69  years oldfemale pt 
DM For the last   17  years 
htn for the last    17  years 
dld  for the last      20  years 
hypothyroidisim 
gouty arthritis 
valvuler heart disease 


presented with  left flank  pain  for the last  one week 
no fever   she  has  chilld 
non dysuria   but she has  frothy urine 
she had  labs  out sdie   and that showed creatinien  4 mg/dl 


medication 
aspirin  100 mg once
concor   5 mg 1x2
mepral 20 mg ocne
quest   2.5 mg 1x2 
dronedarone     400 mg   1x1
alloril  100 mg ocne 
amicor   5 mg  1x1
calcium  600 mg 1x2
lasix    40 mg 1x2
semegle   8   pm 
apidra   6   before  each meal 

today she   came  for follow up 
bp  117/75 

plan 
hold amicor 

add f Ferrous fumarate   1x1
alfacal   once daily 
medrol  4 mg once 
laxadin 
paramold  extra 
to do labs and  abdominal us  for   Evaluation 
