text:  Significant for sodium 140   potassium 3   BUN 35   creatinine 3.6   liver function tests within normal limits   calcium 6.6   albumin 2   magnesium1.4   PT 14   white count 30.1 with 77 polys   13 bands   5 lymphs   and 5 monos . Urine sodium is 75   urine creatinine 143 urine osmose 392 . Pleural fluid pH is 7.29   glucose 91   total protein3.1   LDH 296   70 white blood cells   50 red blood cells . HOSPITAL COURSE  1. Colitis . The patient has a history of ischemic bowel status post SMA Percutaneous Transluminal Coronary Angioplasty with recent admission for gram negative rod urosepsis complicated by C. difficile colitis . The patient received a full course of Flagyl and was C. difficile toxin negative times three prior to transfer . He now returns with fever   rising white count   diarrhea   and dehydration . Initially treated with intravenous ceftizoxime   gentamicin   and Flagyl for presumed sepsis   either with urine or bowel source . He was also started on p.o. Vancomycin . Blood cultures and urine cultures came back negative . Stool for C. difficile returned positive . The diagnosis   therefore   was relapsed C. difficile colitis . Intravenous antibiotics were discontinued and the patient was continued on p.o. Vancomycin . He improved clinically with defervescence   decreased white blood cell count to 10 000 with resolution of left shift   and some decrease in abdominal distention on exam . An abdominal CAT scan revealed thickened bowel wall and thumb printing   primarily involving the cecum and right colon greater than the left   consistent with C. difficile colitis . The diagnosis of recurrent bowel ischemia   however   was not ruled out and this will continue to be a concern in the future . The patient was initially n.p.o. and was then advanced to clear liquids which he tolerated . He will be advanced to soft solids prior to discharge . 2. Azotemia . The patient has chronic renal insufficiency with baseline creatinine 1.8-2 . Creatinine had risen to 4.3 on admission presumed secondary to sepsis and dehydration . With intravenous hydration the BUN and creatinine fell to 12  1.9 which is within normal limits for this patient . The abdominal CAT scan showed no evidence of hydronephrosis orrenal abscess . 3. Mental status . The patient was alert and oriented throughout the admission  however   by personality   he is somewhat cantankerous and demanding of the nurses . He was written for Haldol 1 mg p.o.b.i.d. p.r.n. to help with this problem . DISCHARGE DISPOSITION  Medications on transfer include multivitamin 1 tablet p.o. q.d.  Pepcid 20 mg p.o. b.i.d.  Ventolin inhaler two puffs q.i.d.  Vancomycin 125 mg p.o. q.i.d. times seven days  calcium carbonate 1250 mg p.o. b.i.d.  Lotrimin cream to groin b.i.d. p.r.n.  O2 at four liters per minute  and Haldol 1 mg p.o. b.i.d. p.r.n. Dictated By  CA NA SHUFF   M.D. SO92 VX072  9578 TRANGCA CHIRDSTEN   M.D. ZO84 D  07  17  91 T  07  17  91 Batch