Other specified cardiac dysrhythmias Diabetes mellitus without mention of complication type II or unspecified type not stated as uncontrolled Unspecified essential hypertension Depressive disorder not elsewhere classified Other and unspecified hyperlipidemia Personal history of malignant neoplasm of renal pelvis Atrial fibrillation External hemorrhoids with other complication
 
Name:  ___                   Unit No:   ___
 
Admission Date:  ___              Discharge Date:   ___
 
Date of Birth:  ___             Sex:   F
 
Service: MEDICINE
 
Allergies: 
No Known Allergies / Adverse Drug Reactions
 
Attending: ___.
 
Chief Complaint:
weakness, heart palpitations

 
Major Surgical or Invasive Procedure:
None

 
History of Present Illness:
___, ___ but conversant in ___, with h/o HTN, 
SVT and DM admitted for SVT and generalized weakness after 
recent gastrointestinal illness a/w BRBPR. History obtained from 
the patient and her daughter - she was in her USOH until ___ 
night when she had tenesmus and became lightheaded while 
straining on the toilet. She later developed associated 
fevers/chills, threw up once, and then developed profuse 
diarrhea. Her daughter took her to the ___ ED on ___ ___. Per 
the patient's daughter, her blood tests were mostly normal and 
as she began having more diarrhea, she started to feel better in 
the ED. She was discharged home after 4 hrs. Yesterday, she 
continued to have diarrhea, loss of appetite (no further 
vomiting), and developed small amts of BRBPR - mostly on the 
toilet paper but also in the bowl. She felt very weak yesterday. 
Her daughter called her PCP who ___ over the 
phone. The patient was feeling OK this morning - still with loss 
of appetite, but diarrhea and vomiting had resolved, still had 
persistence of BRBPR - however, this afternoon the patient had 
the sudden onset of palpitations (has had this before). EMS was 
called and found pt to be in SVT - vagal maneuvers and fluid 
bolus failed; she was brought to ED. 
. 
In the ED, initial VS 98.0  162  105/71  18  99%. The patient 
endorsed chest pressure but never pain. She never became 
lightheaded. She was thought to be in SVT. Adenosine 6 mg IV was 
given x 1 and she reverted to NSR. She was given 2L NS. Labs 
notable for nl LFTs and elevated WBC to 15.9 with left-shift. 
Bleeding hemorrhoids were seen on rectal exam. 
. 
Currently, VS 98.8  110/62  102  18  97% on RA. The patient 
appears fatigued. She states she did have hemorrhoids in the 
past several years ago. Her last episode of SVT was > ___ year ago 
- she has intermittently been taking her diltiazem the past few 
days ___ weakness. In the past, she took both digoxin and 
verapamil for SVT. She does endorse abd tenderness in the LLQ. 
.  
ROS: per HPI, denies night sweats, headache, vision changes, 
rhinorrhea, congestion, sore throat, cough, shortness of breath, 
 constipation, melena, dysuria, hematuria.  
+ for early satiety - ? gastroparesis

 
Past Medical History:
Adult Onset DM x ___ years
Renal cell carcinoma s/p R nephrectomy ___ yrs ago at ___ 
___
HTN
HL
H.pylori - ___
Diverticulosis - seen on Cscope in ___
SVT

 
Social History:
___
Family History:
No female cancers. Mother died age ___ unknown cause
Father died age ___ from liver failure
Brother and sister with HTN and diabetes 

 
Physical Exam:
On admission: 
VS - 98.8  110/62  102  18  97% on RA  
GENERAL - NAD, pleasant   
HEENT - PERRLA, EOMI, sclerae anicteric, dry MM, OP clear  
NECK - supple, no JVD, no carotid bruits  
LUNGS - CTA bilat, no r/rh/wh, good air movement, resp unlabored
HEART - RRR, no MRG, nl S1-S2  
ABDOMEN - NABS, soft/ND, TTP to light touch in LLQ, no masses or 
HSM, no rebound/guarding  
EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs) 
 
NEURO - awake, A&Ox3, full strength throughout, nl gait 
. 
On discharge, 
abd pain is resolved. external hemorrhoids visualized. Heart is 
RRR. 
 
