Age: 54.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Malaise, Meningitis, Mental status changes, Metabolic encephalopathy, Multiple sclerosis
Clinical narrative: Hospitalized (12.12.21 - still admitted); COVID-19 positive (12.13.21); fully vaccinated  On Admission:   Brief History and Medical Decision Making:  Patient is a 55 yrs female who is admitted with altered mental status likely secondary to multifactorial etiology.  Patient has a history of multiple sclerosis with bilateral lower extremity weakness and has a known cognitive decline.  Patient resides at a nursing facility.  She tested positive for COVID-19 pneumonia few days ago.  Patient was reportedly not taking her medications at the facility and was nauseated.  She developed altered mental status and fever which prompted her to be evaluated at the emergency department.  As per chart review patient with known cognitive decline however is oriented x4 at baseline. On admission CT head was done which was negative.  Chest x-ray showed bilateral pneumonia.  Labs showed hyponatremia with sodium 150. Patient's UA was positive for urinary tract infection.  Rocephin, azithromycin And vancomycin likely for community-acquired pneumonia and urinary tract infection.  Will continue with IV Rocephin for urinary tract infection at this time.  Patient currently on room air.  Received 1 dose of dexamethasone 6 mg IV for COVID-19 pneumonia treatment. Patient's altered mental status likely secondary to dehydration from COVID-19 infection and urinary tract infection.  Sodium levels improving with D5W infusion.  Will continue to monitor BMP and discontinue D5W 1 sodium levels within normal range.  Continue with IV Rocephin for urinary tract infection.  Will follow-up urine culture results and blood cultures.  Continue dexamethasone for COVID-19. Progress Note from 12.21.21: CHIEF COMPLAINT: Encephalopathy ASSESSMENT / PLAN: Principal Problem:   Encephalopathy Acute metabolic encephalopathy- improving Chronic encephalopathy secondary to MS and/or microvascular dementia - CT head negative for acute changes in ER - Etiology of acute worsening likely secondary to electrolyte abnormalities and infection. Meningitis suspected - MRI brain obtained due to hx of MS, showing no acute ischemic infarction, altho intracranial volume loss greater than expected for age, and T2 hyperintensity within supratentorial white matter possibly related to MS versus chronic microvascular changes. Discussed with Neurology and MRI appears stable with no concern for MS flare.  - Neurology consulted, recommend continuing empiric antibiotics for meningitis at this time, but no indication for LP given that patient is improving and that daughter states she usually becomes confused like this when she is ill.  -Continue ceftriaxone/ampicillin for 10 day course, and vancomycin for total 7 days (ends after today). Day 7/10 abx today - gabapentin and norco resumed (for PN) -psych states no apparent psychiatric pathology Dysphagia-oropharyngeal - barium swallow 12/20/21-pt unable/unwilling to swallow contrast.  -Corpak placed 12/20/21-pt dislikes it, needs wrist restraints.  COVID 19 PNA-resolved CXR bilateral COVID 19 PNA Tested Positive 12/8/21 Remains on room air.  Did not qualify for monoclonal antibodies. Consider starting decadron and remdesivir if patient becomes hypoxic and requires oxygen. AC on eliquis Supportive care