Signal Sprint 03: The Medication List Is Part of the Exam

Mild dehydration or recovery from a recent viral illness

Medication-related adverse effect or electrolyte abnormality

Recommend fluids and follow-up only if symptoms worsen

Obtain a focused medication history, including recent additions or dose changes, and assess orthostatic vital signs

Start an antibiotic for persistent viral symptoms

Reassure the patient that leg cramps are common with aging

His mild upper-respiratory illness last week

Recent hydrochlorothiazide initiation followed by reduced intake, orthostatic changes, electrolyte abnormalities, and increased creatinine

His use of over-the-counter cold medication

Which information most meaningfully changes the interpretation of this visit?

Continue hydrochlorothiazide and advise the patient to drink more water

Address suspected diuretic-related volume depletion and electrolyte abnormalities, reassess medication safety, and determine the appropriate urgency and setting for treatment based on symptoms and laboratory findings

Prescribe a muscle relaxant for leg cramps and repeat labs at the annual physical

Treat for bacterial sinusitis because the symptoms began after a respiratory illness