Age: 77.0
Sex: M
Vaccine: COVID19
Symptoms: Legionella test, Leukocytosis, Liver function test increased, Lung opacity, Malaise
Clinical narrative: The patient is a 79 y.o. male patient of a DO with history of diabetes mellitus type 2, hypertension, anxiety and depression, gout, and GERD, who presented to the Hospital with shortness of breath and found to have COVID-pneumonia.   3/12: Patient seen and examined.  He was ambulating in the room going to the bathroom.  He said he is feeling better however he is increased oxygen requirement to 4 L per nasal cannula.  Patient desatted to 84% on room air with ambulation and recovered to 91% on 4 L.  Sputum culture growing heavy growth of yeast not cryptococcus started on Diflucan 100 mg IV and will go home on oral for 7 days.  Nausea has improved.  He completed 3 days course of remdesivir.  Patient's daughter at bedside and as the patient if he wants to go home or stay here 1 more day and patient wants to go home and family agrees.  Will discharge patient home on oxygen, DuoNebs, nebulizer ordered, walker, prednisone 40 mg for 5 days and then on March 18 taper down to prednisone 20 mg p.o. daily for another 5 days until March 23.  Patient is to continue with Prilosec before breakfast.  Continue with aspirin.  Will send home on Zithromax to 50 mg p.o. daily for 5 days.  Follow-up with PCP in 1 week.  Home health has been ordered and will be seeing him tomorrow.  Daughter is traveling back tomorrow.     Acute hypoxic respiratory failure COVID-19  pneumonia Sepsis Worsening, now requiring 4 L of nasal cannula Now that AKI resolved will start remdesivir 200 mg IV loading dose and then 100 mg IV daily for 2 more days (3/10-3/12) On remdesivir day #2 On Decadron 6 mg IV daily will increase to 10 mg IV daily Continue with Rocephin and azithromycin Sputum culture grew heavy growth yeast, not cryptococcus Started on Diflucan 100 mg IV daily we will go home on 100 mg p.o. daily for 7 days Legionella antigen and S pneumonia is negative Blood cultures negative so far Date of covid positive test: 3/6/2023 Vaccination status: vaccinated End of isolation 3/16/2023 Presentation with shortness of breath, hypertensive, tachycardia, and hypoxia required oxygen.  I elevated troponin, D-dimer, leukocytosis, normal LA and VBG acceptable.  VQ scan low probability for PE on admission, CXR showed bilateral lung opacities suspecting atypical infection.   patient not candidate to Remdesivir for AKI as GFR less than 30. Daily CMP monitoring   Sepsis Present on admission: yes Etiology: COVID pneumonia  SIRS criteria: Heart rate greater than 90, Respiratory rate greater than 20 or PACO2 less than 32mmHg Evidence of end organ damage: Creatine greater than 2.0 or urine output less than 0.5ml/kg/hr x 2 hrs, SBP less than 90 or MAP less than 65 or SBP drop greater than 40mmHg Initial lactic acid: 1.7 Current antibiotic regimen: Ceftriaxone, azithromycin Culture data: Negative so far Vasopressors/steroids: Dexamethasone 6 mg IV daily Initial sepsis checklist:  ? Lactate WNL ? Blood cultures obtained x?? ? Antibiotics initiated x??  Covid-19 Virus Infection Date of onset of symptoms: 3/7/2023 Symptoms present on admission: SOB, and dizziness  Imaging: CXR showed COVID pneumonia Oxygen requirements on admission: yes Medical therapy: steroids and zithromax, and rocephin  Consultants following: none   Mildly elevated LFTs Elevated AST likely secondary to COVID and sepsis Resolved AST 32 <49 <63 Normal ALT and ALP.   AKI Likely secondary to dehydration and acute COVID-19 infection  Resolved  Creatinine 1.02 admission creatinine 2.3, baseline 1.04.  eGFR 28 and the baseline is 72.     Gentle hydration, monitor.   Avoid nephrotoxic medications.  Monitor   Hyperkalemia Resolved K 4.2 <5.3 <5.6  Patient received already 2 breathing treatment.   S/P Lokelma Monitor   COPD Worsening secondary to COVID-19 Pneumonia  He quit smoking several years ago Currently on oxygen 3 L per nasal cannula Anticipate discharge home on oxygen   Diabetes mellitus type 2 Last A1c 6.6% on 02/17/2023.   Patient on diet control.   Hypertension Patient came in with hypotension 70s/40s. Patient on valsartan will hold for now. Resume it when patient is more stable.   Hyperlipidemia Continue home lovastatin.  Gout Continue home allopurinol.   GERD Continue home Protonix   Anxiety and depression Continue home Zoloft, and Remeron.   Morbid obesity BMI 32.3 kg/M2. Lifestyle modification and weight loss advised