The patient was admitted on 4/20/2006 with an Altered Mental Status. A team meeting was held on 3/25/06 and the patient was started on 250 mg b.i.d. of Depakote and Haldol was reduced to just Monday-Wednesday-Friday 1 mg before hemodialysis and 1 mg p.r.n. agitation. On 0/16/06, the patient was diagnosed with pneumonia and started on ceftriaxone IV and Flagyl, which was switched to cefpodoxime and Flagyl for discharge. The patient began to spike fevers on 11/29/06 and was started on antibiotics of ceftriaxone and Flagyl, which was switched to cefpodoxime and Flagyl for discharge, and the cefpodoxime should be dosed after dialysis on Monday-Wednesday-Friday. In terms of endocrine, the patient ultimately discontinued on a regimen of 7 units of Lantus q.a.m. and q.p.m. with 5 units aspart q.a.c. breakfast and lunch and 4 units of aspart q.a.c. dinner. His sliding scale was very light and he is only to be covered with one to two units of aspart during the night as insulin stacks in this patient very easily. At the time of discharge, the patient's fingersticks were well controlled in the 100-200 range and his mental status was A&amp;O x3 and appropriate. Medications on discharge included PhosLo 2001 mg p.o. t.i.d., Depakote 250 mg p.o. b.i.d., folate 1 mg p.o. daily, Haldol 1 mg IV on Monday-Wednesday-Friday given prior to hemodialysis, labetalol 350 mg p.o. b.i.d., lisinopril 80 mg p.o. daily, Flagyl 500 mg p.o. t.i.d. for 14 days, thiamine 100 mg p.o. daily, Norvasc 10 mg p.o. daily, gabapentin 300 mg p.o. q.h.s., cefpodoxime 200 mg p.o. three times a week on Monday-Wednesday-Friday for eight doses given after hemodialysis, Nephrocaps one tablet p.o. daily, sevelamer 2004 mg p.o. t.i.d., Advair diskus 250/50 one puff b.i.d., Nexium 20 mg p.o. daily, Lantus 7 units subcutaneous b.i.d. once in the morning and once evening, aspart 4 units subcutaneous before dinner and 5 units subcutaneous before breakfast and 5 units subcutaneous before lunch, aspart sliding scale starting at blood sugar less than 125 give 0 units, blood sugar 125-300 give 0 units, blood sugar 301-350 give 1 unit, blood sugar 351-400 give 2 units, blood sugar 400-450 give 2 units, albuterol butt paste topical daily, and then p.r.n. Tylenol 650 mg p.r.n. pain, headache, or temperature, albuterol inhaler p.r.n. wheezing, Haldol 1 mg
labetalol
prior to hemodialysis, labetalol 350 mg p.o. b.i.d., lisinopril 80 mg p.o. daily,