Reference no: EM133794803

Question

An 85-year-old woman presented with an acute onset of generalised weakness and functional decline. The patient had a history of insulin-requiring diabetes, hypercholesterolaemia, hypertension, glaucoma and chronic kidney disease. She also had longstanding fungal keratitis (>60 days) which had been unsuccessfully treated with topical therapy. The patient's chronic conditions were managed with multiple medications, including simvastatin 20 mg daily. She had started oral voriconazole, 200 mg twice a day, 32 days before her admission. The patient was observed in hospital for a few weeks. She was examined by two ophthalmology senior house officers and an infectious diseases physician before a general physician made the diagnosis of rhabdomyolysis. Blood tests showed a creatine kinase of 23 200 U/L (normal range 34-145), aspartate transaminase 1030 U/L (<31), alanine transaminase 393 U/L (<34) and creatinine 255 micromol/L (<110). Sodium, potassium, prothrombin time and full blood count were normal.75-year-old man with hypertension, heart failure, type 2 diabetes, and chronic kidney disease comes to your medication therapy management clinic with his daughter for his initial visit and brings his medications. These include a daily aspirin, enalapril, metoprolol, hydrochlorothiazide,furosemide, glyburide, and ibuprofen. He also mentions that he takes some natural products; however, he did not bring