d Hb >10 Leukosit +
EGD & colonoscopy Protein +1
Perbaiki KU dulu. Darah +
Asam urat Leukosit: 250-300
Usg urologi 5/9/2022 Eritrosit : 80-100
Swab PCR
Lab 28/8/2022
Lab 31/8/2022
Hb/Ht/T/L : 10,2/31/327/6,97 Ur/Cr: 215/12,4
MCV/MCH/MCHC : 64/21/33 SGOT/SGPT : 37/29
Diftel : 15/1/0/55/20/9
 6

Lab 27/08/2022 IV Furosemide 20mg/8 jam

Hb/T/L : 8,2/475/30,32 IV ondansentron 4mg/8jam
MCV/MCH/MCHC : 79/28/36 As Folat 2x0,4 mg
Diftel : 0/0/0/91/3/6 Cetirizine 2x10mg
Na/K/Cl/Ca : 134/3,90/111/7,2 Acetylcystein 3x200mg
Anti HCV : negative Sucralfat syr 3xcii
HBsAg : reaktif Amlodipine 1x5mg
Paracetamol 2x1000mg
AGD Aminofluid 1 fls /24 jam
pH/pCO2/pO2/HCO3 : 7,27/13,8/115/6,4 Atorvastatin 1x20mg
Total CO2 : 6,8
BE/Saturasi O2 : -17,4/94,2
P/
Balance cairan/hr
AQSA 2 4B4
Nama: Ridwan bin Usman
Lab 1/9/2022
TL : 30/8/1964
Hb/Ht/T/L : 10,6/30/562/15,57
CM: 1311449 MCV/MCH/MCHC : 83/29/35
TM : 20/08/2022 Diftel : 24/1/0/58/11/6
Ur/Cr : 119/2,30
Ass/ Na/K/Cl : 128/4,60/101
1. CKD stg V on HD ec PGOI
2. Hidronefrosis bilateral Lab 30/08/2022
3. Anemia sedang NN ec PGK Na/K/Cl/Ca :
136/5,40/101/9,7
Th/ Ur/Cr : 81/2,68
Threeway GDS : 318
Bicnat 3x500mg Kolesterol total : 145
Nasetilsistein 3x200mg HDL : 22
LDL : 80
P/ Trigliserida : 35
Balance cairan/hari
Urinalisis 30/8/2022
Lab 1/9/2022 Glukosa +2
Ur/Cr: 140/9,70 Darah +
Leukosit, eritrosit: 2-5
Lab 29/8/2022 Granular cast +
Hb/Ht/T/L : 8,1/24/210/8,93
MCV/MCH/MCHC : 83/28/34 Lab 29/08/2022
Diftel : 4/0/0/66/19/11 Urinalisis
Ur/Cr : 141/9,70
Na/K/Cl : 142/4,00/110 Leukosit : Positif
PT/APTT: 12,80/29,00 Sedimen urin leukosit : positif
Elektrolit :
AQSA 2 5B3 Na/K/Cl:138/4,70/109
Nama: Faisal bin Arbi
TL : 14/08/1969 Lab 27/08/2022
CM: 1315533 Na/K/Cl: 142/5,5/115
TM : 26/08/2022
Lab 26/08/2022
Ass/ Hb/L/T: 7.8/13.30/505
1. CKD stg V Mcv/mch /mchc : 85/29/34
2. DM Tipe 2 Diftel : 5/0/0/71/16/8
3. HF stg C FC NYHA II-III Anti hcv negatif
HBsAg nonreaktif
Th/ Hematokrit: 23
Bedrest PDW/RDW:8,8/14,1
Diet DM 2000 kkal hari dengan protein 40 gram Albumin: 3
O2 2-4LPM Nasal Kanul Ur/Cr : 112/3,6
IV ceftriaxone 2gr/24jam Na/K/Cl/Ca:140/6,4/122/11,
IV Lansoprazole 30 mg /24 jam
 7

