This is a case of Jagonoy, Antonio, 64 year old, male, hypertensive for 8 months has the highest BP of

170/100 and usual BP of 140/70 , 3.6 pack year smoker and was found to be dyslipidemic based on the laboratory
tests done in our institution. He came in due to weakness of his right lower and right upper extremities
accompanied by diaphoresis, dizziness non-rotatory and headache described as pulsatile, nonradiating located at
left occipito-parietal region with a pain scale of 5/10, relieved by rest.
Upon admission to Internal Medicine Station 5B, patient has a GCS of 15 (E4V5M6), not in cardiorespiratory
distress, with the following vital signs: BP 150/100, HR 73, RR 19, Temp 36.7, O2 sat 98%. Laboratory tests
done were CBC , Serum Na, K, Creatinine, SGPT, CBG, FBS, Lipid profile, 12lead ECG, Chest X-Ray, Urinalysis which
revealed normal WBC (8.53) with predominance of neutrophils (.93mmol/L) and monocytes (0.070mmol/L), normal
serum Sodium (Na: 138 mmol/L), normal serum K (3.90 mmol/L), high hemoglobin (165g/L), normal hematocrit
(0.484L/L) normal MCV (86.7 fl, normal MCH (29.6pg), Normal MCHC (341 g/L), normal RDW-CV(13.1%), normal
RDW-SD (41fl), normal platelet count (196 x10^9/L), normal MPV (8.8 fl) and normal PDW (9.0 fl).
Urinalysisrevealed yellow, hazy, no blood and bilirubin, Urobilinogen of +1, no trace of ketone, protein, nitrite,
leukocytes and glucose with a pH of 8.0, specific gravity of 1.010, with an occasional epithelial cells, urates and
bacteria. Non-contrast cranial MRI showed an acute ischemic infarction, Left corona radiate and posterior limb of
Left internal capsule, chonic small vessel ischemic changes, nonspecific blooming artifact with shine-through is seen
in the right frontal area. CBG revealed 89mg/dl. PNSS 1L at 60cc/hour now was started. On low salt low fat diet.
Vital signs were monitored every hour and I. Intake and Output were monitored every shift. Hes on ASA 80mg/tab
OD after lunch, Atorvastatin 40mg/tab, 1tab ODHS, Citicholine 1g/tab BID, Omeprazole 40mg/tab OD, Lactulose
30cc ODHS hold for BM>2x/day, maintained MAP of 110-130mmHg, elevated head of the bed 30degrees, was
referred to Neuro for evaluation.
On the 2nd hospital day, lactulose was increased to 20cc BID and was hold for when bowel movement is
greater than twice a day. IV fluid was decreased to 60cc per hour and progression of neurologic deficit was watched
out for. Bactidol gargle was started 15ml TID for 60 seconds and was referred accordingly. Na, K, Ca++ and SGPT
were followed up
On the 3rd hospital day to consume iVF then shift to heplock. He can sit and drag feet and he was referred
to rehab.
On the 4th hospital day, rehabilitation was facilitated and the patient was given Dulcolax suppository for
bowel movement.