Age: 74.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Alanine aminotransferase normal, Anaemia, Angiogram pulmonary abnormal, Anion gap
Clinical narrative: Hospitalized (1.30.22 - 2.2.22); COVID-19 positive (1.30.22); Fully vaccinated - pfizer x2 Discharge Summary MD (Physician) ? ? Hospital  BRIEF OVERVIEW: Discharge Provider: MD Primary Care Provider: MD Admission Date: 1/30/2022 Discharge Date: Feb 2, 2022    Active Hospital Problems   Diagnosis Date Noted POA ? Stage 3b chronic kidney disease (HCC) 01/30/2022 Yes ? Anemia 01/30/2022 Yes ? Obstructive sleep apnea 01/30/2022 Yes ? Depression 01/30/2022 Yes ? DM (diabetes mellitus) (HCC) 03/10/2015 Yes ? Adenocarcinoma, lung, right identified CT 3/2019 03/20/2019 Yes ? Chronic systolic heart failure (HCC) 12/08/2018 Yes ? Hyperlipidemia 03/10/2015 Yes   Resolved Hospital Problems   Diagnosis Date Noted Date Resolved POA ? Acute hypoxemic respiratory failure due to COVID-19 (HCC) 01/30/2022 02/02/2022 Yes ? Elevated procalcitonin 01/31/2022 02/02/2022 Yes ? Demand ischemia (HCC)    Discharge Disposition:  home or self care    Active Issues Requiring Follow-up:  Pulmonary nodules   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute respiratory failure with hypoxia (HCC)  Nodule of lower lobe of right lung  Acute hypoxemic respiratory failure due to COVID-19 (HCC)  Stage 3 chronic kidney disease, unspecified whether stage 3a or 3b CKD (HCC)  COVID-19   HOSPITAL COURSE: Acute hypoxic respiratory failure on admission was felt to be due to COVID-19 and superimposed bacterial pneumonia.  However it was felt that bacterial pneumonia was more contributory, patient was started on IV ceftriaxone and Zithromax and has completed 3 days.  Oxygen was weaned off and he has remained on room air saturating in the mid 90s.  He was also treated for COVID-19 with IV remdesivir which he has completed 3 days, and he was on Solu-Medrol IV of which he will be discharged with a tapering dose for 5 more days.  He feels much better, doing good on room air, claims cough has resolved, denies chest pain no fever no diaphoresis.  He is advised to follow closely with his family physician on discharge INPATIENT PROCEDURES:   BP 128/97  | Pulse 85  | Temp 36.2 °C (Oral)  | Resp 18  | Ht 1.753 m  | Wt 116.5 kg  | SpO2 92%  | BMI 37.93 kg/m²  FIO2 (%): 85 % Physical Exam HEENT normocephalic atraumatic Neck supple Lungs with good entry bilateral normal respiratory effort Cardiovascular S1-S2 present no murmur Abdomen soft nontender nondistended no guarding no rigidity Extremities no calf tenderness no cyanosis no edema Neurology patient moves all extremities equally cranial nerves are grossly intact  1/30/22 H&P: CHIEF COMPLAINT: Acute hypoxemic respiratory failure due to COVID-19 (HCC  ASSESSMENT / PLAN: * Acute hypoxemic respiratory failure due to COVID-19 (HCC) Assessment & Plan -Unclear duration of s/s; patient tells me few days, also few weeks -Needing 4L NC to maintain sats -CTA no PE, with more asymmetric findings than expected with Covid -Treat for CAP with azithromycin/Rocephin; attempt sputum cx -Also Remdesivir, wt based Solumedrol, mucinex, vit's, PRN albuterol -Proning, IS -Dimer today is 740; ferritin 276, CRP 22.7 -Procalcitonin is 0.55; check blood cultures as well -Is on 2mg Bumex and 80mg Lasix daily; may need to augment with metolazone if respiratory status declines   Stage 3b chronic kidney disease (HCC) Assessment & Plan -Wavers between stages 3a and 3b, today Cr 1.36 with GFR 51 -Monitor with Remdesivir   Chronic systolic heart failure (HCC) Assessment & Plan -Limited echo this month showed EF 