Patient Razia Begum admitted under Dr P.S vijayender Sir (203A) Ca Right Breast with liver and bone mets K/c/o HTN, Type2 DM, HbsAg+ Admitted with complaints of pain at the right breast and tight arm , poor oral intake Now c/o mild pain at right breast Vitals BP 130/90mmHG SPO2 95% on RA PR 65bpm TEMP 99.3F RR 26c/min GRBS 191mg/dl Rx 1. Inj Fentanyl CIVI @2ml/hr 2. Inj Ketorolac 30mg iv bd Correct this
Here is the corrected clinical note for patient Razia Begum:
Patient: Razia Begum
Consultant: Dr. P.S. Vijayender (Ward 203A)
Date: 09/07/2026
Diagnosis:
- Carcinoma Right Breast with Liver and Bone Metastases
- Known case of Hypertension, Type 2 Diabetes Mellitus
- HBsAg Positive (Hepatitis B carrier)
Presenting Complaints (at admission):
- Pain at right breast and right arm
- Poor oral intake
Current Complaints:
- Mild pain at right breast
Vitals:
| Parameter | Value | Interpretation |
|---|---|---|
| BP | 130/90 mmHg | Acceptable (HTN - controlled) |
| SpO2 | 95% on Room Air | Low-normal - monitor |
| Pulse Rate | 65 bpm | Normal |
| Temperature | 99.3°F (37.4°C) | Low-grade fever |
| RR | 26 cycles/min | Tachypnea - needs attention |
| GRBS | 191 mg/dL | Elevated - DM not controlled |
Treatment:
- Inj. Fentanyl CIVI (Continuous Intravenous Infusion) @ 2 ml/hr
- Inj. Ketorolac 30 mg IV BD
Clinical Flags / Suggestions to Review:
-
RR 26/min (Tachypnea): Elevated respiratory rate in a patient with bone and liver mets on opioids - rule out opioid-related respiratory depression, pleural effusion, or pulmonary mets. SpO2 of 95% on room air adds to concern.
-
Ketorolac + HBsAg+ + Liver Mets: Ketorolac is an NSAID with known hepatotoxic potential. In a patient with active liver metastases and Hepatitis B, NSAID use carries significant risk of hepatic decompensation and GI bleeding. Review whether Ketorolac is appropriate here - consider substituting with Paracetamol IV (if liver function permits) or optimizing opioid dosing instead.
-
GRBS 191 mg/dL: Suboptimal glycemic control. Review insulin regimen or sliding scale in the context of poor oral intake (hypoglycemia risk if on fixed-dose insulin with poor PO intake).
-
Low-grade fever (99.3°F): May indicate infection, tumor fever, or HBV-related activity. Consider CBC, LFT, and blood cultures if not already done.
-
Poor oral intake: Nutritional support (oral supplements, dietitian review, or NG feeds) should be considered given the oncologic diagnosis and poor intake.
Note: Ketorolac use should be specifically re-evaluated by the treating team given the combination of liver metastases, HBsAg positivity, and ongoing opioid therapy.
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