Detailed Treatment Process
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Death Summary Department: Geriatrics Sex: Male Age: 84 years Admission time: February 11 Time of death: March 7 at 06:11 Outpatient diagnosis: Cerebral infarction; Hypertension Admission diagnosis: Post-cerebral infarction, possible recurrent infarction; Hypertension (Grade 3, very high risk); Respiratory tract infection; Prostatic hyperplasia Death diagnosis: Post-cerebral infarction, recurrent infarction; Pulmonary infection; Cardiac insufficiency, acute left heart failure; Hypertension (Grade 3, very high risk); Prostatic hyperplasia Main symptoms and signs on admission: Right-sided limb weakness with sluggish response for 1 day. Physical examination: Alert, brought into the ward on a stretcher, breathing steady, no jaundice or petechiae on the skin, no palpable superficial lymph nodes; pupils equal and round, reactive to light; no lip cyanosis, no jugular venous distension, thyroid not enlarged; breath sounds slightly coarse in both lungs, no dry or moist rales; heart rate 80 beats/min, regular rhythm, no pathological murmurs; abdomen soft and flat, no tenderness, liver and spleen not palpable below the costal margin, no lower limb edema; neurological examination: pupils equal and round, diameter 0.25 cm, brisk light reflex, shallow right nasolabial fold, tongue midline, increased muscle tone in all limbs, right upper limb strength Grade 4, right lower limb Grade 3, left limbs Grade 4+, sensation symmetric bilaterally. Tendon reflexes ++ and symmetric. Neck soft, Kernig sign negative, Brudzinski sign negative, right pathological sign positive, left negative. Blood pressure: 120/80 mmHg. (March 7): CRP 66 mg/L White blood cell count 8.53 × 10⁹/L Neutrophils 87.5% Lymphocytes 8.90% Monocytes 3.50% Eosinophils 0.00% Basophils 0.10% Neutrophil absolute value 7.46 Monocyte absolute value 0.30 Lymphocyte absolute value 0.76 Eosinophil absolute value 0.00 Basophil absolute value 0.01 Red blood cell count 3.71 × 10¹²/L Hemoglobin 107 g/L Hematocrit 31.6% Mean corpuscular volume 85.2 fl Mean corpuscular hemoglobin 28.8 pg Mean corpuscular hemoglobin concentration 339 g/L Red cell distribution width 14.5% Platelet count 91.0 × 10⁹/L Plateletcrit 0.11% Mean platelet volume 12.40 fl Platelet distribution width 17.4 fl (March 7): Sodium (dry slide) 127.0 mmol/L Potassium (dry slide) 6.00 mmol/L Chloride (dry slide) 85.0 mmol/L Calcium (dry slide) 1.88 mmol/L Phosphorus (dry slide) 3.22 mmol/L Magnesium (dry slide) 1.09 mmol/L Urea nitrogen (dry slide) 19.0 mmol/L Creatinine (dry slide) 161.3 µmol/L Uric acid (dry slide) 313.50 µmol/L Bile acids 11.3 µmol/L Alanine aminotransferase (dry slide) 2126.0 U/L Aspartate aminotransferase (dry slide) 3058.0 U/L Alkaline phosphatase (dry slide) 105 U/L GGT (dry slide) 42 U/L Total bilirubin (dry slide) 19.1 µmol/L Direct bilirubin (dry slide) 0.00 µmol/L Total protein (dry slide) 53 g/L Albumin (dry slide) 25.9 g/L Albumin/globulin ratio 0.96 Myoglobin 603.70 ng/mL CK-MB (mass) 4.8 ng/mL Troponin 3.992 ng/mL (March 7): pH 7.12 pCO₂ 13.44 kPa pO₂ 13.8 kPa cHCO₃ 26.80 mmol/L TCO₂ 29.90 mmol/L BE -5.6 mmol/L ctHb 117.00 g/L O2Hb 93.50% COHb 0.20% MetHb 0.50% HHb 5.80% (March 7): Prothrombin time 17.80 s PT INR 1.47 Activated partial thromboplastin time 40.4 s Fibrinogen 3.59 g/L Thrombin time 13.30 s D-dimer 4.91 mg/L Antithrombin activity 74% Fibrin (ogen) degradation products 30.30 mg/L (March 2): proBNP 867.80 pg/mL Procalcitonin 0.34 ng/mL Sodium (dry slide) 127.0 mmol/L