20-25%, no apical thrombus -Echo from 2019 with global apical hypokinesis, moderate LV dilation -Also mild MR/TR and grade II diastolic dysfunction -BNP normal today, no effusion/edema on CTA -Continue diuretics (bumex 2mg/Lasix 80mg once daily) -Continue Coreg, statin, Entresto, aspirin, 10meq K daily -Troponin did increase in ED 13 -- > 29; suspect demand etiology; check am   Hyperlipidemia Assessment & Plan -Continue statin   DM (diabetes mellitus) (HCC) Assessment & Plan -A1c was 6.2 earlier this month on metformin -Glucose 117 today, will likely need insulin once steroids received     HISTORY OF PRESENT ILLNESS: Patient is a 75 y.o. male who presents today with shortness of breath and cough for at least a few days. He is a somewhat difficult historian, though is alert/oriented. PMH ischemic systolic heart failure, EF this month 20-25% on Entresto/Bumex/Lasix and s/p AICD, chronic kidney disease 3b, controlled diabetes mellitus, obstructive sleep apnea not on CPAP, right lung cancer s/p RUL lobectomy. He was Covid vaccinated early 2021.    In the ED, he was needing 4L NC to maintain sats, tests (+) Covid. He endorsed chest pain to ED provider, but not to myself. Labs generally unremarkable with stable CKD, normal BNP and troponin 13. Dimer was noted to be slightly elevated 740, so he was sent for CTA chest.    This showed no PE, however, consolidations consistent with atypical pneumonia R > L. He is given Rocephin/azithromycin. Repeat troponin 29. Mild elevated inflammatory markers including procalcitonin 0.55. Blood cultures drawn; he requires admission for treatment of acute hypoxemic respiratory failure d/t Covid.  Review of Systems Constitutional:  Positive for activity change, appetite change and fatigue. Negative for fever.  HENT: Negative for congestion.  Eyes: Negative for visual disturbance.  Respiratory:  Positive for cough and shortness of breath.   Cardiovascular:  Negative for chest pain, orthopnea and leg swelling.  Gastrointestinal:  Positive for diarrhea. Negative for nausea, vomiting, abdominal pain and constipation.  Genitourinary:  Negative for dysuria.  Musculoskeletal:  Negative for joint pain and muscle pain.  Neurological:  Positive for light-headedness and weakness. Negative for loss of consciousness.  Skin:  Negative for rash and wound OBJECTIVE: BP 121/74  | Pulse 92  | Temp 37.2 °C (Oral)  | Resp 22  | Ht 1.753 m  | Wt 116.1 kg  | SpO2 90% Comment: 4L | BMI 37.80 kg/m²  FIO2 (%): 85 % Physical Exam Vitals and nursing note reviewed.  Constitutional:      General: He is not in acute distress.    Appearance: He is well-developed. He is ill-appearing.     Comments: Lying nearly flat in bed; restless, pleasant, somewhat HOH.   HENT:     Head: Normocephalic and atraumatic.     Mouth/Throat:     Mouth: Mucous membranes are moist.  Eyes:     General: No scleral icterus.    Conjunctiva/sclera: Conjunctivae normal.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.     Heart sounds: Murmur heard.  Pulmonary:     Comments: Mild increased work of breathing, but speaks in full sentences. Coarse breath sounds lower fields.  Abdominal:     General: Bowel sounds are normal. There is no distension.     Palpations: Abdomen is soft.     Tenderness: There is no abdominal tenderness.  Musculoskeletal:     Cervical back: Neck supple.     Right lower leg: No edema.     Left lower leg: No edema.  Skin:    General: Skin is warm and dry.     Coloration: Skin is pale.  Neurological:     General: No focal deficit present.     Mental Status: He is alert and oriented to person, place, and time.  Psychiatric:        Mood and Affect: Mood normal