Case Presentation

Mr. Andre Takahashi is a 69-year-old male patient with an end-stage renal disease that was admitted to the hospital after being found on the floor in his nursing home.

ALLERGIES: NKDA
Vitals: BP: 125/80, HR: 62, T: 38.5°C, RR: 22.

Home Medicine Emergency Department Order General Internal Medicine Order
Ramipril
Amlodipine
Atorvastatin
Insulin (glargine and aspart)
CaCO3
Replavite
Calcitriol
Ceftriaxone 1g IV Q24H STAT
Acetaminophen 1g PO Q6H PRN
Ramipril 10mg PO QD
Amlodipine 10mg PO QD
Atorvastatin 20mg PO QD
Insulin Glargine 24 units subcutaneously QHS Insulin Aspart 20 units subcutaneously TID Calcium Carbonate 500mg PO BID
Replavite 1 tab PO QAM
Calcitriol 0.25mg PO QAM
D/C Ceftriaxone
Start Cefazolin 500mg IV Q8H x7 days