Age: 39.0
Sex: M
Vaccine: COVID19
Symptoms: Hyperkalaemia, Hypochloraemia, Hyponatraemia, Intensive care, Leukocytosis
Clinical narrative: Date of Admission  01/16/2022   Date of Discharge  01/18/2022   Reason for Hospitalization   pt reports having nausea, vomiting and chest pain starting 2 days ago. pt denies fevers and chills.  Hospital Course   Patient is a 39 year old male with a past medical history of diabetes mellitus type 2, cyclic vomiting syndrome, gastroparesis, hypertension, obesity and GERD who presented to the ED on 1/16 for several days of worsening nausea and vomiting. Upon arrival to the ED, patient was tachycardic and tachypneic. CBC revealed leukocytosis. CMP showed hyponatremia, hyperkalemia, hypochloremia, hyperglycemia, elevated BUN/Cr, and hypercalcemia. Patient was given 2 1L NS bolus, 10mg IV metoclopramide, 8mg IV zofran, 1000mg IV calcium gluconate, and was started on an insulin drip. Medical office was consulted for admission for presumed HHS and he was brought up to the withheld. He got 1 more NS bolus before lactic acid normalized. BMPs were trended q4hrs. Once blood glucose began to normalize and oral intake was tolerated, he was transitioned from insulin drip to his home subQ insulin regimen and was moved to the floor. Incidentally, COVID PCR from admission was noted to be positive, but patient remains asymptomatic. On day of discharge, he was hemodynamically stable, tolerating oral intake and home medications. Ordered follow up BMP for 1/26, follow up with PCP Dr. in 14 days, and follow up with endocrinology in 1 month. Encouraged 10 total days of isolation ending 1/26.  Discharge Diagnoses      HHS, resolved  Nausea/Vomiting, resolved  s/p insulin gtt  tolerating oral intake and subQ insulin  restarted home insulin regimen:    -20u degludec in am, 25u degludec in pm    -20u aspart at breakfast, 15u at lunch, and 15u at dinner  follow up with Dr.  in 14 days (after 1/26 when isolation ends)  follow up with Endocrinology in 1 month  AKI, improving  Hyperkalemia, resolved  Hyponatremia, improving  -intake improved  -follow up BMP on 1/26  COVID-19 (+)  -PCR positive on 1/16  -asymptomatic  -should remain isolated for 10 days [ending 1/26]  Other Diagnoses   Ongoing  Abdominal pain  BMI 31.0-31.9,adult  Chronic headaches  Constipation  Cyclic vomiting syndrome  Dehydration  DM (diabetes mellitus), type 2, uncontrolled  Elevated ALT measurement  Elevated AST (SGOT)  Gastroparesis  GERD (gastroesophageal reflux disease)  Hypertension  Indigestion  Insulin dependent type 2 diabetes mellitus  Nausea and vomiting  Obesity  Operations and Procedures   none  Consultants   none  Pending Labs  Blood Culture (Preliminary, InProcess, ordered 01/16/2022, 21:08)   -NGTD @ 48 hrs on day of discharge   Ordered BMP for 1/26  Discharge Disposition  home  Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  amitriptyline (amitriptyline 50 m 75 mg, 1.5 Tablet(s), Oral, At Bedtime, 135 Tablet(s), 2 Refill(s)    docusate (docusate sodium 100 mg) 100 mg, 1 capsule(s), Oral, bid, 60 capsule(s), 11 Refill(s)    insulin aspart (NovoLOG insulin F See Instructions, 20 units Subcutaneous before breakfast, 15 units subq before lunch and dinner  Instructions:20 units Subcutaneous before breakfast, 15 units subq before lunch and dinner  insulin degludec (Tresiba insulin See Instructions, 20 units qam 25 units qpm  Instructions:20 units qam 25 units qpm  lisinopril (lisinopril 5 mg) 5 mg, 1 Tablet(s), Oral, Daily, 90 Tablet(s), 3 Refill(s)    metoclopramide (metoclopramide 5 5 mg, 1 Tablet(s), Oral, PC & Bedtime, 120 Tablet(s), 11 Refill(s)    ocular lubricant (Systane) 1 Drop(s), Each Eye, qid, PRN: Dry Eyes, 0 Refill(s)    ondansetron (ondansetron 4 mg) 4 mg, 1 Tablet(s), Oral, q8h, Alternating with promethazine q4 hours, PRN: Nausea/Vomiting  Instructions:Alternating with promethazine q4 hours  pantoprazole (pantoprazole 40 mg 40 mg, 1 Tablet(s), Oral, Daily, 30 Tablet(s), 11 Refill(s)    promethazine (promethazine 12.5 m 12.5 mg, 1 Tablet(s), Oral, q8h, Alternating with Zofran q4 hours, PRN: as needed for nausea/vomiting  Instructions:Alternating with Zofran q4 hours    Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.5 °C  TMIN: 36.5 °C  TMAX: 37.7 °C  HR: 118  RR: 20  BP: 147/82  SpO2: 98%  WT: 81.1 kg  BMI: 28.7      General: well appearing, Asian male of appropriate age, resting comfortably in his bed on 4W Head: normocephalic, atraumatic Eyes: sclera white. conjunctiva pink and moist. Extraocular movements intact. Mouth/Throat: mucosa pink and moist. Dentition healthy. Chest: Palpation without tenderness. Good symmetric expansion. Good breath sounds bilaterally. Chest is clear. Cardiac: tachycardic with normal rhythm. Normal s1 and s2. Abdomen: flat, bowel sounds present. soft and nontender to palpation Musculoskeletal: cupping marks noted on back Neuro: Patient is alert and oriented to person, place, time, and situation. Speech is normal. Psych: flat affect. limited responses to questioning Derm: warm and pink.  Follow Up Appointments     Follow Up Appt, Clinic Name/Phone: withheld, Provider Name: withheld, Within 14 Days, No tests, Reason for Exam hospital discharge f/u, N/V, Comments please schedule appointment after 1/26/22 due to COVID   Follow Up Appt Medicine Endocrinology, Clinic Name/Phone: withheld Provider Name: withheld, Within 1 Month, No tests, Reason for Exam last seen 5/2021, uncontrolled DM, Comments please schedule after 10 days from hospital discharge on 1/18    Appointment Type  When  With  Where  Contact Information  Status   RT1 03/03/2022 02:00 PM  Retina confirmed    Nursing/Other Orders   Regular Diet. Ordered on 01/17/22 13:40:00, Meal Start Time Lunch 1115 to 1245   Intake and Output (I&O). 01/16/22 21:48:00, Continuous Order   Activity As Tolerated. 01/16/22 21:48:00, Continuous Order   Code Status. Code Status Description: Full Code    Attestation by withheld on January 18, 2022 13:47 I have verified the student note and corrections have been made as necessary. I agree with the contents of this note. I independently performed a physical exam and the medical decision-making portion of this service.       Addendum by withheld on January 22, 2022 11:20:50 (Verified)    Attestation by withheld on January 22, 2022 11:20 I personally saw and evaluated the patient on the result date found in the header of this document.  I independently performed the critical/key portions of the Evaluation and Management service and discussed the management with the author of this document.  I agree with everything documented above with the following exceptions/additions:    None - agree with D/C - HHS resolved.  Asymptomatic Covid.  Education and warnings given.