tokens: Admission Date : 2013-05-09 Discharge Date : 2013-06-02 Date of Birth : 1966-03-19 Sex : M Service : Scott HISTORY OF PRESENT ILLNESS : The patient is a 47 year old male , with end stage liver disease secondary to hepatitis C cirrhosis diagnosed about 5 years prior to admission . The patient had undergone treatment with interferon and Ribavirin . He had been admitted to the St. Margaret 's Center for Women & Infants multiple times early in 2013 for management of encephalopathy and ascites . The patient had been discharged from the St. Margaret 's Center for Women & Infants on 2013-05-06 , but was readmitted on 2013-05-09 when noted to have worsening renal function . The patient 's serum creatinine on the day of discharge , on 2013-05-06 , was 1.9 , but was noted to increase to 3.2 on 2013-05-08 , and was further elevated to 3.6 on 2013-05-09 . The patient was admitted with concern for hepatorenal syndrome . PAST MEDICAL HISTORY : 1. Hepatitis C cirrhosis for which the patient was on the liver transplant list . 2. Hypertension . 3. Nephrolithiasis . 4. Hemorrhoids . 5. Knee surgeries . 6. Back surgery . MEDICATIONS : 1. Miconazole nitrate powder tid prn for groin rash . 2. Protonix 40 mg po bid . 3. Lactulose 30 ml tid ( titrated to 4 to 5 bowel movements qd ) . 4. Vancomycin 1 gm IV bid . SOCIAL HISTORY : The patient is married with no children . He works as a counselor at an alcohol and drug treatment facility for teenagers . The patient was previously a heavy alcohol user , but had been sober since 1996 . The patient had also used cocaine in the past , but had also stopped in 1996 . HOSPITAL COURSE : ( Part of the patient 's chart from the period 2013-05-09 to 2013-05-23 is currently unavailable , and this dictation will mainly cover the period from 2013-05-23 to 2013-06-02 ) As previously mentioned , the patient 's creatinine at the time of admission was up to 3.6 from 1.9 at the time of his discharge 3 days prior . Over the following 5 days , the patient 's creatinine improved marginally to 2.7 . Optimization of his fluid balance was managed by the medical service in consultation with hepatology and renal . The patient 's INR on admission was 2.4 , with his PT level being 18.9 . The patient periodically required transfusions of fresh frozen plasma , as well as platelets and red cells . The patient was thrombocytopenic with a platelet count of 49 on the 23 . The patient was continued on vancomycin therapy for his previously diagnosed Methicillin resistant , coagulase negative Staph bacteremia . The patient 's nutrition was suboptimal , and the patient was started on tube feeding . The patient underwent diagnostic and therapeutic paracentesis on 2013-05-16 , 2013-05-21 , and 2013-05-24 . He had no evidence of spontaneous bacterial peritonitis . On 2013-05-25 , a liver became available for transplant to the patient . The patient was taken to the operating room and underwent an orthotopic liver transplant . In order to aid in optimization of the patient 's fluid status , the patient was on continuous Baker Baker dialysis during the procedure . His estimated blood loss was 2 liters . The patient received 5 liters of crystalloid , 9 units of fresh frozen plasma , 9 units of red cells , 6 units of platelets , as well as 1 liter of Cell Saver . The procedure proceeded without complications , and the patient was transferred to the intensive care unit while still intubated following the procedure . The patient underwent an uncomplicated recovery in the intensive care unit . By postop day 1 , the patient was awake , in no distress , and appeared lucid prior to extubation . The patient was extubated on postop day 1 without any problems . The patient was on a Lasix drip to aid in diuresis , and was ultimately converted to oral Lasix on postop day 1 . The patient 's pain control was with morphine . The patient required 2 units of fresh frozen plasma on the night following surgery , and 1 unit of platelets on postop day 1 , but otherwise required no blood products following the liver transplant . The patient was started on sips on postop day 2 , and advanced to clear liquids on postop day 3 . He was advanced to a regular house diet later on postop day 3 . The patient was advanced per protocol to an immunosuppressive regimen of prednisone , Neoral , and CellCept . The patient 's mental status remained essentially clear throughout the entire postoperative period . The patient started ambulating with the assistance of physical therapy following transfer to the surgical floor . At the time of discharge , the patient was independent , ambulating , and functioning well . The patient 's appetite improved significantly , and at the time of discharge the patient was on a regular diet with no tube feed supplements deemed necessary . The patient 's liver function tests all improved appropriately by the time of discharge . The patient 's surgical incision was also healing well by the time of discharge with no evidence of infection . The patient was ultimately deemed ready for discharge on postoperative day 8 . DISCHARGE CONDITION : Stable . DISCHARGE MEDICATIONS : 1. Bactrim single strength 1 tablet po qd . 2. Protonix 40 mg po qd . 3. Metoprolol 25 mg po bid . 4. Fluconazole 200 mg po qd . 5. CellCept 1 gm po bid . 6. Prednisone 20 mg po qd . 7. Dilaudid prn . 8. Neoral 500 mg po bid . 9. Valcyte 450 mg po qod . 10. Lasix 40 mg bid x 21 days . 11. Colace 100 mg po bid . FOLLOW UP : 1. The patient was to follow-up with Dr. Ronald in the Transplant Center 3 days following discharge . 2. The patient was to follow-up with Dr. Lueras of hepatology following discharge . MAJOR SURGICAL PROCEDURES : Liver transplant on 2013-05-25 . Elinor Nicole , New York 12428 Dictated By : Elizabeth F. Wells , M.D. MEDQUIST36 D : 2013-06-05 08:29:54 T : 2013-06-06 10:40:21 Job # : 34705 Signed electronically by : DR. Charles Y.S. Warnock on : Maxine 2013-06-20 5:29 PM ( End of Report )