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What is the appropriate patient status?

70-year-old male with a past medical history significant for nephrolithiasis, MI, CABG, CVA and DM presented to ED with 1 day history of worsening right flank pain, nausea, vomiting and chills. Seen one day earlier with CT demonstrating a stone in the right mid-ureter with associated moderate hydronephrosis with additional stones upper collecting systems bilaterally. BUN 19 CR 1.8 Lactate 3.4

Day of presentation:

 1810: Urology consult. AKI with obstructive uropathy (creatinine increased from 1.5 to 1.8). Possible bilateral ureteral obstruction. Plan: OR.

 1843: Operative procedure: Laser lithotripsy with removal of right distal ureteral stone, placement stent. No obstruction left ureter.

 1851: H&P assessment: Obstructive uropathy. Plan: IV fluids, pain control, IV antibiotics, monitor renal function.

1931: Observation order placed


Day 1:

 0440: CR 1.62, Lactate 1.4

 1145: Urology note: Improving, tolerating PO. Was quite dehydrated: IV NS bolus x2, continue @ 150 ml/hr.

 1214: Hospitalist note: 1 more day IV fluids then discharge home next day if creatinine better.

 1731: Inpatient order placed


Day 2:

 0400: CR 1.22

 1105: Discharge to home

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