View Patient Profiles

Lawson, Audrey

MRN: 123318

Room: 711

DOB: 3/19/2013

Age: 12

Gender: Female

Allergies: NKDA, milk protein intolerance

Admit Notes

Clinical Notes

Vitals

Labs, Cultures, Imaging

Clinical Calculators

MAR

Current Orders

Home Med List

Med Reconciliation

Discharge Planning

Setting	Inpatient Pediatric Unit
Scenario	AL was diagnosed with diabetic ketoacidosis and was given a normal saline bolus and potassium for her initial hypovolemia and hypokalemia. Her DKA has resolved. She has now been diagnosed with new onset Type I Diabetes Mellitus. Dr. Simon requests pharmacy’s recommendations for medication management. AL required 20 units of insulin in the last 24 hours and has no blood ketones or urine ketones. She is tolerating oral food and medications. Dr. Simon reports that she wants to set AL’s target blood glucose at 150 mg/dL and would like to start multiple daily insulin injections. In addition to new therapy recommendations, Dr. Simon requests you look at AL’s current medication profile to determine if changes are needed with any medications.
Admission note taken on 10/19/25
CC	vomiting, tachypnea, recent weight loss
HPI	AL presented to the emergency department yesterday with vomiting, increased work of breathing, and fatigue that started several days ago. Mom reports that over the last month the patient has had increased thirst and urination and seems to have lost weight, because “her clothes are hanging off of her, even though she eats like a horse”. Mom reports that at her well-child checkup a few months ago her weight was 100 pounds. AL is being admitted to the pediatrics floor for further workup.
PMH	ADHD-diagnosed at age 5 Seasonal allergic rhinitis-diagnosed at age 11 Nocturnal enuresis-diagnosed one month ago
Social History	Denies tobacco, EtOH, illicit drug, caffeine use Attends public school, average student, started 6th grade this year	Family History	Father: 36, alive, seasonal allergies Mother: 30, alive, hypercholesterolemia Brother: 8, alive, no significant history
Vaccine History	Childhood immunizations: up to date through age 5, before attending kindergarten Influenza: received for current season	Surgical History	tonsillectomy, age 4
Physical Exam	General: thin, diaphoretic, ill-appearing young female in moderate distress HEENT: PERRLA, EOMI Chest: CTA bilaterally; tachypneic, mild subcostal retractions CV: tachycardia, regular rhythm, no murmurs, rubs, gallops Abd: soft, tender, bowel sounds present GU: menarche has not occurred Ext: no edema, cap refill 3 seconds Neuro: A&O x 3, CII-XII intact, (-) clonus

Clinical Laboratory Report

Test Name	10/20/25	10/19/25	Range
Sodium (Na⁺)	136	134	136-145 mEq/L
Potassium (K⁺)	3.8	3.1	3.5-5 mEq/L
Chloride (Cl^-)	102	98	98-106 mEq/L
Bicarbonate (HCO₃^-)	28	10	23-28 mEq/L
Urea nitrogen (BUN)	12	30	8-20 mg/dL
Creatinine	0.8	1	0.5-1.3 mg/dL
Glucose	120	432	70-115 mg/dL
Hemoglobin A1c		12.8	5.3-7.5 %
Calcium,Total	9.2	9.2	8.6-10.2 mg/dL
Phosphate	4.6	3	3-4.5 mg/dL
Magnesium	2	1.4	1.6-2.6 mEq/L
Protein, total	7.1	7	5.5-9 g/dL
Albumin	4	3.8	3.5-5.5 g/dL
Aminotransferase,aspartate (AST)	30	32	10-40 units/L
Aminotransferase,alanine (ALT)	32	34	10-40 units/L
Lactic dehydrogenase (LDH)	167	166	80-225 units/L
Alkaline phosphatase	90	92	30-120 units/L
Bilirubin, Total	0.4	0.6	0.3-1 mg/dL
Leukocytes (WBC)		10.2	4.5-11 x10³/mcL
Red blood cells (RBC), Female		3.4	4.3-5.7 x10⁸/mcL
Hemoglobin, Female		13	12-16 g/dL
Hematocrit, Female		40	37-47 %
Mean corpuscular hemoglobin (MCH)		31	27-33 picogram
Mean corpuscular volume (MCV)		92	76-100 mcm³
Platelets		254	150-450 x10³/mcL
International normalized ratio (INR)		1.0	0.8-1.2
Prothrombin time (PT)		10.9	9.5-11.3 sec
Partial thromboplastin time,activated (aPTT)		21	25-35 sec

Additional Labs:

Urinalysis	Today	Yesterday
Color	Yellow	Dark yellow
Clarity	Clear	Clear
Spec Gravity	1.22	1.03
pH	5.5	6
Glucose	Negative	4+
Ketones	Negative	3+
Protein	Negative	2+
Blood	Negative	Negative
Bili	Negative	Negative
Nitrites	Negative	Negative
LE	Negative	Negative
Urine culture (cath specimen)	No growth x1 day	pending

