Age: 25.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Blood bilirubin abnormal, Blood culture, Blood fibrinogen, COVID-19, Computerised tomogram abdomen abnormal
Clinical narrative: 7/22--presently admitted Patient is a 27-year-old female with history of alcohol use disorder who was transferred due to concern for acute liver failure, incidentally found to be COVID-positive. The patient has been drinking since high school, but increase use over the last 3 years drinking up to half 1/5 of liquor per day. She was admitted in May 2022 for alcohol-related pancreatitis and unfortunately continued to drink. Last drink of alcohol was 16 days ago per patient. No history of IV drug use, DUI, or jail time related to alcohol use. Has some anxiety, but no other psychiatric disease. Currently, her labs are suggestive of alcoholic hepatitis with elevated AST greater than ALT and significant hyperbilirubinemia. CT scan showed hepatic steatosis and ascites, but no overt cirrhosis. Due to ascites, concern for portal hypertension and possible underlying cirrhosis.  We will complete work-up for other causes of chronic liver disease. She is hyponatremic, likely hypovolemic, giving albumin. IV vitamin K for elevated INR. Counseled on the need for complete alcohol abstinence and enrolling in relapse prevention. Discussed the potential need for liver transplantation. ID consulted for COVID, on room air and asymptomatic. Does have leukocytosis, possible related to alcoholic hepatitis and COVID. 7/23/22- NAD. Afebrile. VSS. Labs reviewed and stable. Paracentesis done 7/22/22. Negative for SBP. Blood cxs pending. Trend LFTs daily. Check for autoimmune hepatitis and viral panel. Avoid NS and consider albumin instead. Correct coagulopathies if required per GI. Optimize diet. Trend INR and continue vit K x 3 days. COVId 19 tx per ID. DVT and GI proph.  7/24/22- ID on board for COVID 19 infection . Leukocytosis worsening. Off abx. Follow ID recs. S/p paracentesis with neg SBP. Blood cxs pending. LFT still elevated but slightly trending down. INR tredning down with Vit K x 3 days total. Liver transplant eval next week. Replace K prn and monitor lytes daily. Pain management. GI and DVT proph.  7/25/22- Pt feels some abd distension but not significant. Repeat paracentesis planned. Optimize nutrition. Use albumin instead of NS bolus. Transplant SW to discuss with patient candidacy for liver transplant. Monitor LFts and bili daily. Correct coagulopathy if needed. Monitor INNR, PLT and fibrinogin daily. Monitor WBC count. ID on board. Off abx currently.    7/26/22- No new complaints. Pending repeat paracentesis. Pt does not meet criteria for liver transplant at this time. LFTs and bili worsening. Will continue to trend.Correct coagulopathy if needed. Monitor INNR, PLT and fibrinogin daily. Monitor WBC count. ID on board. Off abx currently. DVT and GI proph.  7/27/22- Pt reports slight abdominal discomfort. Hepatology on board. Repeat paracentesis. LFTs and bili worsening. Continue to trend. INR 2.2. Leukocytosis stable. Continue off antibiotics. LE US and CTA PE pending.  7/28/22- Pt with no new symptoms since yesterday. Fever spike noted this AM. ID c/s. Repeat cxs. Repeat paracentesis with fluid cultures. Continue covid isolation. LFTs and bili worse today. Continue to trend. LE US and CTA PE negative for clots on 7/27/22  7/29/22- Pt with tmax 99.9 in the last 24 hrs. WBC count has been trending up. S/p paracentesis on 7/29/22 with 9.2 L of dark yellow fluid. Fluid cultures pending. In the meantime has started broad spectrum abx. ID following. Will continue to trend vitals and labs daily. Pt deemed not a candidate for liver transplant. Continue COVID precautions.   8/1--Discontinue w/Isolation. Stopped Hydration, added lasix for LE swelling and edema. Nephro consult for hyponatremia/hypocalcemia. Medications, Labs, Imaging Reviewed. Resume Ordered Home Medications 8/2/22- COVID isolation discontinued 8/2/22. Nephro on board for hyponatremia and diuresis. Lasix dose increased. Replace potassium and lytes prn. Trend AM labs. Hepatology following for liver failure. Peritoneal fluid + GBS. Long term antibiotic ppx needed.  8/3/22 - Pt feels better in regards to edema and distension. Repeat therapeutic paracentesis pending. Trend LFTs. Hepatology on board. Long term abx ppx for SBP per hepatology. Continue IV lasix and album. 8/4/22- Pt feels better. Abdomen still distended. Paracentesis pending. Trend LFts and bili. Hepatology on board. SW transplant to speak to pt today and update on transplant candidacy. Continue lasix. Replace lytes and monitor.