Lactulac syr 3xCII

Amlodipine 1x5mg
AQSA 2 K5b5 Bicnat 3x 500mg
M. Dahlan Asam folat 2x1
CM : 1260775 Iv Cefoperazone 1g/12 jam
TL : 24/12/1969 Drip paracetamol 1g/8 jam
TM : 25/8/2022 N. Asetyl sistein 200/ 8 jam
Ass/
1. CKD stage V dgn edema paru akut
2. Anemia sedang ec PGK P/ 
3. Hiperkalemia (perbaikan) Balance cairan/hr
HD selasa jumat
Th/
bedrest
diet ginjal 1700 kkal/hari + 1 gr protein/kgBB/hari Lab 1/9/2022
amlodipine 1 x 10 gr Ur/Cr: 140/9,70
asam folat 2x400mg
IV levofloxacin 500 mg /24 jam (H2)
Lenal ace 2x1
Lab 29/8/22
NAC 3x1 Hb/Ht/T/L : 8,1/24/210/8,93
Kalitake 3x1 MCV/MCH/MCHC : 83/28/34
IV lansoprazole 30 mg/24 jam Diftel : 4/0/0/66/19/11
IV Furosemide 20mg/12 jam
Ur/Cr : 141/9,70
P/ Ca/Na/K/Cl : 8,5/142/4,00/110
HD rabu-sabtu
Balance cairan/hr Lab 24/8/22
Lab 29/8/2022
Hb/L/T : 8,6/8,40/194
Hb/ht/E/L/T : 7,0/21/3,0/11,26/314 Mcv/mch: 80/29
MCV/MCH/MCHC : 71/23/33 Diftel : 4/1/0/68/17/0
Difftel : 4/0/0/80/11/5 Albumin : 4,10
Albumin : 2,90
Ur/cr : 50/3,40 Ca: 8,4
Ca/Na/K/Cl : 11,5/136/3,60/108 Ur/Cr : 157/9,40
N/K/Cl : 141/3,60/107
Lab 26/8/2022
Hb/L/T : 7,8/11,56/312
MCV/MCH/MCHC : 68/24/35 Lab 21/8/22
Diftel 0/0/0/86/7/7 Hiv r1 non reaktif
Ca : 11,6
Ur/Cr 96/6,1 Lab 20/8/22
N/K/Cl : 136/4,3/109
Hb/L/trom : 5.8/6.47/241
Lab 26/8/2022 Mcv/mch  : 77/28
Ca : 9 Diftel : 3/1/074/15/7
Ur/Cr 154/9,84 Albumin 4.20
Na/K/Cl : 133/6/104
Gds : 99
Ur/Cr: 405/22.3
AQSA 2 6B4
Na/K/Cl : 140/4.6/106
Ridwan bin Usman Risyad
CM : 1311449
TL : 30/8/1964
TM : 20/8/2022 HCU MEDICAL B12 (PINDAH ICU)
Musa A Gani
Ass/
1. CKD Stage V on HD ec PGOI Ass/
2. Hidronefrosis bilateral 1. CKD stge V dengan uremic ensefalopati
3. Anemia sedang NN ec PGK 2. Hipertensi on therapy
3. DM tipe 2
Th/ 4. ISK
Bedrest
Threeway Th/
O2 2lpm (nk) Drip Paracetamol 1g/8jam
Diet ginjal 1700kkal/hari Drip levofloxacin 500mg/24jam
IV lansoprazole 30mg/12 jam IV Omeprazole 40mg/12jam
Lenal ace 2x1 Flumuicil syr 3xCI
 8

Nystatin
Ventolin 1resp/12 jam P/
HD selasa-jumat Balance cairan
Asam folat 2x400mg USG urologi
IV Meropenem 1g/8jam Transfusi PRC 1 kolf on HD

