HISTORY AND PHYSICAL
CC: vomiting and diarrhea, weakness.
HPI: 81 y/o F, lives alone, with HTN, HLD, hypothyroidism, presents with 3 days of nonbloody watery diarrhea (6-8/day) and vomiting after a church potluck; several attendees similarly ill. Unable to keep fluids down x 24 h. Generalized weakness, near-fall at home this AM. No abx in 3 months.
Meds: losartan 50 mg daily, atorvastatin 20 mg, levothyroxine 75 mcg.
Vitals: T 37.4, HR 104, BP 102/58, RR 16, SpO2 97% RA.
Exam: Frail, dry MM, poor skin turgor. Abd soft, hyperactive BS, mild diffuse tenderness. A&Ox3.
Labs: Cr 2.1 (baseline 0.9, 06/2026), BUN 48, Na 141, K 3.1, HCO3 19. WBC 9.9. Stool C. diff PCR pending. GI pathogen panel: norovirus GII detected.
ASSESSMENT/PLAN:
1. AKI, prerenal - Cr 2.1 from baseline 0.9, due to volume depletion from GI losses + ARB. Hold losartan. LR 150 mL/h after 2 L bolus. Strict I/O, BMP in AM.
2. Dehydration due to viral gastroenteritis (norovirus) - IVF, ondansetron PRN, contact precautions, advance diet as tolerated.
3. Hypokalemia - K 3.1 from GI losses. KCl 40 mEq PO x2, recheck.
4. HTN - hold losartan as above.
5. HLD - continue statin. 6. Hypothyroidism - continue levothyroxine.
7. Weakness/near-fall - PT/OT eval.
Full code. DVT ppx heparin SQ.
HD2
S: Diarrhea slowing (2 episodes overnight), no emesis, tolerating clears.
O: T 36.9, HR 84, BP 124/70. UOP 2.1 L. Labs: Cr 1.0 (from 2.1), BUN 22, K 3.7, HCO3 23. C. diff PCR negative.
A/P:
1. AKI, prerenal - resolved with IV fluids, Cr 1.0. Saline lock this afternoon if taking PO. Continue holding losartan for now.
2. Dehydration due to norovirus gastroenteritis - improving, advance to regular diet.
3. Hypokalemia - improved, 1 more dose KCl.
4. HTN, HLD, hypothyroidism - as above.
5. Weakness - PT: unsteady, min assist, recommends SNF short-term rehab. CM consulted.
HD3
S: No diarrhea x 24 h. Eating 75% of meals. Worked with PT.
O: T 36.8, HR 78, BP 132/76. Labs: Cr 0.9, BUN 15, K 4.0.
A/P:
1. AKI - worsening, Cr trending up. Nephrology consulted, appreciate recs. Hold nephrotoxins, renal US ordered, continue IVF.
2. Dehydration due to norovirus gastroenteritis - resolved.
3. Hypokalemia - resolved.
4. HTN - BP 130s, continue holding losartan, reassess at discharge.
5. HLD, hypothyroidism - home meds.
6. Deconditioning/unsteady gait - SNF referral sent, awaiting bed offer.
Pt resting comfortably, A&Ox3. Voiding without difficulty, UOP adequate. No stools this shift. Saline locked since 09/11, taking fluids well. Ambulated to BR with walker + 1 assist. Bed alarm on, fall precautions maintained.
HD4
S: Feels "back to normal," wants to go home but agrees with rehab.
O: T 36.6, HR 76, BP 138/78. Labs: Cr 0.9, BUN 14, K 4.2, Na 140.
A/P:
1. AKI - worsening, Cr trending up. Nephrology consulted, appreciate recs. Hold nephrotoxins, renal US ordered, continue IVF.
2. Dehydration/norovirus gastroenteritis - resolved.
3. Hypokalemia - resolved.
4. HTN - restart losartan 25 mg tomorrow.
5. Unsteady gait - awaiting SNF bed (Maple Grove offered for 09/15).
DISCHARGE SUMMARY
Admit 09/10/2026 - Discharge 09/15/2026 to Maple Grove SNF (short-term rehab).
Principal diagnosis: Acute kidney injury, prerenal, due to dehydration - resolved.
Secondary diagnoses: Dehydration due to norovirus gastroenteritis. Hypokalemia. Hypertension. Hyperlipidemia. Hypothyroidism. Deconditioning.
Hospital course: 81F with 3 days of vomiting/diarrhea (norovirus on GI panel), Cr 2.1 from baseline 0.9 with K 3.1. Treated with IV fluids and K repletion; Cr 1.0 by HD2 and 0.9 thereafter. Losartan held and restarted at reduced dose 09/14. Diarrhea resolved HD3. Remained in hospital for PT and SNF placement due to unsteady gait.
Discharge meds: losartan 25 mg daily (reduced), atorvastatin 20 mg, levothyroxine 75 mcg.
Follow-up: BMP in 1 week at SNF; PCP 2 weeks.