Age: 70.0
Sex: F
Vaccine: COVID19
Symptoms: Glycosylated haemoglobin increased, Hyperkalaemia, Hypervolaemia, Hypophagia, Hypotension
Clinical narrative: Pfizer Dose 1 8/10/21 (EW0191) Pfizer Dose 2 9/9/21 (FF2587) COVID Positive 1/25/22 (per pt) COVID Negative 2/5/22 COVID Negative 2/17/22 COVID Negative 2/22/22  2/5/22: This is a 70-year-old female with history of chronic kidney disease stage 3, peripheral vascular disease status post left below-the-knee amputation in the past, type 2 diabetes mellitus, hyperlipidemia, hypertension, morbid obesity, multiple sclerosis in remission and meningioma who was sent from skilled nursing facility due to worsening dyspnea. Patient was diagnosed with COVID-19 about 11 days ago and has been gradually feeling worse. She has dyspnea that seems to be getting worse over the past 2 days. She has no associated chest pain, abdominal pain, nausea, vomiting, diarrhea, constipation or fever. Patient was most recently admitted on 11/20/2021 and was discharged on 11/29/2021 for respiratory distress, healthcare acquired pneumonia, altered mental status, catheter associated urinary tract infection and bacteremia.   In the emergency department, patient was initially hypotensive with blood pressure of 83/33 and was hypoxic. She was put on 2 L of O2 via nasal cannula. Patient received IV fluids and her repeat blood pressure was 138/115. Labs showed a sodium of 123, potassium of 7.1, creatinine of 3.45, WBC count of 14, platelets of 514. Chest x-ray showed left basilar atelectasis or infiltrate. Patient was given nebulizer treatment, IV fluids, a dose of IV insulin, azithromycin and Rocephin, calcium gluconate and sodium bicarbonate.  2/14/22: Patient is a 70-year-old female with a history of MS, morbid obesity, T2 DM, left BKA and recent COVID-19 infection presented with SOB.   In the emergency department, patient was initially hypotensive with blood pressure of 83/33 and was hypoxic. She was put on 2 L of O2 via nasal cannula. Patient received IV fluids and her repeat blood pressure was 138/115. Labs showed a sodium of 123, potassium of 7.1, creatinine of 3.45, WBC count of 14, platelets of 514. Chest x-ray showed left basilar atelectasis or infiltrate. Patient was given nebulizer treatment, IV fluids, a dose of IV insulin, azithromycin and Rocephin, calcium gluconate and sodium bicarbonate.   Patient was admitted for fluid overload, AKI, severe hyperkalemia and left-sided infiltrate concerning for pneumonia.  Nephrology was consulted.  Patient was started on a Bumex drip. Renal function continue to improve. Foley was removed and patient had good urine output. Creatinine is back to baseline.  Patient was treated with IV antibiotics.  Patient has remained on room air and afebrile.   During hospitalization, her blood sugar is persistently elevated since admission despite being on Lantus 22 units with sliding scale.  However hemoglobin A1c is only 7.3% which is quite fine considering her multiple mobile comorbidities and she is non-ambulatory.  Patient reports that in nursing home she does not eat the food and hardly take any insulin.  Discussed with patient that we will discharge her on Lantus and sliding scale.  Discussed the risk of hypoglycemia in the need to monitor.  Discussed the need to increase her oral intake.  Patient has verbalized understanding.  Patient to follow-up with PCP.