P/ Lab 1/9/2022
Balance cairan/hari Hb/Ht/T/L : 9,6/27/218/23,35
Evaluasi Ur, cr, elektrolit /3hari MCV/MCH/MCHC : 77/28/36
Diftel : 0/0/1/87/6/6
Lab 30/8/2022 Ur/Cr : 63/5,90
Hb/Ht/T/L : 7,8/22/132/31,23 Ca/Mg: 10,1/3,4
MCV/MCH/MCHC : 80/28/35 Na/K/Cl :138/3/30/107
Diftel : 1/0/0/82/6/11
Ur/Cr : 77/3,00 Lab 30/8/2022
Ca/Mg: 9,6/2,9 Hb/Ht/T/L : 9,4/26/170/8,44
Na/K/Cl : 135/3,60/107 MCV/MCH/MCHC : 76/27/36
Diftel : 1/1/0/71/11/16
Lab 28/8/2022 Ur/Cr : 68/6,9
Hb/Ht/T/L : 8,6/24/103/23,5 Ca/Mg: 9,5/3,5
MCV/MCH/MCHC : 79/29/36 Na/K/Cl : 139/3,00/107
Diftel : 2/0/0/85/3/10
Ur/Cr : 136/4,50 Lab 28/8/2022
Ca/Mg: 9,6/2,9 Hb/Ht/T/L : 8,4/24/128/10,50
Na/K/Cl : 135/3,90/115 MCV/MCH/MCHC : 80/28/35
Diftel : 1/1/0/77/7/14
Lab 27/8/22 GDS: 72
Hb/L/trom : 8,6/21,24/110 PT/APTT: 16,30/37,90
Mcv/mch  : 78/28 Ddimer: 750,00
Diftel : 1/0/0/87/3/9 Ur/Cr : 226/24,00
OT/PT : 35/21 Ca/Na/K/Cl :6,3/142/5,00/121
Albumin 2,8
Gds : 99 pH/pCO2/pO2/HCO3: 7,256/19,90/56/8,9
Ur/Cr: 191/5,9 total CO2: 9,6
Na/K/Cl : 138/4,2/114 BE/Saturasi O2: -15,3/84,7

HCU MEDICAL B4 Bilirubin total/direct/indirect: 0,33/0,16/0,17

Aini Rasyidah SGOT/SGPT: 25/17
1315604 Albumin: 3,20
TL: 10/9/1979 Troponin T/CKMB: 0,05/20
TM: 28/8/2022
HCU MEDICAL B9
Ass/ Nama : Rohani binti Rayeuk
1. Penurunan kesadaran ec dd 1) uremic ensefalopati CM: 1315738
2) sepsis TL: 02/01/1943
2. Sepsis ec dd 1) pneumonia 2) urosepsis TM: 29/8/2022
3. CAP
4. HF stg C FC NYHA III-IV Ass/
5. HHD 1. Penurunan kesadaran ec dd 1) uremic
ensefalopati 2) sepsis
Th/ 2. CKD stage V dgn uremic ensefalopati
Drip paracetamol 1g/8jam 3. CAP
IV Ceftriaxone 1g/12jam 4. Closed fracture neck femur dextra
IV Omeprazole 40mg/12jam
IV Citicoline 500mg/12jam Th/
IV Furosemide/12 jam HD dilakukan jika TD>100 mmHg
Valsartan 80mg/24 jam IVFD Nacl 0,9% 10tpm
Amlodipine 10mg/24jam IV Meropenem 1g/12 jam
Sucralfat syr 3xCI Bicnat 3x500mg
HD senin kamis (4jam, UF 1000, Qb 200, heparin reguler) IV omeprazole 40/12j
 9

IV PCT 1g/8j
IV Furosemide 20g/8j Lab 30/8/2022
Allopurinol 300mg/24j Tubex TF : 6
Ceftriaxone 1g/12j Ca: 7,5
Ur/Cr:169/2,91
P/ Na/K/Cl: 136/4,90/110
Balance cairan/hari
Cek ur, cr /3hari Lab 28/8/2022
Kultur darah + STAB Hb/Ht/T/L : 8,2/23/20/10,78
Pantau hemodinamik/ jam MCV/MCH/MCHC : 66/23/35
Menunggu keputusan keluarga untuk tindakan Diftel : 0/0/0/84/8/8
HD Ur/Cr : 143/3,60