Potassium (dry slide) 4.20 mmol/L Chloride (dry slide) 88.0 mmol/L Calcium (dry slide) 1.99 mmol/L Phosphorus (dry slide) 1.12 mmol/L Magnesium (dry slide) 0.78 mmol/L Urea nitrogen (dry slide) 7.2 mmol/L Creatinine (dry slide) 58.6 µmol/L Uric acid (dry slide) 134.90 µmol/L Bile acids 2.2 µmol/L Alanine aminotransferase (dry slide) 39.0 U/L Aspartate aminotransferase (dry slide) 51.0 U/L Alkaline phosphatase (dry slide) 114 U/L GGT (dry slide) 31 U/L Total bilirubin (dry slide) 11.6 µmol/L Direct bilirubin (dry slide) 0.00 µmol/L Total protein (dry slide) 54 g/L Albumin (dry slide) 24.4 g/L Albumin/globulin ratio 0.82 Myoglobin 53.10 ng/mL CK-MB (mass) 3.1 ng/mL Troponin 0.123 ng/mL Repeated test, results consistent (March 2): White blood cell count 14.0 × 10⁹/L Neutrophils 91.40% Monocytes 3.90% Lymphocytes 4.70% Eosinophils 0.00% Basophils 0.00% Neutrophil absolute value 12.80 Monocyte absolute value 0.50 Lymphocyte absolute value 0.70 Eosinophil absolute value 0.00 Basophil absolute value 0.00 Red blood cell count 3.71 × 10¹²/L Hemoglobin 112 g/L Hematocrit 32.0% Mean corpuscular volume 86.3 fl Mean corpuscular hemoglobin 30.3 pg Mean corpuscular hemoglobin concentration 351 g/L Red cell distribution width 13.9% Platelet count 213 × 10⁹/L Mean platelet volume 10.30 fl (March 2): Prothrombin time 11.40 s PT INR 1.03 Activated partial thromboplastin time 28.7 s Fibrinogen 3.84 g/L Thrombin time 13.80 s D-dimer 0.79 mg/L Antithrombin activity 84% Fibrin (ogen) degradation products 7.00 mg/L (March 2): pH 7.41 pCO₂ 7.91 kPa pO₂ 9.6 kPa cHCO₃ 36.70 mmol/L TCO₂ 38.50 mmol/L BE 9.60 mmol/L (February 27): Procalcitonin 0.17 ng/mL (February 27) Stool routine: Color yellow Consistency soft Macrophages / Ascaris eggs / Roundworm eggs / Hookworm eggs / Fat droplets / Whipworm eggs / Red blood cells / White blood cells / HP / Yeast-like fungi / Occult blood test positive (++) (February 22): Color brown Consistency pasty Macrophages not found Ascaris eggs not found Roundworm eggs not found Hookworm eggs not found Fat droplets not found Whipworm eggs not found Red blood cells not found White blood cells / HP / White blood cells not found HP / Yeast-like fungi not found Occult blood test weakly positive (February 22): CRP 52 mg/L White blood cell count 19.98 × 10⁹/L Neutrophils 89.8% Lymphocytes 5.30% Monocytes 4.60% Eosinophils 0.20% Basophils 0.10% Neutrophil absolute value 17.98 Monocyte absolute value 0.91 Lymphocyte absolute value 1.05 Eosinophil absolute value 0.03 Basophil absolute value 0.01 Red blood cell count 4.08 × 10¹²/L Hemoglobin 114 g/L Hematocrit 34.6% Mean corpuscular volume 84.8 fl Mean corpuscular hemoglobin 27.9 pg Mean corpuscular hemoglobin concentration 329 g/L Red cell distribution width 13.7% Platelet count 254.00 × 10⁹/L Plateletcrit 0.34% Mean platelet volume 13.30 fl Platelet distribution width 19.2 fl (February 26): Myoglobin 68.90 ng/mL CK-MB (mass) 1.8 ng/mL Troponin 0.294 ng/mL (February 25): proBNP 1480.00 pg/mL Sodium (dry slide) 141.0 mmol/L Potassium (dry slide) 3.90 mmol/L Chloride (dry slide) 106.0 mmol/L Calcium (dry slide) 1.90 mmol/L Phosphorus (dry slide) 0.95 mmol/L Magnesium (dry slide) 0.91 mmol/L Glucose (dry slide) 6.6 mmol/L Urea nitrogen (dry slide) 9.9 mmol/L Creatinine (dry slide) 69.4 µmol/L Uric acid (dry slide) 210.50 µmol/L Bile acids 2.7 µmol/L Alanine aminotransferase (dry slide) 32.0 U/L Aspartate aminotransferase (dry slide) 53.0 U/L Alkaline phosphatase (dry slide) 99 U/L GGT (dry slide) 27 U/L Total bilirubin (dry slide) 11.2 