Age: 72.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Decreased appetite, Dehydration, Dyspnoea, Fatigue, Gout
Clinical narrative: Hospitalized twice (9.13.21; 9.2.21).  Currently hospitalized.  (9.13.21) COVID-19 positive (9.2.21);  fully vaccinated  Admission Date: 9/2/2021 Discharge Date: 9/7/2021  Discharge Disposition:  home or self care      Active Issues Requiring Follow-up: COVID 19 infection: follow up with PCP CKD stage IV: follow up nephrology DM2: follow up PCP Supratherapeutic INR: follow up coumadin clinic  Possible OSA: follow up with PCP for overnight pulse oximetry test    DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COVID-19 [U07.1] Pneumonia due to COVID-19 virus [U07.1, J12.82]   HOSPITAL COURSE: Per H&P: "Patient is a 72 y.o. male  who presents to hospital with weakness and difficulty breathing. The patient is known to have history of multiple comorbidities including aortic insufficiency with status post aortic valve replacement, asthma, chronic systolic congestive Heart failure with left ventricular ejection fraction 21%, GI bleed in the past, coronary artery disease, hypertension, benign prostatic hypertrophy, pulmonary hypertension, chronic kidney disease stage IV rheumatic fever, and diabetes mellitus type 2. In the last few days, the patient has been feeling weak, experiencing fatigue and some difficulty breathing.  Recently he attended a wedding in Oregon and 2 days afterward he started to have fever, chills, and diaphoresis.  He felt his taste has changed and his appetite declined.  He was presented to the emergency department for evaluation and his COVID-19 PCR rapid test came back positive.  In February 2021, the patient had his to initial vaccines of Pfizer. The patient chest x-ray showed patchy pulmonary parenchymal opacities bilaterally and mostly prominent adjacent to the left hemidiaphragm again.  In the emergency department, the patient was tachypneic and with ambulation his oxygen saturation dropped down to 86% on room air.  The patient was admitted to the hospital for further evaluation treatment."   Patient quickly recovered in regards to his COVID infection. Patient would occasionally require O2 but was adament that he occasionally drops his O2 due to his CHF and pulmonary disease history. Patient was treated with dexamethasone while inpatient. Other issues addressed:    DM type 2 with hyper and hypo glycemic events- patient has his own way of treating diabetes at home that seems to work for him per patient and wife. At one point in his hospitalization he was hyperglycemic due to his steroid use. BB scale was increased, then because he was having high blood sugars patient didn't eat a snack following his SSI dose. He then had one low BG and refused to take insulin at all the next day. Prior to discharge patient was placed back on his BID lantus dose and BG seemed to be improved.    Hyperkalemia: resolved   AKI on CKD IV: patient was mildly dehydrated throughout stay. Prior to discharge I did give him one 500 cc bolus which did bring creatinine down to normal. I requested that patient not take his diuretics at home if he is not eating/drinking normally. Patient tells me that he weighs himself every day and gives himself dose range of demdex based on his weight. Patient has an outpatient visit with nephrology scheduled for this month.    Supratherapeutic INR: Patient was not treated with vitamin K on admission as he had no signs of bleeding. Patient's coumadin was held all 5 days but INR remained in the 4.2-5 range. Patient states that he has a INR machine at home and he is willing to hold his coumadin dose until his INR floats within a normal range. He will also call coumadin clinic tomorrow and discuss results.    Readmission on 9.13.21: HISTORY OF PRESENT ILLNESS: Patient is a 73 y.o. male who presented last night for evaluation of increasing shortness of breath and cough productive of thick sputum. He was recently hospitalized for COVID-19 and felt well for 1-2 days after discharge. Unfortunately, symptoms re-emerged and have become unbearable in the past 36-48 hours. Denies chest pain. Afebrile. PO intake has been limited and has not had a bm in 4-5 days. Urinating well.   In the ER< he was hypoxic and had increasing o2 demands. Imaging showed extensive bilateral patchy airspace disease c/w COVID-19 and showed extensive mucous plugging. No CTA obtained due to poor renal function. Empiric antibiotics were started by the ER provider. Troponin elevated but no chest pain.