FE Report

DISCHARGE SUMMARY

ADMITTING DIAGNOSES

1. Right lower lobe pneumonia.

2. Chronic obstructive pulmonary disease.

3. History of congestive heart failure.

4. Atrial arrhythmia.

DISCHARGE DIAGNOSES

1. Right lower lobe pneumonia – improved.

2. Chronic obstructive pulmonary disease – stable.

3. Congestive heart failure – stable.

4. History of atrial and ventricular arrhythmias – stable.

5. Theophylline toxicity - resolved.

6. Allergic dermatitis secondary to quinidine - resolved.

7. Quinidine toxicity - resolved.

ADMITTING HISTORY AND PHYSICAL FINDINGS

The patient is an 82-year-old who had increasing shortness of breath, and weakness, and weight loss, and anorexia 2 to 3 days prior to admission.  There had been evidently no change in his medications.

Physical examination revealed temperature to be 100 degrees, pulse was 88.  Coronary:  Regular rate rhythm.  Lungs:  Clear.  Extremities:  Without edema.

LABORATORY ON ADMISSION

CBC:  White count 19,800 with 73 polys, 15 bands, 12 lymphs, hematocrit 39.8.  Electrolytes were within normal limits.  Chest x-ray showed some blurring at the right costophrenic angle consistent with a right lower lobe pneumonia.  Further labs showed a digoxin level of 1.2, theophylline level of 30.4, quinidine level of 6.0.

HOSPITAL COURSE

The patient was admitted to the medical floor.  The theophylline was withheld until levels dropped into the therapeutic range.  Quinidine was discontinued, and the patient was changed to verapamil.  His pneumonia was treated with I.V. Kefzol.  He was given oxygen by nasal cannula.  Because of occasional PVCs and elevated LDH, he was transferred to telemetry for monitoring while beginning verapamil therapy and having discontinued quinidine therapy.  He was noted to have occasional PVCs and PACs - chronic for him.  Subsequently he was noted to occasionally have multifocal atrial tachycardia with variancy versus occasional PVCs.  It was very difficult to discern the nature of his arrhythmia.  LDH isoenzymes failed to show any evidence of myocardial infarction.  Serial cardiograms showed no acute changes.

Followup chest x-ray on the day before discharge showed marked improvement and right lower lobe infiltrate.  Theophylline level on 04/05 was 15.0.  CBC on day of discharge showed a white count of 12,800 with 79 polys and no bands.

DISPOSITION

Discharged home.  Followup in the office in 1 week.

MEDICATIONS

1. Theo-Dur 300 mg p.o. b.i.d (admitting dose was t.i.d.).

2. Proventil 2 puffs q.i.d.

3. Vancenase nasal spray 1 to 2 sprays each nostril b.i.d. to t.i.d.

4. Digoxin 0.125 mg q.a.m.

5. Lasix 40 mg q.a.m.

6. Micro-K 10 mEq q.a.m.

7. Verapamil 80 mg t.i.d.