µmol/L Direct bilirubin (dry slide) 0.00 µmol/L Total protein (dry slide) 52 g/L Albumin (dry slide) 24.6 g/L Albumin/globulin ratio 0.90 Myoglobin 99.50 ng/mL CK-MB (mass) 1.8 ng/mL Troponin 0.477 ng/mL (February 25): Prothrombin time 11.80 s PT INR 1.06 Activated partial thromboplastin time 27.3 s Fibrinogen 3.07 g/L Thrombin time 15.30 s D-dimer 0.92 mg/L Antithrombin activity 85% Fibrin (ogen) degradation products 5.90 mg/L (February 25): CRP 43 mg/L White blood cell count 16.40 × 10⁹/L Neutrophils 88.8% Lymphocytes 4.30% Monocytes 6.90% Eosinophils 0.00% Basophils 0.00% Neutrophil absolute value 14.60 Monocyte absolute value 1.10 Lymphocyte absolute value 0.70 Eosinophil absolute value 0.00 Basophil absolute value 0.00 Red blood cell count 3.81 × 10¹²/L Hemoglobin 113 g/L Hematocrit 33.90% Mean corpuscular volume 89.0 fl Mean corpuscular hemoglobin 29.6 pg Mean corpuscular hemoglobin concentration 332 g/L Red cell distribution width 14.0% Platelet count 215.00 × 10⁹/L Plateletcrit 0.22% Mean platelet volume 10.30 fl (February 22): Prothrombin time 12.70 s PT INR 1.12 Activated partial thromboplastin time 31.8 s Fibrinogen 3.79 g/L Thrombin time 14.60 s D-dimer 0.62 mg/L Antithrombin activity 66% Fibrin (ogen) degradation products 4.70 mg/L (February 22): CK-MB (mass) 3.4 ng/mL Myoglobin 326.60 ng/mL Troponin quantitative 0.09 ng/mL (February 20): pH 7.316 pO₂ 20.90 kPa pCO₂ 5.81 kPa ctHb 11.70 g/L BE(B) -3.9 mmol/L sO₂ 99.00% TCO₂ 51.40 mmol/L HCO₃⁻ 21.60 mmol/L HCO₃std 21.20 mmol/L Hct 36.00% (February 20): Sodium (dry slide) 139.0 mmol/L Potassium (dry slide) 3.70 mmol/L Chloride (dry slide) 104.0 mmol/L Myoglobin 167.40 ng/mL CK-MB (mass) 3.3 ng/mL Troponin 0.201 ng/mL (February 19): Procalcitonin 0.73 ng/mL Sodium (dry slide) 135.0 mmol/L Potassium (dry slide) 3.30 mmol/L Chloride (dry slide) 102.0 mmol/L Myoglobin 76.80 ng/mL CK-MB (mass) 1.9 ng/mL Troponin 0.074 ng/mL (February 19): CRP 148 mg/L White blood cell count 10.64 × 10⁹/L Neutrophils 67.5% Lymphocytes 26.50% Monocytes 5.50% Eosinophils 0.40% Basophils 0.10% Neutrophil absolute value 7.19 Monocyte absolute value 0.58 Lymphocyte absolute value 2.82 Eosinophil absolute value 0.04 Basophil absolute value 0.01 Red blood cell count 3.97 × 10¹²/L Hemoglobin 113 g/L Hematocrit 34.0% Mean corpuscular volume 85.6 fl Mean corpuscular hemoglobin 28.5 pg Mean corpuscular hemoglobin concentration 332 g/L Red cell distribution width 12.8% Platelet count 183.00 × 10⁹/L Plateletcrit 0.21% Mean platelet volume 11.60 fl Platelet distribution width 12.7 fl (February 19): Procalcitonin 0.82 ng/mL proBNP 1001.00 pg/mL Sodium (dry slide) 135.0 mmol/L Potassium (dry slide) 3.20 mmol/L Chloride (dry slide) 100.0 mmol/L Urea nitrogen (dry slide) 7.7 mmol/L Creatinine (dry slide) 82.9 µmol/L Uric acid (dry slide) 265.80 µmol/L Bile acids 2.5 µmol/L Alanine aminotransferase (dry slide) 28.0 U/L Aspartate aminotransferase (dry slide) 41.0 U/L Alkaline phosphatase (dry slide) 92 U/L GGT (dry slide) 16 U/L Total bilirubin (dry slide) 11.1 µmol/L Direct bilirubin (dry slide) 0.00 µmol/L Total protein (dry slide) 63 g/L Albumin (dry slide) 31.8 g/L Albumin/globulin ratio 1.02 (February 19): Prothrombin time 14.30 s PT INR 1.24 Activated partial thromboplastin time 30.7 s Fibrinogen 4.82 g/L Thrombin time 14.00 s D-dimer 1.11 mg/L Antithrombin activity 58% Fibrin (ogen) degradation products 11.40 mg/L (February 18): CRP 183 mg/L White blood cell count 10.20 × 10⁹/L Neutrophils 82.2% Lymphocytes 13.70% Monocytes 2.70% Eosinophils 1.10% Basophils 