CHIEF COMPLAINT: F/U stage III chronic kidney disease.
DIAGNOSES: The patient admitted with:
1. Right upper quadrant abdominal pain.
2. Elevated liver enzymes, possible biliary colic.
3. Stage III chronic kidney disease with a creatinine of 1.6.
4. History of chronic kidney disease, baseline creatinine 1.3 year ago, etiology unknown.
5. The patient recently relocated here from Chicago, no old records.
6. Atrial fibrillation on Plavix.
7. Dyslipidemia on Lipitor.
SUBJECTIVE: He is currently in nuclear medicine for biliary scan so I was not able to see him. Nurse reports persistent right upper quadrant pain.
Liquid diet only. No shortness of breath.
MEDICATIONS: Reviewed in detail. He is on D5 half-normal saline at 150/hr.
PHYSICAL EXAMINATION: GENERAL: He defervesced overnight. VITAL SIGNS: Temperature
now is 99. His blood pressure is 120/70 with a heart rate of 110 and saturations are 100% on room air.
His urine output yesterday was 1600, fluid balance positive March 10. Exam was limited as the patient is
currently in nuclear medicine.
LABORATORY DATA: His white count is 4 down to 14,000, hematocrit 45%, platelet count is 186.
Sodium 140, potassium 4.7, chloride 102, bicarbonate 27, BUN is 22, creatinine 1.8, uric acid 4.9, calcium
8.3, phosphorus 2.3, GOT was down to 38. GPT is down to 60, albumin is 2.6, magnesium is 2.4.
Urine sodium 71, urine creatinine 180, FNA is less than 1%. Urinalysis showed positive blood, but negative
WBCs, RBCs. Urine myoglobin was inconclusive. Total CPK was only 47.
ASSESSMENT AND MEDICAL DECISION-MAKING: Stage III chronic kidney disease, unclear etiology.
Creatinine is actually up a little bit today despite vigorous hydration. Most likely he presents with febrile
illness right upper quadrant pain, elevated liver enzymes consistent with biliary colic. I doubt rhabdomyolysis
based on low CPK.
PLAN: Continue hypotonic fluids. We will discontinue potassium supplements. Replace phosphorus.
Watch his fluid balance and electrolytes closely. We will check an intact PTH. Continue antibiotics per
infectious disease. Followup biliary scan results when available.
