Dale Mayman has a known chronic liver disease secondary to alcoholic cirrhosis. He has abused alcohol for over 25 years (6 – 8 beers per day). Mr. Mayman has also a history of hypertension.
History:
Dale Mayman has a chronic liver disease managed with salt restriction and diuretic therapy. Mr. Mayman is slightly confused, jaundices with ascites noted on abd exam. Neither Mr. Mayman nor his wife can recall if he has received a paracentesis before. Wife has told the ER Physician that Mr. Mayman has been restless and somewhat more confused the last four days. He also has had increasing bleeding from his gums.
Lab completed: CMP, PT/INR, ammonia, CBC, Blood cultures x 2, UA and urine culture, sputum culture, serum ETOH, urine tox screen. WBC, Liver enzymes, PT, and ammonia elevated. Low protein.
He received a dose of Lactulose and had a paracentesis performed in the ER with removed 1200 mL of yellow slightly cloudy fluid. Tolerated the procedure well with small dressing over the site. The paracentesis revealed a spontaneous bacterial peritonitis. He appeared jaundiced with mild ascites despite the paracentesis.
Mr. Mayman & his wife refused inpatient care. Risk explained to Mr. Mayman and his wife. They voiced that they recognized the risk but did not feel more confortable at home. Home health arrange.
Discharge meds:
Aldactone 100 mg PO Daily
Lasix 40 mg PO Daily
Inderal 10 mg PO BID - hold if HR < 60, SBP < 100
MVI table PO Daily
Lactulose 30 mL PO Daily
Vancomycin 1 gram IVPB every 12 hours
He was sent home on home health care for assist with medication, diet, and IV Antiobiotics .
Pt to be seen in office in one week. |