Age: 69.0
Sex: M
Vaccine: COVID19
Symptoms: Resting tremor, SARS-CoV-2 test positive, Skin warm, Superinfection, Wheelchair user
Clinical narrative: PRESENTING PROBLEM: Hyponatremia [E87.1] Chronic obstructive pulmonary disease, unspecified COPD type (HCC) [J44.9] COVID-19 [U07.1]   HOSPITAL COURSE:  Patient is a 70 y.o. male with past medical history of COPD, hearing loss, smoker, ETOH, marijuana use, polio osteopathy of lower right leg. Patient is currently not on any home medications. He has a past medical history of chronic obstructive pulmonary disease but does not use bronchodilator medications at home. Last PCP visit was a year ago, but prior it was over 6 years ago. He is a poor historian.    He presented to hospital today with confusion, weakness, and multiple falls. Due to severe weakness he has had multiple falls- unclear if he has had any head trauma. Wife at bedside reports patient became dizzy one week ago and fell in bath tub. Then on Sunday he started to have diarrhea, became weaker, fell out of bed, and tested positive for COVID. Wife reports since he has became increasingly weaker, confused, and decreased appetite. She reports he did feel warm to touch and he was complaining of chills. He arrived to the ER in a wheelchair due to severe weakness- unable to ambulate on his own.    In the ER, patient required supplemental oxygen per ER physician. VBG unremarkable. Remained afebrile. NA 119, AST 175, ALT 53. CBC unremarkable. Film array revealed COVID positive. Head CT revealed no acute intracranial abnormality. Chest xray revealed subtle increased opacity in the region of the right middle lobe may be related to infection. No evidence of pneumothorax or large pleural effusion.    During hospitalization, sodium level was slowly increased from 119 to 128. Hyponatremia most likely secondary to hypovolemia due to poor oral intake. NA 119->124->125->128->129-> 128. Patient discharged with daily sodium tabs. Plan to repeat BMP in one week and follow up with primary care provider in 1-2 weeks.    He was treated for covid infection with superimposed bacteria pneumonia. Received one dose of remdesivir. Received three days of ceftriaxone and azithromycin, discharged with two additional days of keflex and azithromycin for a five day course of antibiotics. Discharged with tessalon for cough. Blood culture remain negative. PT and OT recommended home with home health. He is discharged without services due to refusal of services. CIWA score remained a zero during hospital course. Patient received folate, thiamine, and multivitamin. Discuss to continue OTC regimen upon discharge. Also discharged with zofran. Resting tremors and cogwheel rigidity, maybe concerning for Parkinson disease vs parkinsonism. Recommend following up with neurology outpatient. Brain MRI rule out structural abnormalities. ETOH is probably compounding.    Patient was seen and examined today- he is alert and oriented. He is sitting up comfortably in bed eating breakfast upon examination. Denies chest pain, shortness of breath, abdominal pain. Reports fatigue, weakness, and cough. Denies fevers and chills.  Patient is discharged in stable condition- all labs and imaging reviewed. No concerns at this time. All questions were answered prior to discharge.        ETOH abuse Reports 8 beers daily during the week days and more during the weekend  -CIWA ordered -thiamine, folic acid, multivitamin ordered  Smoker Assessment & Plan Smokes 1/2 daily of cigarettes and marijuana  -Not ready to quick  -nicotine patch during hospitalization ordered     CONSULTS / RECOMMENDATION: PT/OT- home with home health    INPATIENT PROCEDURES: None   BP 112/67  | Pulse 82  | Temp 36.3 °C (Oral)  | Resp 20  | Ht 1.676 m  | Wt 51 kg  | SpO2 92%  | BMI 18.15 kg/m²