Reference no: EM132470522
87 year old female presents to ED with chief complaint of severe diarrhea. She has a history of metastatic papillary thyroid cancer on lenvatinib, hypothyroidism, hypertension, and HFpEF. She reports intermittent diarrhea for the last 1.5 months. 2 weeks ago she had 2-3 days of severe diarrhea, with ~3-4 watery bowel movements a day. She called her oncologist at that time who obtained stool cultures, she reports were negative. She presents now with severe diarrhea she describes as "a volcano exploding," 4-5 times a day, starting yesterday. She called her oncologist who instructed her to go to the emergency room.
She reports increased fatigue and weakness over the last 2-3 days. On exam she has a mildly distended abdomen with no tenderness or organomegaly appreciated on palpation. 1+ pitting edema of the lower extremities, L>R. Her BUN and creatinine are 32 mg/dL and 1.5 mg/dL respectively, up from her baseline of 15 mg/dL and 0.8 mg/dL.
Her home mediation list is doxazosin, apixaban, acetaminophen, amlodipine, levothyroxine, lisinopril, and lenvatinib.
Identify potential problem and make an alternative regimen
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