Age: 77.0
Sex: F
Vaccine: COVID19
Symptoms: Lactic acidosis, Malnutrition, Metabolic acidosis, Metabolic encephalopathy, Multiple fractures
Clinical narrative: HOSPITALS Discharged as Deceased Summary  BRIEF OVERVIEW: Discharge Provider: DO Primary Care Physician at Discharge: DO Admission Date: 12/30/2024  Active Hospital Problems   Diagnosis Date Noted POA ? Septic shock 12/31/2024 Yes ? Fecal impaction of colon 12/31/2024 Yes ? Shortness of breath 12/31/2024 Yes ? COVID-19 12/31/2024 Yes ? Lactic acidosis 12/31/2024 Yes ? High anion gap metabolic acidosis 12/31/2024 Yes ? Elevated troponin 12/31/2024 Yes ? Elevated brain natriuretic peptide (BNP) level 12/31/2024 Yes ? Acute hypoxic respiratory failure 12/31/2024 Yes ? Acute metabolic encephalopathy 12/31/2024 Yes ? Normocytic anemia 12/31/2024 Yes ? End of life care 12/31/2024 Unknown ? Gastroesophageal reflux disease without esophagitis 08/29/2024 Yes ? Unspecified severe protein-calorie malnutrition 08/23/2024 Yes ? Generalized anxiety disorder 05/09/2024 Yes ? Parkinson's disease with dyskinesia 04/10/2024 Yes ? Gait instability using walker 04/10/2024 Yes ? Rheumatoid arthritis 04/02/2024 Yes ? Essential hypertension 02/29/2012 Yes ? Hyperlipidemia, unspecified 02/29/2012 Yes  Resolved Hospital Problems No resolved problems to display.  Pre-Existing Active Problems   Diagnosis Date Noted POA ? Fall, subsequent encounter 08/29/2024 Unknown ? Multiple fractures 08/29/2024 Unknown ? Acute cystitis with hematuria 08/29/2024 Unknown ? Fall at home, initial encounter 08/22/2024 Unknown ? Chronic pain of left ankle 07/17/2024 Unknown ? Gross hematuria 05/06/2024 Unknown ? Other conjunctivitis 05/06/2024 Unknown ? Blepharoconjunctivitis of both eyes 04/11/2024 Unknown ? Peripheral polyneuropathy 04/10/2024 Unknown ? Hyponatremia 04/10/2024 Unknown ? Hypomagnesemia 04/10/2024 Unknown ? Closed nondisplaced fracture of body of right calcaneus with routine healing 04/02/2024 Unknown ? Senile osteoporosis 04/02/2024 Unknown ? Current moderate episode of major depressive disorder without prior episode 01/30/2020 Unknown ? Hilar lymphadenopathy 09/11/2019 Unknown ? Lung mass 08/13/2019 Unknown ? Osteoarthritis of multiple joints 11/29/2018 Unknown  Preliminary Cause of Death: Acute on chronic respiratory failure, Aspiration pneumonia   Discharge Disposition: Deceased  DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Septic shock [A41.9, R65.21] Respiratory failure [J96.90] End of life care [Z51.5]  HOSPITAL COURSE: Patient was an 81 y.o. female with a past medical history of  anxiety, hypertension, rheumatoid arthritis, Parkinson's disease and severe protein calorie malnutrition who presented to the hospital on 12/30/24 with complaints of shortness of breath from her assisted living facility.  Pt was admitted to CCU.  Pt found to be septic with lactic acidosis thought to be due to pneumonia. Pt covid + but most CT findings more consistent with bacterial pneumonia. Chronic aspiration suspected.  She was started on broad spectrum antibx (zosyn/vanco) as well as remdesivir and decadron for covid.  She required norepi for BP support and high flow NC for hypoxic resp failure.  On 1/1/25, physician discussed GOCwith pt's husband and dtr and decision made to change goal of care to comfort focused care.  On 1/2/25, pt was minimally responsive. She had increased work of breathing at rest and was grimacing despite a recent dose of ativan. Comfort plan discussed with dtr at bedside and  Morphine gtt was started for uncontrolled dyspnea. Pt was evaluated by hospice and admitted as GIP.  She appeared comfortable after a few hours on morphine infusion.  Overnight, dtr expressed being uncomfortable with plan for comfort focused care and requested that antibx be restarted. Zosyn and Vanco were restarted.  The pt died 1/3/2025 with family at bedside.