0.30% Neutrophil absolute value 8.40 Monocyte absolute value 0.30 Lymphocyte absolute value 1.40 Eosinophil absolute value 0.10 Basophil absolute value 0.03 Red blood cell count 3.78 × 10¹²/L Hemoglobin 114 g/L Hematocrit 33.30% Mean corpuscular volume 88.2 fl Mean corpuscular hemoglobin 30.3 pg Mean corpuscular hemoglobin concentration 343 g/L Red cell distribution width 14.0% Platelet count 171.00 × 10⁹/L Plateletcrit 0.18% Platelet distribution width 17.0 fl Mean platelet volume 10.70 fl (February 19): pH 7.27 pCO₂ 8.37 kPa pO₂ 7.9 kPa cHCO₃ 28.10 mmol/L TCO₂ 30.10 mmol/L BE -0.1 mmol/L ctHb 129.00 g/L O2Hb 84.80% COHb 0.70% MetHb 0.60% HHb 13.90% (February 18): Sodium (dry slide) 128.0 mmol/L Potassium (dry slide) 3.40 mmol/L Chloride (dry slide) 96.0 mmol/L Myoglobin 73.20 ng/mL CK-MB (mass) 1.1 ng/mL Troponin 0.096 ng/mL (February 18) Stool routine: Color yellow Consistency pasty Macrophages not found Ascaris eggs not found Roundworm eggs not found Hookworm eggs not found Fat droplets not found Whipworm eggs not found Red blood cells not found White blood cells 0-2 /HP Yeast-like fungi not found Occult blood test negative (February 17): Myoglobin 151.30 ng/mL CK-MB (mass) 2.6 ng/mL Troponin 0.130 ng/mL (February 16): Sodium (dry slide) 133.0 mmol/L Potassium (dry slide) 3.80 mmol/L Chloride (dry slide) 105.0 mmol/L rT3 0.51 ng/mL (February 16): CK-MB (mass) 4.1 ng/mL Myoglobin 62.70 ng/mL Troponin quantitative 0.19 ng/mL (February 15): Prothrombin time 13.20 s PT INR 1.16 Activated partial thromboplastin time 30.5 s Fibrinogen 5.05 g/L Thrombin time 13.20 s D-dimer 1.03 mg/L Antithrombin activity 76% Fibrin (ogen) degradation products 11.00 mg/L (February 15): CRP 81 mg/L White blood cell count 9.70 × 10⁹/L Neutrophils 90.5% Lymphocytes 5.90% Monocytes 3.60% Eosinophils 0.00% Basophils 0.00% Neutrophil absolute value 8.78 Monocyte absolute value 0.35 Lymphocyte absolute value 0.57 Eosinophil absolute value 0.00 Basophil absolute value 0.00 Red blood cell count 3.76 × 10¹²/L Hemoglobin 108 g/L Hematocrit 32.2% Mean corpuscular volume 85.6 fl Mean corpuscular hemoglobin 28.7 pg Mean corpuscular hemoglobin concentration 335 g/L Red cell distribution width 12.9% Platelet count 159.00 × 10⁹/L Plateletcrit 0.20% Mean platelet volume 12.50 fl Platelet distribution width 16.5 fl (February 15): pH 7.39 pCO₂ 5.96 kPa pO₂ 12.0 kPa cHCO₃ 26.20 mmol/L TCO₂ 27.60 mmol/L BE 0.90 mmol/L ctHb 113.00 g/L O2Hb 95.40% COHb 1.00% MetHb 0.70% HHb 2.90% (February 15) Urinalysis: Color yellow Transparency slightly cloudy Specific gravity 1.015 pH 6.00 Nitrite negative Urine protein 75.00 mg/dl Urine glucose normal mg/dl Ketones negative mg/dl Urobilinogen normal mg/dl Bilirubin negative mg/dl Red blood cells 150 /µl Leukocyte esterase negative /µl Red blood cells (microscopy) 15-20 /HP White blood cells (microscopy) not seen /HP Epithelial cells (microscopy) not seen /HP Crystals (microscopy) not seen /HP Hyaline casts not seen /LP Granular casts not seen /LP Cellular casts not found/LP | Yeast-like fungi not found | (February 15) Stool routine: Color yellow | Consistency hard | Macrophages / | Ascaris eggs / | Roundworm eggs / | Hookworm eggs / | Fat droplets / | Whipworm eggs / | Red blood cells /HP | White blood cells /HP | Yeast-like fungi / | Occult blood test weakly positive (February 15) Procalcitonin 4.03 ng/mL | proBNP 1637.00 pg/mL | Sodium (dry slide) 126.0 mmol/L | Potassium (dry slide) 4.00 mmol/L | Chloride (dry slide) 98.0 mmol/L | Calcium (dry slide) 2.02 mmol/L | Phosphorus (dry