Lab 1/9/2022 Lab 26/8/22

Hb/Ht/T/L : 12,6/35/56/16,34 Hb/L/trom : 7,4/12,5/35
MCV/MCH/MCHC : 83/30/36 Mcv/mch  : 64/22
Diftel : 0/0/0/88/8/4 Diftel : 0/0/0/80/12/8
Ur/Cr : 212/5,00 Albumin 2,6
Ca/Mg: 8,0/2,2 Gds : 161
Na/K/Cl :145/5,00/115 Ur/Cr: 115/4,0
Bilirubin total/direct/indirect: 8,19/5,83/2,36 Na/K/Cl : 135/5,8/109
SGOT/SGPT: 125/50
Albumin: 2,70 ————————————————————————

HCU MED B12 MINA2 7B3

Zuriani binti Umar Fatimah binti M. Adam
CM: 1315515 CM: 1315609
TL: 25/2/1968 TL: 12/4/1964
TM: 26/8/2022 TM: 28/8/2022

Ass/ Ass/
1. CKD stge V dengan uremic syndrome 1. Penurunan kesadaran ec dd stroke iskemik
2. Anemia sedang ec PGK 2. AKI stage III dd acute on CKD
3. Hipoalbuminemia 3. DM tipe 2 NW

Th/ Th/
Asam folat 2x400mg IVFD Nacl 0,9%
Bicnat 3x500mg N asetilsistein 3x200mg
N asetilsistein 3x200mg IV Ceftriaxone 2g/24jam
IV Levofloxacin 500mg/24j IV Levofloxacin 500mg/24jam
Combivent 1resp/8j Bicnat 3x500mg
Codein 2x10mg Asam Folat 2x400mg
Metilprednisolon 2x4mg
IV Meropenem 1g/8j P/
Combivent 1resp/8j HD (keluarga menolak)
Pantau hemodinamik/jam
Cek ur, cr
P/ Lab 1/9/2022
Konsul HCU medical Ur/Cr: 116/6,65
Pantau hemodinamik/jam
Lab 30/8/2022
Lab 1/9/2022 Hb/Ht/T/L : 9,8/28/408/14,5
Hb/Ht/T/L : 7,3/21/25/9,68 MCV/MCH/MCHC : 77/27/36
MCV/MCH/MCHC : 66/23/35 Diftel : 9/0/1/69/14
Diftel : 0/0/0/87/10/3 Albumin : 2,10
Malaria: negatif Ur/Cr : 117/6,54
PT/APTT: 16,10/35,70 Asam urat: 4,8
Fibrinogen: 392,00 Ca/Na/K/Cl :7,7/133/5,40/112
Ddimer: >4000,00 PT/APTT: 14,90/43,30
Albumin: 2,90 Ddimer: >4000,00
 10

Hba1c: 7,20 Lab 29/8/2022

Kolesterol total/HDL/LDL: 121/45/56 Hb/Ht/T/L : 7,4/21/181/25,66
Trigliserida: 79 MCV/MCH/MCHC : 82/29/35
GDP: 65 Diftel : 0/0/0/93/5/2
HbsAg: reaktif
Urinalisis 30/8/2022 SGOT/SGPT: 19/10
Warna: Kuning Ur/Cr : 67/2,20
Kejernihan: keruh Na/K/Cl : 118/3,50/92
Leukosit +
Protein +2 —————————————————————
Glukosa –
Keton + Arafah 2 K 5D
Nitrit - Fitriani binti abu bakar
Uro + CM: 1316012
Bilirubin – TL: 27/7/1984
Darah + TM: 31/8/2022

Leukosit: 25-50 Ass/

Eritrosit: 80-100 1. Hipertensi gestasional dd hipertensi primer
Bakteri + 2. G4P3A0 hamil 36-37 minggu

