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Vogel, Logan

MRN: 231289

Room: ED7

DOB: 1/1/1971

Age: 54

Gender: Male

Allergies: Erythromycin (GI upset), Sulfisoxazole (throat swelling)

Admit Notes

Clinical Notes

Vitals

Labs, Cultures, Imaging

Clinical Calculators

MAR

Current Orders

Home Med List

Med Reconciliation

Discharge Planning

Setting	Emergency Department
Scenario	You are a pharmacist working in the Emergency Department.
Admission note taken on 10/19/25
CC	shortness of breath and cough
HPI	Patient arrived at the emergency room via automobile and chief complaint of shortness of breath and relatively non-productive cough. This has been preceded by a three-month history of increasing fatigue. Plan is to admit patient and consult ID service.
PMH	HIV x 14 years HCV x 4 years PCP 3 times, 7, 6, & 4 years ago Cryptococcal meningitis, once 4 years ago Type 2 Diabetes Mellitus x 10 years HIV nephropathy x 4 years Hyperlipidemia x 8 years Peripheral neuropathy x 1 year Depression x 12 years
Social History	Tobacco: 1.5 ppd x 32 years ETOH: none for past 4 years Illicit Drugs - intranasal cocaine used for approximately 20 years, stopped using 6 years ago Caffeine: espresso in the morning Occupation: currently on disability, was an automotive mechanic Status: never married, is in monogamous relationship with male partner of 4 years who is involved and supportive of patient's care Children: no children Physical Activity: has not exercised regularly due in part to recent increase in fatigue, but also the increase in numbness and tingling in his lower extremities. Prior to, he walked 2 miles on the beach every morning. Diet: eats vegetarian diet cooking at home most nights	Family History	Father: deceased, unknown age or reason Mother: age 75 alive with HTN Sister: age 48 alive and well Brother: age 50 alive and well
Vaccine History	None on file	Surgical History	None on file
Physical Exam	Gen: mildly cachectic white maile appearing to be stated age in mild respiratory distress HEENT: PERRLA, EOMI, R & L fundus exam without retinopathy, sclera slightly icteric, mucus membranes moist, no oral lesions, dentition intact, no oral thrush Skin: dry skin, no rashes Neck: no JVD appreciated, no carotid bruits, no thyromegaly Heart: RRR, no S3, S4, no murmur Lungs: mild diffuse bilateral rales Abdomen: soft, symmetrical, nontender, nondistended, +BS, liver palpable 3 fingers breaths below the costal margin, spleen non palpable, no ascites GU: intact and WNL Extremities: warm to touch, pedal and brachial pulses present bilaterally

Clinical Laboratory Report

Test Name	10/19/25	03/23/25	Range
Sodium (Na⁺)	144	140	136-145 mEq/L
Potassium (K⁺)	4.0	4.4	3.5-5 mEq/L
Chloride (Cl^-)	98	100	98-106 mEq/L
Bicarbonate (HCO₃^-)	30	22	23-28 mEq/L
Urea nitrogen (BUN)	49	45	8-20 mg/dL
Creatinine	1.5	1.2	0.5-1.3 mg/dL
Glucose	200	115	70-115 mg/dL
Hemoglobin A1c	7.0	6.8	5.3-7.5 %
Calcium,Total	8.3	6.9	8.6-10.2 mg/dL
Phosphate	4.2	4.3	3-4.5 mg/dL
Magnesium	1.9	2.0	1.6-2.6 mEq/L
Protein, total	6.1	6.2	5.5-9 g/dL
Albumin	2.1	2.3	3.5-5.5 g/dL
Aminotransferase,aspartate (AST)	70	60	10-40 units/L
Aminotransferase,alanine (ALT)	150	45	10-40 units/L
Lactic dehydrogenase (LDH)	96	98	80-225 units/L
Alkaline phosphatase	61	61	30-120 units/L
Bilirubin, Total	1.0	0.9	0.3-1 mg/dL
Leukocytes (WBC)	9.3	4.9	4.5-11 x10³/mcL
Red blood cells (RBC), Male	4.8	4.9	3.8-5.1 x10⁸/mcL
Hemoglobin, Male	9.9	12.3	14-18 g/dL
Hematocrit, Male	29	39.9	42-50 %
Mean corpuscular hemoglobin (MCH)	27	30	27-33 picogram
Mean corpuscular volume (MCV)	90	83	76-100 mcm³
Platelets	116	110	150-450 x10³/mcL
International normalized ratio (INR)	1.0	0.9	0.8-1.2
Prothrombin time (PT)	10.4	9.6	9.5-11.3 sec
Partial thromboplastin time,activated (aPTT)	29.6	28	25-35 sec

Additional Labs:

ABG	Today	7 Months Ago
pO2 (mmHg)	61
pCO2 (mmHg)	42
pH	7.4
HCO3 (mEq/L)	24
HEMATOLOGY	Today	7 Months Ago
PMNs (%)	75	90
Lymphs (%)	17	8
Bands (%)	6	1
Eos (%)	1	1
Monos (%)	1	0
HIV Panel	Today	7 Months Ago
CD4 abs (cells/mcL)	50	213
Viral Load (copies/mL)	100,000	<50