slide) 0.97 mmol/L | Magnesium (dry slide) 0.75 mmol/L | Glucose (dry slide) 7.2 mmol/L | Urea nitrogen (dry slide) 6.0 mmol/L | Creatinine (dry slide) 79.0 µmol/L | Uric acid (dry slide) 176.50 µmol/L | Bile acids 2.4 µmol/L | Alanine aminotransferase (dry slide) 32.0 U/L | Aspartate aminotransferase (dry slide) 52.0 U/L | Alkaline phosphatase (dry slide) 83 U/L | γ-Glutamyl transferase (dry slide) 18 U/L | Total bilirubin (dry slide) 12.9 µmol/L | Direct bilirubin (dry slide) 0.00 µmol/L | Total protein (dry slide) 63 g/L | Albumin (dry slide) 29.5 g/L | Albumin/globulin ratio 0.88 | Myoglobin 166.30 ng/mL | Creatine kinase MB (mass) 4.0 ng/mL | Troponin I 0.096 ng/mL (February 14) Alpha-fetoprotein 1.34 ng/mL | Carcinoembryonic antigen 2.42 ng/mL | Prostate-specific antigen 1.59 ng/mL | Free prostate-specific antigen 0.34 ng/mL | F-PSA/T-PSA 0.21 | CA-19-9 9.67 U/mL | CA-125 44.87 U/mL | CA-15-3 10.43 U/mL | CA724 2.65 U/mL | CA211 1.39 ng/mL | Neuron-specific enolase 12.55 µg/L | Squamous cell carcinoma antigen 1.30 ng/mL | CA242 0.10 U/mL (February 14) Hepatitis B surface antigen (-) 0.00 IU/mL | Hepatitis B surface antibody (+) > 1000.00 mIU/mL | Hepatitis B e antigen (-) 0.369 S/CO | Hepatitis B e antibody (-) 1.77 S/CO | Hepatitis B core antibody (-) 0.22 S/CO | Hepatitis C core antigen (-) 0.06 S/CO | Hepatitis A IgM antibody negative (-) (February 14) B-CTX 0.10 ng/mL | Total P1NP 21.23 ng/mL | Osteocalcin 1.90 ng/L | Total 25-hydroxyvitamin D 18.66 ng/mL | Parathyroid hormone 15.97 pg/mL (February 14) C-reactive protein 73 mg/L | White blood cell count 10.32 × 10⁹/L | Neutrophils 87.5% | Lymphocytes 7.80% | Monocytes 4.60% | Eosinophils 0.00% | Basophils 0.10% | Neutrophil absolute value 9.03 | Monocyte absolute value 0.47 | Lymphocyte absolute value 0.81 | Eosinophil absolute value 0.00 | Basophil absolute value 0.01 | Red blood cell count 3.91 × 10¹²/L | Hemoglobin 113 g/L | Hematocrit 33.4% | Mean corpuscular volume 85.4 fl | Mean corpuscular hemoglobin 28.9 pg | Mean corpuscular hemoglobin concentration 338 g/L | Red cell distribution width 12.8% | Platelet count 159.00 × 10⁹/L | Plateletcrit 0.19% | Mean platelet volume 11.70 fl | Platelet distribution width 12.8 fl (February 14) pH 7.49 | pCO₂ 4.21 kPa | pO₂ 25.6 kPa | HCO₃⁻ 23.60 mmol/L | TCO₂ 24.60 mmol/L | Base excess 0.70 mmol/L | Actual HCO₃⁻ 98.00 g/L | Oxygen saturation 98.30% | Carboxyhemoglobin 0.70% | Methemoglobin 0.40% | Reduced hemoglobin 0.60% (February 14) Stool routine: Color yellow | Consistency soft | Macrophages not found | Ascaris eggs not found | Roundworm eggs not found | Hookworm eggs not found | Fat droplets not found | Whipworm eggs not found | Red blood cells not found /HP | White blood cells not found /HP | Yeast-like fungi not found | Occult blood test negative (February 14) C-reactive protein 70 mg/L | White blood cell count 7.70 × 10⁹/L | Neutrophils 86.2% | Lymphocytes 8.70% | Monocytes 4.70% | Eosinophils 0.30% | Basophils 0.10% | Neutrophil absolute value 6.64 | Monocyte absolute value 0.36 | Lymphocyte absolute value 0.67 | Eosinophil absolute value 0.02 | Basophil absolute value 0.01 | Red blood cell count 3.91 × 10¹²/L | Hemoglobin 113 g/L | Hematocrit 34.2% | Mean corpuscular volume 87.5 fl | Mean corpuscular hemoglobin 28.9 pg | Mean corpuscular hemoglobin concentration 330 g/L | Red cell distribution width 12.9% | Platelet count 160.00 × 10⁹/L | Plateletcrit 0.20% | Mean platelet volume 12.50 fl | Platelet distribution width 14.9 fl (February 14) proBNP 456.00 pg/mL | Procalcitonin 