Discharge summary
Your patient was diagnosed with Type 2 diabetes 20 years ago and was admitted under your team with sepsis secondary to pneumonia from which she recovered well with IV co-amoxiclav and oral clarithromycin antibiotics. Her medicines on admission were Ramipril 5mg od PO, Metformin 750mg bd PO, Simvastatin 40mg daily.
However, as a result of her infection, her kidney function had deteriorated and your consultant advised stopping her Ramipril (temporarily) and metformin (permanently) as her blood glucose levels were consistently high at 20mmol/l. She has been assessed by the diabetic team who commenced her on insulin. Insulin Mixtard 30 20 units sc morning, Insulin Novomix 30 18 units sc evening. She continues to take simvastatin 40mg. She was due to see an ophthalmologist but missed her appointment.
Write a discharge summary for this patient. Consider which other professionals may be contacted and by whom.
Suggestions for discharge summary
Dear Dr (GP)
Mrs DM was admitted under the care of Dr [consultant] on [date] with breathlessness and fevers. She was treated with IV co-amoxiclav and oral clarithromycin for a community acquired pneumonia. Her renal function had deteriorated as a result of poor oral intake and, as a result, we stopped her ramipril temporarily. She was also reviewed by the Diabetic team who advised stopping her metformin and commencing her on insulin as her blood glucose levels were consistently high at 20mmol/l.
We would be grateful if you could monitor her renal function and re-introduce her ramipril at a reduced dose of 2.5mg once it returns to her baseline level of creat x, urea y and potassium z. Her renal function at discharge were as follows: creat a, urea b and potassium c.
Since she missed her ophthalmology appointment as a result of this admission, we would be grateful if you could arrange a further outpatient appointment. Please could you also review in your diabetic clinic and refer to the diabetic team at Hospital Name if required.
Drug History
No known drug allergies
Meds on admission
Ramipril 5mg od PO Metformin 750mg bd PO Simvastatin 40mg od PO
Meds on discharge
Insulin Novomix 30 20 units sc morning Insulin Mixtard 30 18 units sc evening Simvastatin 40mg od PO Ramipril - to be reviewed depending on renal function and re started at 2.5mg
Yours sincerely
[Name] F1 Doctor
'Practical Prescribing for Medical Students' - Chapter 4 - Greg Heath and Helen Bradbury
Copyright eBook 2019, University of Leeds, Leeds Institute of Medical Education.