Pertinent Results:
On admission: 
.
___ 05:30PM BLOOD WBC-15.9* RBC-4.09* Hgb-12.3 Hct-36.4 
MCV-89 MCH-30.1 MCHC-33.8 RDW-12.8 Plt ___
___ 05:30PM BLOOD Neuts-85.4* Lymphs-11.1* Monos-3.0 
Eos-0.4 Baso-0.2
___ 05:30PM BLOOD Glucose-181* UreaN-9 Creat-0.7 Na-134 
K-3.7 Cl-102 HCO3-22 AnGap-14
___ 05:30PM BLOOD ALT-12 AST-18 AlkPhos-49 TotBili-0.4
___ 05:30PM BLOOD Lipase-27
___ 05:30PM BLOOD cTropnT-0.02*
___ 06:10AM BLOOD Calcium-8.5 Phos-1.9* Mg-1.4*
. 
Blood cultures x 2: NGTD
 
Brief Hospital Course:
Hospitalization Summary:  
___, primarily ___ but conversant in ___, with 
h/o HTN, SVT, and DM admitted for SVT and generalized weakness 
after recent gastrointestinal illness a/w BRBPR.
. 
# SVT: Presented to ED with HRs in the 160s. Vagal maneuvers 
were unsuccessful and she converted to NSR with adenosine 6 mg. 
Telemetry showed no further events. The patient has a history of 
SVT and had been intermittently taking diltiazem 30 mg TID over 
the preceding few days because of her gastrointestinal illness. 
She was restarted on this regimen on discharge. 
. 
# N/V/D, abd pain: Nausea, vomiting, and diarrhea had all 
resolved prior to admission but the patient had a recent episode 
of gastroenteritis. She had persistence of LLQ abdominal pain 
and leukocytosis so empiric ___ (started by PCP) was 
continued to complete a 7-day course out of concern for possible 
contribution from diverticulitis. Abd pain had resolved prior to 
discharge and the patient was eating a regular diet. 
. 
# BRBPR: Rectal exam revealed bleeding external hemorrhoids. She 
had no pain or itching. Hct was stable and the patient was 
encouraged to increase the amount of fiber in her diet. She was 
scheduled for GI follow-up. 
.  
# DM: Patient was restarted on home metformin on discharge. 
. 
# HTN: continued lisinopril 20 mg ___ 81 mg ___
. 
# HL: continued statin
. 
# GERD: continued omeprazole 20 mg ___
. 
# Depression: continued effexor
. 
# Transitional Issues: 
- The patient was full code during this admission
- contact was with daughter ___ ___ 
- completion of antibiotic course (___)
- suppression of SVT with diltiazem
- further management of bleeding hemorrhoids 

 
Medications on Admission:
Lisinopril 20 mg ___
Metformin 1000 mg BID
Simvastatin 20 mg ___ 81 mg ___
Omeprazole 20 mg ___
Effexor ER 75 mg ___
Diltiazem 30 mg TID  

 
Discharge Medications:
1. lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 
 
2. metformin 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a 
day).  
3. simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY 
(Daily).  
4. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable 
PO DAILY (Daily).  
5. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) 
Capsule, Delayed Release(E.C.) PO DAILY (Daily).  
6. venlafaxine 75 mg Capsule, Ext Release 24 hr Sig: One (1) 
Capsule, Ext Release 24 hr PO DAILY (Daily).  
7. diltiazem HCl 30 mg Tablet Sig: One (1) Tablet PO TID (3 
times a day).  
8. ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H 
(every 12 hours) for 5 days: Last day is ___.  
9. metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3 
times a day) for 5 days: Last day is ___.  

 
Discharge Disposition:
Home
 
Discharge Diagnosis:
Primary: 
SVT
Hemorrhoidal bleeding
Abdominal pain
. 
Secondary: 
DM
HTN

 
Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.

 
Discharge Instructions:
It was a pleasure caring for you at the ___ 
___. You were admitted for a very fast heart rate 
(supraventricular tachycardia) and for rectal bleeding after 
your recent gastrointestinal illness. Your fast heart rate 
resolved with a medication called adenosine and you had no 
further episodes. We think your rectal bleeding was the result 
of hemorrhoids and you should increase the amount of fiber in 
your diet to help treat this problem. You will complete a 1-week 
course of antibiotics for possible diverticulitis in addition to 
gastroenteritis. 
. 
We made the following changes to your medications: 
We STARTED ciprofloxacin 500 mg twice per day 
and metronidazole 500 mg three times per day 
for a total of 7 days (you should complete the prescription that 
Dr. ___
. 
Your follow-up appointments are listed below. 
 
Followup Instructions:
___

{'weakness': ['Other specified cardiac dysrhythmias', 'Diabetes mellitus without mention of complication', 'type II or unspecified type', 'not stated as uncontrolled'], 'heart palpitations': ['Other specified cardiac dysrhythmias', 'Atrial fibrillation'], 'fevers/chills': [], 'vomiting': [], 'diarrhea': [], 'loss of appetite': [], 'BRBPR': ['External hemorrhoids with other complication'], 'abd tenderness': [], 'early satiety': []}