0.32 ng/mL | Myoglobin 68.40 ng/mL | Creatine kinase MB (mass) 1.3 ng/mL | Troponin I 0.018 ng/mL (February 12) Prothrombin time 12.20 s | PT INR 1.09 | Activated partial thromboplastin time 23.3 s | Fibrinogen 4.11 g/L | Thrombin time 13.10 s | D-dimer 0.37 mg/L | Antithrombin III activity 105% | Fibrin (ogen) degradation products 2.30 mg/L (February 12) PAgT inhibition rate (AA) 76.00% | Thromboelastography-R 2.8 min | Thromboelastography-K 1.5 min | Thromboelastography-ANGLE 69.2 deg | Thromboelastography-MA 70.6 mm | Thromboelastography-CI 3.7 | Thromboelastography-EPL 0.0% (February 12) Unsaturated iron-binding capacity 48.6 µmol/L | Cholesterol 9055 U/L | Apolipoprotein E 4.3 mg/dl | Fibronectin 229.00 mg/L | Homocysteine 13.4 µmol/L | Free fatty acids 0.80 mmol/L | Cystatin C 1.40 mg/L | Prealbumin 139.0 mg/L | Bile acids 10.9 µmol/L | Alanine aminotransferase 11 U/L | Aspartate aminotransferase 21 U/L | Mitochondrial-AST 9 U/L | Alkaline phosphatase 86 U/L | γ-Glutamyl transferase 14.0 U/L | Total bilirubin 19.1 µmol/L | Direct bilirubin 6.4 µmol/L | Total protein 63.8 g/L | Albumin 34.7 g/L | Albumin/globulin ratio 1.19 | AST:ALT 1.91 | BUN:CREA 19.46 | Sodium 139.0 mmol/L | Potassium 4.30 mmol/L | Chloride 107.0 mmol/L | Carbon dioxide 25.3 mmol/L | 0.84 mmol/L | Magnesium 0.71 mmol/L | Glucose 5.77 mmol/L | Urea nitrogen 8.04 mmol/L | Creatinine 72 µmol/L | Uric acid 236 µmol/L | Retinol-binding protein 20.2 mg/L | Serum total cholesterol 3.50 mmol/L | Triglycerides 0.44 mmol/L | HDL cholesterol 1.30 mmol/L | LDL cholesterol 1.99 mmol/L | Apolipoprotein A 1.30 g/L | Apolipoprotein B 0.76 g/L | Lipoprotein(a) 17.20 mg/dl | Apolipoprotein A:Apolipoprotein B 1.7 | Creatine kinase 212 U/L | α-Hydroxybutyrate dehydrogenase 176 U/L | Lactate dehydrogenase 231 U/L | High-sensitivity C-reactive protein 121.05 mg/L (February 12) Total triiodothyronine 0.92 nmol/L | Total thyroxine 122.10 nmol/L | Free triiodothyronine 3.12 pmol/L | Free thyroxine 16.40 pmol/L | Thyroid-stimulating hormone 0.30 µIU/mL (February 12) Glycated hemoglobin 5.70% (February 12) Albumin 49.8% | Alpha-1 5.3% | Alpha-2 12.1% | Beta 12.0% | Gamma 20.8% (February 12) Lactate dehydrogenase 1 20.1% | Lactate dehydrogenase 2 31.0% | Lactate dehydrogenase 3 21.6% | Lactate dehydrogenase 4 10.6% | Lactate dehydrogenase 5 16.7% (February 12) Urinalysis: Color yellow | Transparency clear | Specific gravity 1.017 | Yeast-like fungi not found | pH 6.50 | Nitrite negative | Urine protein negative mg/dl | Urine glucose normal mg/dl | Ketones negative mg/dl | Urobilinogen normal mg/dl | Bilirubin negative mg/dl | Red blood cell hemoglobin 50 /µl | Leukocyte esterase negative /µl | Red blood cells (microscopy) 2-4 /HP | White blood cells (microscopy) not found /HP | Epithelial cells (microscopy) not found /HP | Crystals (microscopy) not found /HP | Hyaline casts not found /HP | Granular casts not found /LP | Cellular casts not found /LP (February 12) pH 7.30 | pCO₂ 7.03 kPa | pO₂ 12.0 kPa | HCO₃⁻ 25.30 mmol/L | TCO₂ 26.90 mmol/L | Base excess -1.0 mmol/L | Actual HCO₃⁻ 52.00 g/L | Oxygen saturation 94.30% | Carboxyhemoglobin 2.20% | Methemoglobin 0.30% | Reduced hemoglobin 3.20% (February 12) White blood cell count 16.10 × 10⁹/L | Neutrophils 84.9% | Monocytes 4.30% | Lymphocytes 10.70% | Eosinophils 0.00% | Basophils 0.10% | Neutrophil absolute value 13.70 | Monocyte absolute value 0.70 | Lymphocyte absolute value 1.70 | Eosinophil absolute value 0.00 | Basophil absolute value 0.02 | Red blood cell count 3.84 × 