Reference no: EM133466978

CASE:

An 88-year-old community-dwelling woman presents for an acute appointment at your PCP office. She complains of abdominal pain, fever, and incontinence for the past three days. She has a history of mild cognitive impairment, hypertension, hypothyroidism, and depression. Her medication list is as follows: amlodipine 5mg daily, lisinopril 10mg daily, levothyroxine 100mcg daily, escitalopram 10mg daily. She denies a history of similar symptoms. Past surgical history is significant for a cesarean section 50 years ago and ambulatory closed appendectomy with no complications five days ago. Her temperature is 37.8 °C, heart rate is 122/min, blood pressure is 124/78 mmHg, and respiratory rate is 14/min. Her mucous membranes are dry. Auscultation reveals high-pitched tinkling bowel sounds. She has mild tenderness throughout the abdomen, but there is no rebound, guarding, or rigidity. No masses or hernias are identified. She smells of urine. You order labs at the adjacent laboratory. Laboratory examination is significant for a white blood cell count of 8.2 × 103/μL (normal 4.1-10.9 × 103/μL), hemoglobin 17 g/dL (12.3-15.7 g/dL), hematocrit 51% (37-46%), sodium 141 mEq/L (135-145 mEq/L), potassium 2.9 mEq/L (3.5-5.0 mEq/L), chloride 93 mmol/L (98-106 mEq/L), bicarbonate 34 mEq/L (24-30 mEq/L), BUN 36 mg/dL (7-22 mg/dL), and creatinine 1.2 mg/dL (0.56-1.0 mg/dL). Urinalysis demonstrates proteinuria, moderate WBC, moderate bacteria. Urine culture is pending.

1. What antibiotic would you prescribe this patient and why? (Include dosage/route/duration)

2. Would you treat the 2.9 potassium? Why or why not?

3. Overall, how would you approach treatment for this patient? Be as specific/detailed as possible.