Age: 79.0
Sex: F
Vaccine: COVID19
Symptoms: Condition aggravated, Cough, Echocardiogram abnormal, Ejection fraction normal, Electrolyte substitution therapy
Clinical narrative: COVID+ 12/14/22.  Vaccination status - moderna x3 BRIEF OVERVIEW: Discharge Provider: DO Primary Care Provider: MD Admission Date: 12/14/2022 Discharge Date: Dec 24, 2022   Active Hospital Problems   Diagnosis Date Noted POA ? Unspecified severe protein-calorie malnutrition  12/15/2022 Unknown ? Essential hypertension 11/07/2022 Yes ? Mixed hyperlipidemia 11/07/2022 Yes ? Chronic midline low back pain without sciatica 11/07/2022 Yes ? Status post vertebroplasty 11/07/2022 Yes ? Mixed incontinence urge and stress 11/07/2022 Yes ? Seizure  03/10/2022 Yes ? Heart murmur    Discharge Disposition:  home health care svc  Active Issues Requiring Follow-up:  Hyponatremia - sodium stable around 131. 1.5L fluid restriction advised on discharge - check BMP in the next week, ordered and results will be forwarded to PCP - stop HCTZ - f/u PCP in the next 1-2 weeks Iron deficient anemia - GI will call to schedule EGD/c-scope - Continue iron daily on DC - CBC in the next week, ordered and results will be forwarded to PCP - She will hold iron the next couple of days to ensure dark stool resolves with iron cessation.  Seizure disorder - continue home meds, f/u with neuro outpatient MVP with MR - f/u with cardiology outpatient, will likely need referral from PCP HTN - blood pressure stable on lower end of normal without meds. Stop lisinopril and amlodipine on discharge DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute hyponatremia [E87.1] COVID-19 [U07.1] HOSPITAL COURSE: Patient is an 80-year-old female who presented with weakness/fatigue and cough and found to have COVID-19 infection and  hyponatremia. She had been on hydrochlorothiazide prior to admission.  Chest x-ray showed moderate cardiomegaly with no acute consolidation, infiltrate or effusion.  In the emergency department, sodium level was found to be 100. Emergency department physician did contact on-call nephrologist who did not recommend any hypertonic saline as patient with normal mental status but stated to monitor sodium and if sodium was greater than 107, then D5W was to be started. Patient found to have hypokalemia as well as hypo magnesemia and these electrolytes were replaced.   Patient admitted to the intensive care unit for closer monitoring and frequent sodium checks. She did receive IV fluids in the emergency department but further fluids have been held. In the ICU sodium improved >107, IV NS started per nephrology. Echo ordered by CC team and showed normal EF, severe left atrial dilation, MVP w/ mod-severe MR. Pt sodium slowly improved and maintained around 131-132 just with oral diet, nephrology recommended discharging on 1.5L restricted diet.    She was also noted to develop severe anemia requiring 1 unit PRBC on 12/18. She reported having black BM while in ICU. Iron studies showed iron deficiency. B12, folate, LDH and haptoglobin were normal. Pt hgb quickly improved following blood tranfusion. GI was consulted and pt started on PPI BID, as pt stabilized and sodium improved her hemoglobin remained mostly stable so outpatient endoscopies are planned.  Hemoglobin starting to trend slightly lower again, decreased to 8.7 on day of discharge compared to recent baseline around 9.5. She is having dark bowel movements on day of discharge once per day but currently taking iron supplements. These have been daily and unchanged even when she had no change in hemoglobin. She was re-evaluated by PT closer to DC who recommended home with home health. Spouse agreeable and okay with plan. Pt eventually discharged on 12/24/22.