10¹²/L | Hemoglobin 117 g/L | Hematocrit 33.90% | Mean corpuscular volume 88.2 fl | Mean corpuscular hemoglobin 30.5 pg | Mean corpuscular hemoglobin concentration 345 g/L | Red cell distribution width 14.3% | Platelet count 153.00 × 10⁹/L | Mean platelet volume 10.60 fl | C-reactive protein 57 mg/L (February 12) pH 7.39 | pCO₂ 5.71 kPa | pO₂ 8.9 kPa | HCO₃⁻ 25.50 mmol/L | TCO₂ 26.80 mmol/L | Base excess 0.50 mmol/L | Actual HCO₃⁻ 86.00 g/L | Oxygen saturation 96.60% | Carboxyhemoglobin 0.40% | Methemoglobin 0.50% | Reduced hemoglobin 2.50% (February 12) proBNP 464.00 pg/mL | Myoglobin 157.10 ng/mL | Creatine kinase MB (mass) 2.6 ng/mL | Troponin I 0.017 ng/mL | Special Examinations and Important Consultations February 15 Chest X-ray: Increased lung markings bilaterally. February 18 Chest X-ray: Increased and blurred lung markings bilaterally, possible mild inflammation in both lower lobes; please correlate with clinical findings. February 19 Chest X-ray: Increased lung markings bilaterally; please correlate with clinical findings. February 27 Chest X-ray: Increased and blurred lung markings bilaterally. February 28 Chest CT (plain scan): Bilateral pneumonia with consolidation in the right lower lobe, small right pleural effusion, left pleural thickening. March 4 Electrocardiogram: Sinus tachycardia, atrial premature beats, ST-T changes (ST elevation 1.5 mm in V1 upward, horizontal depression 0.5 mm in I, II, aVL, V5, V6). Treatment Course After admission, the patient underwent various examinations and was given alprostadil to improve microcirculation, mecobalamin for nerve nutrition, aspirin for antiplatelet therapy, levofloxacin for anti-infection, ambroxol for expectoration, and losartan potassium for blood pressure control. Because the patient choked while eating, a nasogastric tube was placed. From February 14 onward, the patient developed high fever, copious sputum that was difficult to expectorate, and oxygen saturation of 80-90%. Suspected worsening infection led to transfer to the geriatric ICU for further treatment. After transfer to the ICU, the patient was placed on critical condition notification, Level I nursing, strict bed rest, cardiac monitoring, oxygen therapy, and regular monitoring of blood routine, CRP, liver and kidney function, electrolytes, PCT, proBNP, and other indicators. Active anti-infective treatment was given (imipenem-cilastatin sodium; sputum culture showed Candida glabrata, so voriconazole was added; sputum later showed MRSA, so linezolid was added), along with ambroxol for expectoration, thymosin to enhance immunity, doxofylline for bronchodilation, nebulized inhalation, alprostadil for blood activation and circulation improvement, aspirin for antiplatelet aggregation, mecobalamin for nerve nutrition, and other symptomatic supportive measures. Subsequent sputum cultures were negative for MRSA and fungi, and linezolid was discontinued. The patient experienced multiple episodes of heart failure and improved after treatment with diprophylline, methylprednisolone for spasmolysis and bronchodilation, lanatoside C for cardiac strengthening, and furosemide for diuresis. On March 6 at 18:40, the patient developed marked shortness of breath and heart rate increase to 137-145 beats/min. He was given diprophylline, methylprednisolone, furosemide, lanatoside C, isoprenaline, and morphine spray to reduce cardiac load, but showed little improvement. At 1:10 on March 7, blood pressure and oxygen saturation dropped suddenly, with lowest blood pressure 53/26 mmHg