Age: 65.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Mental status changes, Metabolic function test, Monocyte count normal, Monocyte percentage, Neutrophil count increased
Clinical narrative: 1/30/22   65-year-old female with notable past medical history for anxiety/depression, osteoarthritis, mixed asthma/COPD, hypertension, seizure disorder, history of UTIs, history of pneumonia, and history of ovarian cancer in remission.  Her ED attending and family, they report altered mental status at home and on initial evaluation in ED and patient was unable to provide much history.  However bedside today patient is alert and oriented x2, place and self.  She seems fatigued but can provide fairly reliable history.  She states that yesterday she progressively felt more and more unwell throughout the day, noting initially pronounced fatigue and weakness eventually developing chills (but did not take temperature at home), cough, and mild shortness of breath.  She states she also developed confusion stating she could not remember is that it happened, times, in order of events.  She denies any chest pain, nausea, vomiting, or diarrhea.  She is vaccinated against COVID-19, and denies recent travel or any known sick contacts.  Today she states that she feels mildly better than she did at home. Review of Systems General: As above HEENT: Denies recent falls, head trauma, cold/URI symptoms, rhinorrhea, sore throat. CVS: Denies chest pain, palpitations, racing heart, edema. RS: Respiratory symptoms as above Abdominal: Denies abdominal pain, nausea, vomiting, diarrhea, constipation, hematemesis, melena, hematochezia. Genitourinary: Denies dysuria. Endocrine: Denies hot/cold flashes. Neurological: Denies headaches, visual disturbance, dizziness, syncope, falls, trauma. Psychiatric: Denies suicidal/homicidal ideation. All systems reviewed and negative except pertinent positives, which are as noted in history of present illness.  Collection Time: 01/30/22  6:08 AM Result Value Ref Range   White Blood Count 11.27 (H) 4.5 - 11.0 10*3/uL   Red Blood Count 4.11 4.0 - 5.2 10*6/uL   Hemoglobin 12.7 12.0 - 16.0 g/dL   Hematocrit 39.9 36.0 - 46.0 %   Mean Corpuscular Volume 97.1 80.0 - 100.0 fL   Mean Corpuscular Hemoglobin 30.9 26.0 - 34.0 pg   Mean Corpuscular HGB Conc 31.8 31.0 - 37.0 g/dL   Red Cell Distribution Width-CV 12.4 12.0 - 16.8 %   Platelet Count 244 140 - 440 10*3/uL   Mean Platelet Volume 10.1 8.4 - 12.4 fL   Diff Type Hospital CBC w/AutoDiff (Lab)   Neutrophils % 86.3 (H) 45 - 80 %   Lymphocyte % 5.9 (L) 15 - 50 %   Monocyte % 5.0 0 - 15 %   Eosinophil% 2.0 0 - 7 %   BASO% 0.4 0 - 2 %   Immature Granulocyte% 0.4 0.0 - 1.0 %   Nucleated RBC % 0 0 /100(WBC)   Neutrophil Abs 9.75 (H) 2.0 - 8.8 10*3/uL   Lymphocyte-Absolute 0.66 (L) 0.7 - 5.5 10*3/uL   Monocyte Absolute 0.56 0.0 - 1.7 10*3/uL   EOS-Absolute 0.22 0.0 - 0.8 10*3/uL   Basophil Abs 0.04 0.0 - 0.2 10*3/uL   Immature Granulocyte Abs 0.04 0.00 - 0.10 10*3/uL Urinalysis   Collection Time: 01/30/22  6:08 AM Result Value Ref Range   Color-Urine Light yellow     Clarity-Urine Clear     Specific Gravity Urine 1.015 1.005 - 1.030 (Lab)   pH-Urine 6.5 5.0 - 9.0 (pH)   Protein-Urine 20 (A) Negative mg/dL   Glucose-Urine Negative Negative mg/dL   Ketone-Urine Negative Negative mg/dL   Bilirubin-Urine Negative Negative mg/dL   Occult Blood-Urine Negative Negative (Lab)   Nitrite-Urine Negative Negative (Lab)   Urobilinogen-Urine Normal Normal (Lab)/dL   Leukocyte Esterase-Urine Negative Negative (Lab)   Source-Urine Urine Midstream     Reflex Microscopic? Macroscopic only performed   Lactic Acid   Collection Time: 01/30/22  6:08 AM Result Value Ref Range   Lactic Acid  1.5 0.7 - 2.0 mmol/L Toxicology Screen, urine   Collection Time: 01/30/22  6:21 AM Result Value Ref Range   Amphetamines-Urine Scrn Negative Negative   Barbiturates-Urine Screen Negative Negative   Benzodiazepines-Urine Screen Negative Negative   Cannabinoids-Urine Screen Negative Negative   Cocaine-Urine Screen Negative Negative   Opiates-Urine Screen Negative Negative Comprehensive Metabolic Panel(CMP)   Collection Time: 01/30/22  8:41 AM Result Value Ref Range   Sodium 143 136 - 145 mmol/L   Potassium 3.6 3.5 - 5.1 mmol/L   Chloride 108 (H) 98 - 107 mmol/L   Carbon Dioxide 25 22 - 29 mmol/L   Anion Gap 10 5 - 13 (arb'U)   Glucose 123 (H) 74 - 99 mg/dL   Blood Urea Nitrogen (BUN) 20 10 - 20 mg/dL   Creatinine-Blood 1.23 (H) 0.55 - 1.02 mg/dL   BUN/Creatinine Ratio 16.3 RATIO   Estimated GFR 44 (L) >60 /1.73 m2   Estimated GFR if 53 (L) >60 /1.73 m2   Total Protein 6.8 6.2 - 8.0 g/dL   Albumin 3.9 3.2 - 4.6 g/dL   Globulin 2.9 1.5 - 4.5 g/dL   Albumin/Globulin Ratio 1.3 1.1 - 2.5 RATIO   Calcium 9.0 8.4 - 10.2 mg/dL   Total Bilirubin 0.5 0.2 - 1.2 mg/dL   AST/SGOT 18 5 - 34 U/L   ALT/SGPT 7 0 - 55 U/L   Alkaline Phosphatase 80 40 - 150 U/L Toxicology Screen   Collection Time: 01/30/22  8:42 AM Result Value Ref Range   Acetaminophen <18.0 <18.0 ug/mL   Ethylalcohol <10 <10 mg/dL   Salicylate <5.0 2.0 - 20.0 mg/dL   CT Chest Wo Contrast:  1/30/22- IMPRESSION: Multifocal pneumonia most probably involving the left lower lobe. The findings are nonspecific. Although not the typical presentation of Covid 19 pneumonia, it is not excluded. XR Chest 1 Vw  1/30/22- IMPRESSION:   Mild nonspecific perihilar infiltrates  2/1/22-Discharge note-65-year-old female with a past medical history of asthma, COPD, seizures, anxiety, bipolar disorder, depression, hypertension and hyperlipidemia who is mid to the hospital for acute respiratory failure secondary to COVID-19 pneumonia.  She was also found to have an acute kidney injury.  Upon hospitalization, a COVID-19 test was ordered which came back positive.  CT chest was consistent with groundglass opacities.  She was initially started on broad-spectrum IV antibiotics but since this was likely Covid, this was discontinued.  Over the course of her hospitalization, Patient's condition remained stable.  She is remained on room air, patient was back stable for discharge.  She did not qualify for an IV steroids.  Patient was discharged home in stable condition.