Fasting Lipids	Today	7 Months Ago
Trig (mg/dL)	580	400
HDL-C (mg/dL)	38	30
LDL-C (mg/dL)	115	125
Urinalysis	Today	7 Months Ago
Glucose	neg	neg
Ketones	neg	neg
Specific Gravity	1.001	1.013
Bacteria	neg	neg
WBC	neg	neg
RBC	neg	neg
Protein	1+	1+
Leuk Est	neg	neg
Nitrite	neg	neg

Cultures:

Blood cultures: 2 sets from 2 sites pending.
Induced putum sample set: gram stain negative for bacteria, silver stain positive for Pneumocystis jeroveci

HIV Phenotype Results (last month)
Current regimen: efavirenz, stavudine, didanosine	Previous meds: saquinavir, ritonavir, lamivudine, zidovudine
efavirenz - resistant	saquinavir - resistant
nevirapine - resistant	indinavir - resistant
delavirdine - resistant	ritonavir - resistant
zidovudine - resistant	nelfinavir - resistant
didanosine - resistant	amprenavir - resistant
zalcitabine - sensitive	lopinavir - sensitive
stavudine - resistant	lamivudine - resistant
abacavir - sensitive	tenofovir - sensitive

Hepatitis Panel	Result
4 Years Ago	total anti-HAV non-reactive, HBsAb non-reactive, HBsAg non-reactive, HCV Ab reactive
3 Years Ago	HCV genotype - 1a, HCV viral load 430,000 copies/mL
7 Months Ago	HCV viral load 1,960,000 copies/mL

Imaging Studies:

Chest X-ray (today): plain film front and lateral chest x-ray showing interstitial infiltrates with "ground glass" appearance. Costal margins present. No other abnormalities noted.

Vital Sign	10/19/25 08:36	03/23/25 07:39
Height (cm)	180	180
Weight (kg)	73	74
Body Temperature (°C)	38.1	36.6
Blood Pressure (mmHg)	110 / 60	130/68
Heart Rate (bpm)	90	80
Respiratory Rate (bpm)	24	18
Oxygen Saturation (%)	90	97

Current Orders

Medication
History

Upon diagnosis of HIV 14 years ago, patient received zidovudine as monotherapy for approximately 1 year. He was grossly non-compliant and ultimately was not followed by the HIV clinic for the past 10 years, in part due to self-destructive behavior.
6 years ago patient began visiting his family doctor in part to get off cocaine but also to right his life. After being diagnosed with HCV, he again agreed to be followed by the HIV clinic.
Patient has been compliant with his medications (missing 1-2 doses per month) as verified by pill counts and pharmacy refill records. He is enthusiastic about his care and helpful to the clinicians who follow his care.
Current antiretroviral regimen: efavirenz, stavudine, didanosine
Previous antiretroviral meds (discontinued 7 months ago): saquinavir, ritonavir, lamivudine, zidovudine
Patient has failed trimethoprim/sulfamethoxazole desensitization twice.

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

Patient Name: Vogel, Logan Date of Birth: 1/1/1971 Room#: ED7	Allergies:	Immunization History:
Community Rx Info: Rx Insurance:	Social History:
Additional Notes:

DRUG STRENGTH DF	STRENGTH ROUTE FREQ	PRN?	MED REC ACTION
Efavirenz 600 mg tablet	1 PO HS	no
Stavudine 20 mg capsule	1 PO BID	no
Didanosine 200 mg ER capsule	1 PO BID	no
Azithromycin 200 mg tablet	6 PO QWEEK	no
Dapsone 100 mg tablet	1 PO QD	no
Fluconazole 100 mg tablet	1 PO QD	no
Atorvastatin 20 mg tablet	1 PO HS	no
Glipizide 10 mg tablet	1 PO QD	no
Desipramine 25 mg tablet	1 PO HS	no
Lisinopril 10 mg tablet	1 PO QD	no
Metformin 500 mg tablet	1 PO BID	no
Sertraline 50 mg tablet	1 PO QD	no
			Action Key: C = Continue, D = Discontinue^, H = Hold^, M = Modify^* ^*must provide reason

Medication

10/19/25

Clinical Notes

Medication Discharge Orders

Hospital Medications
Medication	Instructions	Comments	Continue	Modify	Discontinue	New Rx sent

Previous Home Medications
Medication	Instructions	Comments	Continue	Modify	Discontinue	New Rx sent

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: Vogel, Logan

Date of Birth: 1/1/1971

Room: ED7

Medication (name/strength)	Dose	Route	Frequency	Notes

Height	180 cm
Actual Body Weight (ABW)	73 kg
Ideal Body Weight (IBW)	75.3 kg
ABW % of IBW	97 %
Adjusted Body Weight (AjBW)	74.4 kg
Body Surface Area (BSA)	1.91 m²
Body Mass Index (BMI)	22.5 kg/m²