———————————————————————— Lab 31/8/2022

Hb/Ht/T/L : 13,0/36/320/12,87
Arafah 3 K 7B MCV/MCH/MCHC : 80/29/36
Rukiyah binti Ramli Diftel : 1/0/0/77/18/4
1298839 PT/APTT : 13,90/32,20
TL: 1/7/1961 SGOT/SGPT : 17/11
TM: 29/8/2022 Ur/Cr : 12/0,50
Na/K/Cl : 139/3,60/108
Ass/
1. AKI stg II post renal Urinalisa
2. Ca endometrium post kemoterapi Keton +1
3. Anemia sedang NN ec peny kronik
4. Hipernatremia hipoosmolar hipervolemik —————————————————————

Th/ RUMAH SAKIT LAMA

Threeway
IV furosemid 20mg/8j AQSA 1 ISO 3
Flumuicil 3x200g Samsul Rizal
IV Ceftriaxone 2g/24jam CM: 1207792
Drip Paracetamol 100g/8jam TL: 1/8/2004
Curcuma g/12jam TM: 16/8/2022
IVFD Nacl 0,9%
IV Meropenem 1g/12jam Ass/
IV ondansetron 4mg/8jam 1. susp difteri
Flukonazol 1x150mg 2. CKD stge V on HD
3. hipoalbuminemia
P/
Cek DR ur cr per 3 hari Th/
HD senin-kamis
Lab 1/9/2022 4jam, UF 1000
Hb/Ht/T/L : 12,1/34/102/41,28 Transfusi on HD
MCV/MCH/MCHC : 79/28/36
Diftel : 0/0/0/97/2/1 Asam folat 2x400
Ur/Cr : 65/1,60 NAC 3x200
Na/K/Cl : 117/3,50/95 Bicnat 3x500

Lab 30/8/2022 Lab 24/8/2022

CA125: 83,3 Hb/Ht/T/L : 7,7/20/85/12,72
MCV/MCH/MCHC : 74/28/38
 11

Diftel : 0/0/1/86/8/5 Total co2 : 8,1

Albumin : 2,29 Be :-20,8
Ca : 5,1 Saturasi o2: 98,4
Ur/Cr : 143/8,80
Na/K/Cl : 140/2,80/107 ISO PINERE K7B5
Husnaini
Lab 23/8/22 CM:
Hb/L/T: 7,9/15,70/110 TL:
Diftel: 0/0/0/90/6/4 TM:
PT/APTT: 16,70/ 36,80
Fibrinogen: 628 Ass/
Ddimer: 1480 1. COVID 19 confirmed case (RT PCR)
SGOT/SGPT: 355/34 2. CKD stg V dgn uremic syndrome
Albumin : 2,30 3. Anemia sedang
4. Hipoalbumin sedang
Lab 18/8/2022
Hb/L/Tr : 10,6/15,15/104
MCV/MCH : 74/28
Diftel : 1/0/0/86/6/7
Ur/cr : 419/24,9
Na/K/Cl : 135/3,5/112
Kalsium 5,7

RICU
Suryati binti Sabirin
CM: 1315317
TL: 30/6/1985
TM: 24/8/2022

Ass/
1. COVID 19
2. CKD stge V on HD dgn uremic ensefalopati
3. Hipocalsemia berat
4. Hipoalbuminemia
5. ISK

Th/
HD hari minggu 28/8/2022

Lab 29/8/2022
AGD
pH/pCO2/pO2/HCO3 : 7,4/33,7/51/21,1
Total CO2 : 22,1
BE/Saturasi O2 : -2,4/85,8

Lab 26/8/22
Hb/L/trom : 11,1/27,9/87
Mcv/mch  : 78/27
Diftel : 0/0/0/95/4/1
Albumin 2,2
Kalsium 5,8
Ur/Cr: 146/6,99

Lab 26/8/22
AGDA:
Ph : 7,068
Pco2 : 25,10
Po2 : 164
Hco3 : 7,3