PPhantomAI

Mrs. G.E

PID-20143

63 yrs · Female · 66 kg · 158 cm · Surgical Ward

Diagnosis
Major depressive disorder, post-operative nausea
Vitals
BP128/78 mmHgNormalBlood PressureReference90–120 / 60–80 mmHgActual128/78 mmHg
HR92 bpmNormalHeart RateReference60–100 bpmActual92 bpm
RR18/minNormalRespiratory RateReference12–20 breaths/minActual18/min
TEMP37.2°CNormalTemperatureReference36.1–37.2°CActual37.2°C
SPO296%NormalOxygen SaturationReference≥ 95%Actual96%
Labs
Serum Creatinine0.9 mg/dLNormalSerum CreatinineReference0.5–1.3 mg/dLActual0.9 mg/dL
Creatinine Clearance68 mL/minNormalCreatinine ClearanceReference≥ 50 mL/min (normal/mild impairment)Actual68 mL/min
eGFR72 mL/min/1.73m²NormaleGFRReference≥ 60 mL/min/1.73m²Actual72 mL/min/1.73m²
Liver FunctionWithin normal limitsNormalLiver FunctionReferenceWithin normal limitsActualWithin normal limits
Blood Glucose6.1 mmol/LNormalBlood GlucoseReference4.0–7.8 mmol/LActual6.1 mmol/L
Potassium3.2 mmol/L (low)LowPotassiumReference3.5–5.0 mmol/LActual3.2 mmol/L (low)
Allergies & Status
No known drug allergies (NKDA)
Not applicable
Clinical Notes
Post-operative day 2 following laparoscopic cholecystectomy, experiencing nausea. Ondansetron prescribed for symptom control. Potassium is low, likely related to furosemide and post-operative fluid shifts.

Current Medications

  • Citalopram 40 mg once daily
  • Lisinopril 10 mg once daily
  • Furosemide 20 mg once daily

New Prescriptions — Pending Dispense

Ondansetron 8 mg
IV, Every 8 hours as needed for nausea
Unit: 42 Central: 60 Auto-Reorder Triggered
IV Cannula 22GConsumable
For antiemetic administration
Normal Saline 500mLConsumable
IV, As required
Recommended Additions

These aren't on the prescription, but this chart implies they'll be needed to actually administer it.

IV Giving Set

An IV cannula has been prescribed — a giving set is needed to actually administer fluids or medications through it. Needed to administer Normal Saline as an IV infusion.

Syringes & Needles (appropriate size)

Needed to draw up and administer: Ondansetron (IV).

Clinical AI Analysis
0%Risk Score
0%AI Confidence
ModeratePriority Level

Medication Interactions

Citalopram + OndansetronModerate

Both citalopram and ondansetron prolong the QT interval. Combined use increases the risk of QT prolongation and torsades de pointes, an effect compounded here by this patient's low potassium (3.2 mmol/L) from furosemide use.

→ Correct hypokalaemia before or alongside administration. Consider an alternative antiemetic with lower QT risk, or use the lowest effective ondansetron dose with ECG monitoring.

Alternatives

Metoclopramide 10 mg (lower QT risk, caution with extrapyramidal effects in older adults)
Domperidone (caution: also has some QT effect — assess overall risk individually)

Counselling Points

Report any palpitations, dizziness, or fainting immediately to nursing staff
Potassium levels will be corrected alongside anti-nausea treatment
This is a precaution, not a reason to withhold nausea relief entirely
Dispense With Monitoring

The QT-prolongation risk is real but manageable: correct the potassium, use the lowest effective dose, and monitor. This does not need to be withheld outright, but should not be dispensed without addressing the electrolyte abnormality first.

Duplicate Prescription Check

No duplicate or overlapping therapy detected.

Dose Accuracy Check

Ondansetron 8 mg — Within the typical adult range of 4-8mg per dose.

Interaction Cross-Check

Every unique pair across current medications and new prescriptions — not just new-vs-current.

Citalopram + OndansetronNew RxModerate
Citalopram + LisinoprilLow
Citalopram + FurosemideLow
Lisinopril + FurosemideLow
Lisinopril + OndansetronNew RxLow
Furosemide + OndansetronNew RxLow

Renal Function & Dosing

68NormalCreatinine ClearanceReference≥ 50 mL/min (normal/mild impairment)Actual68mL/min
Cockcroft-Gault recalculation: 66.7 mL/min
Normal / Mild Impairment

No medications on this chart require renal dose banding from the reference table.

Acid-Base Disturbance Profile

Low
pH
7.49HighpHReference7.35–7.45Actual7.49
pCO₂
44 mmHgNormalpCO₂Reference35–45 mmHgActual44 mmHg
HCO₃⁻
34 mEq/LHighHCO₃⁻Reference22–26 mEq/LActual34 mEq/L
Lactate
1 mmol/LNormalLactateReference< 2 mmol/LActual1 mmol/L
Metabolic AlkalosisUncompensated

Elevated bicarbonate is driving the alkalemia; a raised pCO2 alongside it would indicate the lungs are compensating by hypoventilating.

→ Likely contributed to by ongoing furosemide use and the low potassium already noted on her chart.

How This Affects the Treatment Plan — Suggested Interventions

Ongoing loop diuretic use is a common contributor to metabolic alkalosis and often travels with hypokalaemia — review the diuretic dose and replace potassium as needed.
Alkalosis frequently travels with hypokalaemia, and both independently raise QT-prolongation risk — extra caution is warranted alongside any QT-prolonging medicine already on this chart.
Check chloride and potassium — most metabolic alkalosis is chloride-responsive and corrects with volume and electrolyte repletion.

Theatre

No theatre procedure currently scheduled for this patient.

Unit vs Central Stock — This Patient's Medications

AMC, ROL, and months-of-stock (MOS) at both the unit and central store, with a recommendation for each.

Citalopram
Unit StockAdequate
265
Stock
187
AMC
1.4
MOS

Stock within normal range (~1.4 months of stock) — no action needed.

Central StoreAdequate
1050
Stock
1100
AMC
1
MOS

Stock within normal range (~1 months of stock) — no action needed.

Lisinopril
Unit StockAdequate
430
Stock
293
AMC
1.5
MOS

Stock within normal range (~1.5 months of stock) — no action needed.

Central StoreAdequate
1900
Stock
1750
AMC
1.1
MOS

Stock within normal range (~1.1 months of stock) — no action needed.

Furosemide
Unit StockBelow Reorder Level
205
Stock
210
AMC
1
MOS

Order 345 units to reach max stock level before it runs out (~1 months of stock remain).

Central StoreBelow Reorder Level
880
Stock
1250
AMC
0.7
MOS

Order 2120 units to reach max stock level before it runs out (~0.7 months of stock remain).

Send Requisition to Bulk Store
Ondansetron
Unit StockBelow Reorder Level
42
Stock
76
AMC
0.6
MOS

Order 178 units to reach max stock level before it runs out (~0.6 months of stock remain).

Central StoreBelow Reorder Level
60
Stock
340
AMC
0.2
MOS

Order 840 units to reach max stock level before it runs out (~0.2 months of stock remain).

Send Requisition to Bulk Store