Question

AS is an 86 y/o female that is 65" and weighs 110lbs. who has been in your hospital for 8 days and has developed a catheter related UTI for which the attending has prescribed ciprofloxacin. Upon admission her serum creatinine was 0.8mg/dl. She has been dehydrated and refusing to eat and is pushing to be discharged. Her SCr this morning is 1.4mg/dL. Her PMH includes DM, and hyperlipidemia. Her medications are as follows: Ciprofloxacin 400mg IV q 12H for 7 days Lisinopril 10mg PO QD Metformin 1000mg PO BID Lovastatin 40mg PO QHS Ibuprofen 400mg q 8H Calculate her CrCl and make any adjustments to her current regimen. What would you recommend to control AS’s glucose levels while hospitalized?

Answer 1

AS's creatinine clearance should be calculated using the Cockcroft-Gault equation to adjust medication dosing due to her increased serum creatinine levels. Medication adjustments, specifically for ciprofloxacin, are necessary given her renal impairment. Tighter glucose control may be achieved with insulin therapy due to the discontinuation of metformin in the context of renal function decline and dehydration.

Step-by-step explanation:

To calculate the creatinine clearance (CrCl) for AS, an 86-year-old female patient, you can use the Cockcroft-Gault equation. Given her weight of 110lbs (converted to kg), height of 65 inches, age, and serum creatinine of 1.4mg/dL, her CrCl can be estimated to assess her kidney function, which is important for dosing medications like ciprofloxacin. Since her serum creatinine has increased from 0.8mg/dL upon admission to 1.4mg/dL, indicating decreased renal function, an adjustment in medication dosing may be necessary, particularly for drugs like ciprofloxacin that are renally cleared.

Regarding AS's diabetes management during her hospital stay, it is important to monitor her blood glucose levels frequently and adjust her anti-diabetic medications as needed. AS is currently on metformin 1000mg twice daily, but given her compromised renal function and potential risks of lactic acidosis, especially in the setting of dehydration, metformin should be discontinued. Insulin therapy may be considered for tighter glucose control during her hospitalization.