12-09-2008, 06:57 PM
A 65 year old man presents to the emergency department complaining of fever, chills and a productive cough for the past three days. he also complains of right sided chest pain and shortness of breath. He says that his chest pain aggrevates with deep breathing. The patient's past medical history is significant for diabetes and hyperlipidemia. He is on aspirin, simvastatin, glipizide, metformin and rosiglitazone. He does not use tobacco, alcohol or drugs. On physical examination, he has a temperature of 102.5F, a bp of 110/70mm and a pulse of 112/mins, and respirations of 24/min. His mucous membranes are dry and chest x-ray reveals a right lower lobe pneumonia. His lab work shows
Hemoglobin of 17g/dl
Platelets 0f 250,000/mm3
WBC of 16,500/mm3
Serium Sodium of 140mEq/ml
Potassium of 4.5mEq/ml
BUN of 48mg/dl
Creatinine 2.0mg/dl
Serum calcium 10.3mg/dl
Blood glucose 128mg/dl
Blood cultures are obtained and antibiotics are administered. What is the appropriate next step in management of this patient?
A. Add lisinopril
B. Discontinue Rosiglitazone
C. Discontinue metformin
D. Discontinue Glipizide
E. Begin bisphonate therapy
F. Phlebotomy
Hemoglobin of 17g/dl
Platelets 0f 250,000/mm3
WBC of 16,500/mm3
Serium Sodium of 140mEq/ml
Potassium of 4.5mEq/ml
BUN of 48mg/dl
Creatinine 2.0mg/dl
Serum calcium 10.3mg/dl
Blood glucose 128mg/dl
Blood cultures are obtained and antibiotics are administered. What is the appropriate next step in management of this patient?
A. Add lisinopril
B. Discontinue Rosiglitazone
C. Discontinue metformin
D. Discontinue Glipizide
E. Begin bisphonate therapy
F. Phlebotomy
