Age: 77.0
Sex: M
Vaccine: COVID19-2
Symptoms: Refusal of treatment by patient, SARS-CoV-2 test positive, Sepsis, Serum ferritin increased, Troponin increased
Clinical narrative: Patient is a 78 year old  male with a history of CLL, CKD stage 3a, T2DM, recent OLH 8/8/23-8/9/23 for neck pain, who presented to hospital 8/11/23 with progressive fever and cough x 2 weeks. Found to have acute hypoxic respiratory failure in setting of COVID-19/concern for CAP, AKI, and acute LLE DVT. Course complicated due to increased O2 requirement. Transferred to ICU 8/15/23 for increasing O2 requirements. Isolation discontinued 8/23/23.    1. Acute Hypoxic Respiratory Failure: In setting of COVID-19, possible CAP, cannot r/o PE though unable to do CTA due to CKD. CXR 8/11/23 with multifocal Pneumonia. On 3L NC in the ED with acute worsening to HHFNC 8/13/23. TTE 8/13/23 with preserved EF and normal RV function. Transferred to ICU for increased O2 demands 8/15/23. Weaned off Oxygen.  Walk test completed before discharge, no hypoxia. Follow up with PCP. 2. COVID-19 Pneumonia with Sepsis: Sepsis present on admission. Presented as above. Was on Oxygen with elevated WBC. Symptom onset ~7/28/23, tested positive on 8/12/23, vaccinated/boosted x2. Elevated CRP, ESR, Ferritin. Supportive care. Afebrile. Decadron x 10 days, started on 8/12/23, completed. Pulmonology followed. Isolation discontinued 8/23/23 per discussion with Infection Prevention Control.  3. Concern for CAP: Presented as above. Imaging as discussed. No sputum production, urine Ag negative. Procal 0.77. Stopped Azithro. s/p empiric IV Ceftriaxone x 7 days, Mucinex.   4. Recurrent Hyperkalemia: patient  states he usually has issues with elevated K+  outpatient due to CKD. K+  5.6 on 8/20/23. s/p IV Lasix. K+  5.6 on 8/21/23. Lasix ordered. K+ 6.0-- >5.3 on 8/22/23. K+ 5.6 on 8/23/23. Received  Lokelma. Resolved. BMP check in 1 week.  5. Fall: morning of 8/24/23. Tripped. Slightly hit head. No external injuries. No change in mental status. REFUSED CT Head. Asked wife to keep a close watch for any mental status changes.  6. Acute LLE DVT: BLEVD 8/12/23 negative for DVT in RLE, acute DVT in the popliteal and one paired peroneal vein. Continued on Eliquis. 8/13/23 TTE did not reveal RV dysfunction. Follow up with PCP for refills. New Eliquis script sent on discharge as no need of starter pack at this time. Coupon- free 1 month. $47 co-pay subsequent.  7. AKI on CKD stage 3a, Hyperkalemia: Baseline Cr ~1.4. Cr uptrend to 1.9-2 with K >5. Concern for urinary retention per wife. IVF deferred due to respiratory status. Held home ARB/hydrochlorothiazide. Bladder US unremarkable. Trending down. Monitored. Resumed home medications on discharge. 8. Elevated Troponin: Due to above. Admit troponin 70, repeat delta -35. ECG  with LBBB (new compared to ECG  2015). No chest pain. TTE as mentioned. 9. CLL: Known history, baseline WBC ~200 but as high as 290 in March 2023, admit WBC 230, follows with Dr (Heme-Onc). Diagnosed in 2011. Not on medication, on observation. Monitored WBC.  10. Acute on Chronic Anemia: Hb  baseline ~9-10, down to 7.9 on 8/13/23, no active bleeding. INR 1.7, on Eliquis for DVT. Monitored.  11. Hypertension: Continued home Norvasc, ARB/hydrochlorothiazide on discharge.   12. T2DM: Known history, A1c 7.2% in 5/2023. Held home orals for Lantus plus SSI while inpatient. Per discussion with Pharmacist, Lantus dose decreased 8/22/23 and stopped 8/23/23. Metformin to be continued on discharge.  13. Code Status: Full, discussed with patient and wife 8/13/23.  14. VTE  Prophylaxis: Eliquis.