Blood gas (yesterday)

pH 7.26
PaO2 (mm Hg) 70
PaCO2 (mm Hg) 40
Bicarbonate (HCO3-) (mEq/L) 10

Diabetes Screening (yesterday)

Glutamic acid decarboxylase (GAD): Pending
Islet cell antibody: Pending
C-peptide: Pending

Other (yesterday)

UhCG: Negative

Cultures:

None

Imaging Studies:

CXR: Unremarkable
EKG: Normal sinus rhythm

Vital Sign	10/20/25 07:15	23:23	17:34	10/19/25 09:58
Height (cm)	152			152
Weight (kg)	41			41
Body Temperature (°C)	37.1	38.5	36.9	37.7
Blood Pressure (mmHg)	94 / 58	64/42	62/42	64/42
Heart Rate (bpm)	90	125	124	122
Respiratory Rate (bpm)	22	39	40	40
Oxygen Saturation (%)	98%	98	98	98%

Current Orders

DRUG	DOSE	FREQ & TIME	PRN?

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?

USE	START DATE	STOP DATE	NOTES

Medication
History

AL takes acetaminophen for mild pain or fever. She has not required any in the last month. She was recently started on desmopressin for nocturnal enuresis. Prior to 2 months ago, she had not had a problem with bed-wetting. In the last month, she has experienced nocturnal enuresis several nights per week. Since starting desmopressin and limiting beverages for 1 hour prior to bedtime, bed-wetting only happens 1-2 nights per week.
She experiences seasonal allergies, worse in the spring and fall; but really is never comfortable (complains of itchy eyes and nasal congestion), even with her current treatment plan.
She has a difficult time focusing on her homework in the afternoon and takes her ADHD medication every day. Her difficulty with concentrating started last school year. School started back last week and she is again having problems. Mom reports that “it is a daily struggle to get homework done after school.”

Compliance/dosing issue: none

Home Medication List: verified by pharmacy on admit (10/19/25)

Patient Name: Lawson, Audrey Date of Birth: 3/19/2013 Room#: 711	Allergies:	Immunization History:
Community Rx Info: Rx Insurance:	Social History:
Additional Notes:

DRUG STRENGTH DF	STRENGTH ROUTE FREQ	PRN?	LAST DOSE (date/time)	ADVERSE EFFECTS	ADHERENCE	NOTES	MED REC ACTION
Loratadine 10 mg tablet	1 PO QD	no	7:30 10/18/25	none	never misses
Desmopressin 0.2 mg tablet	1 PO HS	no	20:30 10/18/25	none	never misses	taken for past month
Adderall XR 20 mg capsule	1 PO QD	no	7:30 10/18/25	none	never misses
							Action Key: C = Continue, D = Discontinue^, H = Hold^, M = Modify^* ^*must provide reason

Medication	10/20/25	10/19/25
D10% ½ NS with 20 mEq KCl + 20 mEq KPhos per liter IV alternating with order #2		06:50 18:42
½ NS with 20 mEq KCl + 20 mEq KPhos per liter IV alternating with order #1		12:28 23:11
Insulin (regular) 1 unit/mL titrate BG to 150 mg/dL IV continuous		06:56 18:20

Clinical Notes

Medication Discharge Orders

Hospital Medications
Medication	Instructions	Comments	Continue	Modify	Discontinue	New Rx sent
D10% ½ NS with 20 mEq KCl + 20 mEq KPhos/L	alternating IV infusion
½ NS with 20 mEq KCl + 20 mEq KPhos/L	alternating IV infusion
Insulin (regular)	100 units/mL, continuous IV infusion	change to insulin aspart and insulin detemir
Insulin aspart	3 units SC 15 min before each meal	do not take if not eating
Insulin detemir	9 units SC before bedtime
Dextroamphetamine/ Amphetamine	5 mg PO QD after school	to help with homework

Previous Home Medications
Medication	Instructions	Comments	Continue	Modify	Discontinue	New Rx sent
Loratadine	10 mg PO QD
Desmopressin	0.2 mg PO HS
Adderall XR	20 mg PO QD	for ADHD

Discharge Planning - Medication List and Instructions

Patient Name:
Admission Date:	Discharge Date:	Service:
Principle Diagnosis on Admission:
Secondary Diagnosis:
Allergies:

Medications ADDED this visit: (begin taking these)	Medications CHANGED this visit: (modify what you were taking)	Medications STOPPED this visit: (stop taking these)

Final Discharge Medication List
Medication/Route/Dosage/Frequency/Duration	Comments	Morning	Afternoon	Evening	Bedtime










As Needed Medications

Medication Reconciliation - Finalized Medication List

Patient Name: Lawson, Audrey

Date of Birth: 3/19/2013

Room: 711

Medication (name/strength)	Dose	Route	Frequency	Notes

Height	152 cm
Actual Body Weight (ABW)	41 kg
Ideal Body Weight (IBW)	45.5 kg
ABW % of IBW	90 %
Adjusted Body Weight (AjBW)	43.7 kg
Body Surface Area (BSA)	1.32 m²
Body Mass Index (BMI)	17.7 kg/m²