Ms. ABC is a 57 years old female who suffers from morbid obesity and also has diabetes and obstructive sleep apnea. She was evaluated in the Bariatric Surgical Center for placement of a band. During her workup, she was noted to have evidence of cholelithiasis. It was felt that the patient would benefit from the removal of her gallbladder prior to having band placement secondary to her diabetes and the risk of infection of the band. The patient was scheduled to undergo her procedure on today; however, at blood glucose check, the patient was noted to be hyperglycemic, her sugar was 438 mg/dl. She was admitted to the hospital for treatment of her hyperglycemia.
H
yperglycemia, cholelithiasis, obstructive sleep apnea, diabetes mellitus, hypertension, and cholecystitis.
- History of present illness
- Admission diagnoses
- Discharge Diagnoses
- Procedure
- Service
- Discharge Instructions
Hyperglycemia, cholelithiasis, obstructive sleep apnea, diabetes mellitus, and hypertension.
Hyperglycemia, cholelithiasis, obstructive sleep apnea, diabetes mellitus, hypertension, and cholecystitis.
Laparoscopic cholecystectomy.
Surgery.
To return to the Medifast diet. To continue with her blood glucose. She needs to follow up with Dr. B, and she will see me next week on Friday. We will determine if we will proceed with her lap band at that time. She may shower. She needs to keep her wounds clean and dry. No heavy lifting. No driving on narcotic pain medicines. She needs to continue with her CPAP machine and continue to monitor her sugars.
Snapshot Summury
Ms. ABC was admitted to the hospital. She was seen by Dr. A. He put her on an insulin drip. Her sugars slowly did come down to normal down to between 115 – 134 mg/dl. On the next day, she was then taken to the operating room, where she underwent her laparoscopic cholecystectomy. She was noted to be a difficult intubation for the procedure. There were some indications of chronic cholecystitis, a little bit of edema, mild edema and adhesions of omentum around the gallbladder. She underwent the procedure. She tolerated without difficulty. She was recovered in the Postoperative Care Unit and then returned to the floor. Her blood sugar postprocedure was noted to be 233 mg/dl. She was started back on sliding scale insulin. She continued to do well and was felt to be stable for discharge following the procedure.
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