Hospital day 2

12 yo F

Working dx: DM II, obesity, bipolar affective disorder, ADHD, possible willie pradder Medications: Metformin 500 mg po q 12hr Subjective- Patient is a 12 y/o girl with a hx of DMII, bipolar disorder, and adhd who was brought to the ED 3/15 by the police after an altercation with her mother regarding food that became violent. She has been admitted for evaluation by psychiatry, endocrinology, nutrition, behavioral medicine and genetics. Today she states she is feeling happy and that she is enjoying doing activities with the volunteers. Her mother informs us that she has been ordering extra meals from the cafeteria when she is not there. Genetics has seen her and agrees with an initial dx of willie prader but would like to do the workup outpatient once Medicaid status has been determined. No other service has seen her as of yet but psych has agreed to transfer to their service once space becomes available. Objective 102 Hr 20RR 99.5F 123/85 BP Weight 123.0kg 99 percentile

General: NAD, afebrile, some hirsutism on face, and arms Neck- acanthosis nigrans Chest- CTA BL CV- RRR, s1+s2 GI- soft, non tender, no grimacing to palpation, bowel sounds present, Cbc 16.5/12.8/38.1/311 BMP 137/40/104/23.3/11/0.43/ 103 AST 28 ALT 28 ALK phos 150 HCG negative A&P NG is a 12 y/o F who was brought by the police for a physical altercation at home with her mother. She is being evaluated for an underlying source of her aggression, obesity and unhealthy food behaviors with willi prader as the initial working dx. Other sources of possible acute behavioral changes have been ruled out by hx, exam and initial lab studies. She is waiting to be seen by psych, endo, and behavioral medicine and transferred to psych. Plan Continue metformin Carb counting diet with strict feed times Further work up by other specialties NH4 29

Tox screen negative

Transfer to psych once space becomes available