Age: 69.0
Sex: F
Vaccine: COVID19
Symptoms: Occult blood negative, PCO2 normal, PO2 decreased, Platelet count normal, Prohormone brain natriuretic peptide increased
Clinical narrative: Pfizer Dose 1 2/25/21 (EN6198) Pfizer Dose 2 3/18/21 (EN6207) COVID Positive 1/13/22  1/13/22: The patient is a 70-year-old female with a past medical history significant for COPD on 2 L home oxygen, depression GERD hyperlipidemia hypertension.  The patient was brought to the hospital with a chief complaint of fall. According to the patient she fell at 4:00 p.m. on 01/12/2022.  She states that she felt a little dizzy and fell to the floor denies losing consciousness or hitting her head anywhere.  Denies any bleeding from any site at this current point in time.  States that she has had episodes of dizziness and fold in the past as well.  She states that she lives by herself and she has help that comes approximately 3 times a week.  She was found on the floor of her house by the help.  Patient states that she is compliant with her medications.   At this current point in time she denies any fevers chills headache blurry vision dizziness lightheadedness shortness of breath cough chest pain abdominal pain nausea vomiting diarrhea constipation.   Family history:  Reviewed and noncontributory.   In the emergency department the patient's heart rate was 97 respiratory rate was 20 pulse ox was 94% on 2 L nasal cannula oxygen and blood pressure was 123/57.  The patient's sodium was 126 potassium 4.4 chloride 90 CO2 25 anion gap 11 glucose 112 BUN 6 creatinine 0.48 ALT 34 AST 206 alkaline phosphatase 146 T bili 0.4 albumin 4.2 patient's calcium was 9.2 lactic acid was 2.0 proBNP was elevated at 8 871.  CK was more than 20,000 and troponins were less than 0.01.  Patient's urine sodium was 54 and urine creatinine was 81. On VBG the patient's pH was 7.4 pCO2 was 48 PO2 was 35 bicarb was 30.  Stool occult blood was negative.  Patient's white blood cell count was 9.0 hemoglobin 13.6 hematocrit 39.7% platelets were 242. Urinalysis showed protein urea.  Nephrology was consulted while the patient was in the emergency department.  In the emergency department the patient was given Tylenol 1000 mg 1 time, Flexeril, Toradol, 1 L of lactated Ringer's injection, morphine.  1/19/22: Patient is a 70-year-old female with a past medical history significant for COPD chronically on 2 L nasal cannula oxygen came with a chief complaint of fall and hyponatremia.  Patient had various imaging conducted which showed no acute fracture CT of the head was negative. During her hospitalization it was found out the patient has hyponatremia nephrology was consulted recommended fluid restriction along with Lasix and gentle IV hydration. Patient's hyponatremia status improved.  Patient also had rhabdomyolysis due to the fall.  CK levels improved.  Also patient was diagnosed to be COVID-19 positive but remained on her home demand of 2 L nasal cannula oxygen.  Also there is right middle lobe atelectasis for which Mucinex 1200 mg p.o. b.i.d. was added along with chest physiotherapy.  On 01/19/2022 patient stated that she would like to be discharged home and stated that she will refuse to participate in any care on 01/19/2022.  This was discussed with the patient's granddaughter and she agrees to take the patient home.  Patient was discharged the hospital on 01/19/2022 in a stable medical condition on 01/19/2022.  Patient was discharged with COVID safe at home program along with VNA services.  Also patient was instructed to follow-up with PCP in 1-2 days and repeat BMP in 2 days.