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IHD drug dependence T2DM discharge medications atorvastatin aspirin metoprolol metformin management
Here is a detailed analysis of this hospital discharge certificate:
Discharge Certificate - Full Analysis
Administrative Details
| Field | Value |
|---|---|
| Document Type | Discharge Certificate - Left Against Medical Advice (LAMA) |
| Date of Discharge | 7/6/26 (7th June 2026) |
| Time | 2:30 PM |
| Patient Category | Free / Paying / Cabin |
| Ward | Medical / Nutrition |
| Page | 1 |
Final Diagnosis
The primary diagnoses documented are:
- IHD (Ischaemic Heart Disease)
- Drug Dependence (written as "Dru Topodence" - likely "Drug Dependence")
- T2DM (Type 2 Diabetes Mellitus)
Surgery / Procedure Note
"Discharge performed - Haemodynamically Stable condition"
This indicates the patient was haemodynamically stable at the time of leaving.
Referral
- Referred to: Cardio OPD (Cardiology Outpatient Department)
- This suggests ongoing cardiac follow-up was planned post-discharge.
Investigations Done (Right Side - Baby/Patient Section)
| Finding | Value / Result |
|---|---|
| 2D ECHO | Done |
| LVEF | ~60% (Left Ventricular Ejection Fraction - within normal range, ≥55%) |
| Lung findings | No PLNMA (possibly No Pleural/Pneumonia) |
| Trop-T | Negative (-ve) - rules out acute myocardial infarction |
| TLC | 7.9 × 10³ (Total Leukocyte Count - within normal range ~4-11 × 10³) |
| Hb | 132 (likely 13.2 g/dL - normal) |
| Na | 101 (Sodium - significantly LOW, normal 135-145 mEq/L) ⚠️ |
| K | 8.9 (Potassium - critically HIGH, normal 3.5-5.0 mEq/L) ⚠️ |
| Cr | 0.5(?) (Creatinine) |
| Urea | Value noted |
Note: The Na (101) and K (8.9) values, if accurate as written, represent severe electrolyte abnormalities (profound hyponatraemia and life-threatening hyperkalaemia). These may be handwriting misreads or the key reason the patient was admitted/treated.
Advice / Discharge Medications (Left Side)
The physician documented the following advice and prescriptions:
| # | Medication | Dose/Duration | Notes |
|---|---|---|---|
| 1 | Avoid junk/fast food (Lifestyle advice) | - | Diet counselling |
| 2 | Tab. Aspirin 75 | OD × 1 month | Antiplatelet for IHD |
| 3 | Tab. Atorve (Atorvastatin) 40 | OD HS × 1 month | Statin for lipid/IHD |
| 4 | Tab. Ramipril (5000?) | BD × 1 month | ACE inhibitor for IHD/T2DM renoprotection |
| 5 | Tab. Metoprolol (25?) | OD × 1 month | Beta-blocker for IHD |
| 6 | Tab. Metformin (500) | BD × 1 month | Oral hypoglycaemic for T2DM |
| 7 | Tab. B.Com Plex (B-Complex) | OD × 15 days | Vitamin supplement |
| 8 | Refer to Cardio OPD | - | Cardiac follow-up |
| 9 | Review in 1 month / For OPD | - | General follow-up |
Clinical Summary
This patient with known IHD + T2DM was admitted, found haemodynamically stable with a normal LVEF (~60%) and negative Troponin-T (no acute MI event). They were discharged against medical advice (LAMA) and prescribed a standard secondary prevention regimen:
- Aspirin - antiplatelet therapy
- Atorvastatin - lipid-lowering / plaque stabilisation
- Ramipril - ACE inhibitor (cardioprotective + renoprotective in diabetes)
- Metoprolol - rate/rhythm control and cardiac protection in IHD
- Metformin - glycaemic control for T2DM
The Drug Dependence diagnosis is notable and may relate to the LAMA (the patient left before the treating team recommended).
Key Concerns to Follow Up
- Electrolyte abnormalities - if Na=101 and K=8.9 are accurate, urgent recheck is needed at OPD.
- LAMA risk - patient left against advice; compliance with medications is uncertain.
- Cardio OPD referral - must be attended urgently for IHD management.
- Substance dependence - needs separate addiction/psychiatric evaluation.
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