and SaO₂ 62%. Anesthesia was urgently called for intubation and mechanical ventilation. Dopamine and norepinephrine were given to raise blood pressure, nikethamide and lobeline to stimulate respiration, and sodium bicarbonate to correct acidosis. Heart rate then declined; continuous chest compressions were performed, epinephrine and atropine were given to increase heart rate, and external pacing was applied. Ventricular tachycardia occurred and was treated with lidocaine 50 mg. Blood pressure remained low; hydroxyethyl starch was given for volume expansion, and dopamine, dobutamine, and norepinephrine were used to maintain blood pressure. Because serum potassium was elevated, calcium gluconate and glucose-insulin were given to lower potassium. Micro-blood glucose was 2.6 mmol/L, so 25% glucose was pushed intravenously to correct hypoglycemia. Despite these resuscitation efforts, heart rate and blood pressure continued to decline from 5:40. Repeated boluses of epinephrine and dopamine failed to improve the situation. At 6:11, spontaneous breathing and heartbeat ceased, major arterial pulsation disappeared, pupils were dilated and fixed, and the ECG showed a flat line. Clinical death was declared. Complications: Pulmonary infection; Cardiac insufficiency; Acute left heart failure Death details: At 1:10 on March 7, the patient suddenly developed decreased blood pressure and oxygen saturation, with lowest blood pressure 53/26 mmHg and SaO₂ 62%. Anesthesia was urgently called for intubation and mechanical ventilation. Dopamine and norepinephrine were given to raise blood pressure, nikethamide and lobeline to stimulate respiration, and sodium bicarbonate to correct acidosis. Heart rate then declined; continuous chest compressions were performed, epinephrine and atropine were given to increase heart rate, and external pacing was applied. Ventricular tachycardia occurred and was treated with lidocaine 50 mg. Blood pressure remained low; hydroxyethyl starch was given for volume expansion, and dopamine, dobutamine, and norepinephrine were used to maintain blood pressure. Because serum potassium was elevated, calcium gluconate and glucose-insulin were given to lower potassium. Micro-blood glucose was 2.6 mmol/L, so 25% glucose was pushed intravenously to correct hypoglycemia. Despite these resuscitation efforts, heart rate and blood pressure continued to decline from 5:40. Repeated boluses of epinephrine and dopamine failed to improve the situation. At 6:11, spontaneous breathing and heartbeat ceased, major arterial pulsation disappeared, pupils were dilated and fixed, and the ECG showed a flat line. Clinical death was declared. Cause of death: Pulmonary infection Treatment outcome: Death The above is the death summary. The patient was hospitalized on February 11 and died on March 7, with a hospital stay of approximately one month. Admission diagnoses included post-cerebral infarction state, hypertension, and respiratory tract infection. Chief complaint: Right-sided limb weakness with sluggish response for 1 day. On admission he was alert, with asymmetric right limb muscle tone consistent with cerebral infarction. No fever, cough, or sputum; breath sounds slightly coarse bilaterally, no dry or moist rales. On the day of admission (February 11), the patient choked while eating, so a nasogastric tube was placed. From February 14 onward, he developed high fever, copious difficult-to-expectorate sputum, and oxygen saturation of 80%–90%. He was transferred to the geriatric ICU and ultimately died.