Age: 78.0
Sex: M
Vaccine: COVID19, COVID19, COVID19, COVID19, COVID19, COVID19
Symptoms: Sinus bradycardia
Clinical narrative: Discharge Disposition:  SNF   Medications, instructions, follow up information: See patient Discharge Instructions/AVS.   Hospital Course and Significant Findings: Mr. is a  81 Y male with known pituitary adenoma/secondary hypothyroidism, cognitive decline, HTN, recent hospitalization (6/2/2023 -6/14) with subsequent transfer to SNF, now presenting from day of discharge from the SNF with AMS and weakness. He was found to be COVID-19 started on Remdesivir. Sodium found toi be 126 and was started on salt tablets and IV saline.Nephrology consulted for hyponatremia and he was started on hypertonic saline. Sodium levels improved to the 130s. Endocrinology recommended transition the patient off of intravenous hydrocortisone and change to hydrocortisone 45 mg po qam and 15 mg po q afternoon for a total of 3 days. After that 3-day timeframe, the patient can resume his standard hydrocortisone dose of 15 mg every morning and 5 mg every afternoon. He improved clinically with treatment. Patient with baseline cognitive decline, however, mentation improved during hospitalization. He was found to have bradycardia down to high 30s. Remained asymptomatic, EKG sinus bradycardia. Cardiology consulted and no interventions needed given COVID status, lack of symptoms, and EKG findings. Heart rate improved to 50s and patient remained asymptomatic. At time of discharge, patient was on room air, he was medically stable for transfer to SNF. He will need to continue sodium tablets and 1.5L fluid restriction with repeat BMP. Follow-up outpatient with PCP, Endocrinology.    Primary Procedures:  None   Secondary Procedures: None   Reason for Hospital Admission (Admitting Diagnosis):  COVID-19 Hyponatremia   Complications: none   Consults:  HOSPITAL MEDICINE - INITIAL INPATIENT CONSULTATION. HOSPITAL MEDICINE - ONGOING INPATIENT CONSULTATION. Smoker: No.   Condition on Discharge: stable   Code Status at Time of Discharge: Full Code     Note Details  Author (M.D.) File Time 7/10/2023  4:05 PM Author Type Physician Status Addendum Last Editor (M.D.) Specialty Hospital Medicine Hospital Acct # Admit Date 7/2/2023  ED to Hosp-Admission (Discharged) on 7/2/2023  ED to Hosp-Admission (Discharged) on 7/2/2023   Revision History   Detailed Report  Note shared with patient Additional Orders and Documentation   Results Imaging   Meds    Orders    Flowsheets   Encounter Info:  History, Allergies, Education, Care Plan, Detailed Report   Hospital Problem List   ESSENTIAL HTN  SECONDARY HYPOTHYROIDISM  ADRENAL INSUFFICIENCY, UNSPECIFIED  ALTERED MENTAL STATUS, UNSPECIFIED  PITUITARY MACROADENOMA  URINARY RETENTION  HYPONATREMIA Care Timeline  07/03   Admitted from ED (Observation) 0105 07/04   Admitted 0927 07/10   Discharged 1840  Discharge   SNF - Skilled bed (or Subacute)   SNF Orders (Printed 7/10/2023)   Discharge Orders BICARBONATE BUN CBC + DIFF (AT REG LAB). CHLORIDE CREATININE W GFR, CALCULATED GLUCOSE MAGNESIUM POTASSIUM SODIUM Medication List at Discharge   ascorbic acid 500 mg Oral DAILY  bisacodyl 10 mg 1 Suppository Rectal DAILY AS NEEDED, . Use as 2nd line treatment if 1st line treatment is ineffective  chlorhexidine gluconate 0.12 % 15 mL Mucous Membrane EVERY 12 HOURS  cholecalciferol (vitamin D3) 1,000 Units Oral DAILY  docusate sodium 250 mg Oral DAILY, for bowel regularity. Hold for loose stools  heparin sodium,porcine 5,000 Units Subcutaneous EVERY 12 HOURS  hydrocortisone 5 mg Take 3 tablets by mouth every morning with a meal AND 1 tablet every afternoon.  hydrocortisone sodium succ/PF 100 mg intraMUSCULAR  AS NEEDED, . For self administration  levothyroxine sodium 75 mcg Oral EVERY MORNING  magnesium hydroxide 400 mg/5 mL 30 mL Oral DAILY AS NEEDED, . Hold if creatinine is greater than 2.5. Use as 1st line medication  melatonin 3 mg Oral EVERY BEDTIME AS NEEDED  multivitamin,therapeutic 1 tablet Oral DAILY  omega-3 fatty acids 1,000 mg Oral DAILY  sennosides   8.6 mg Oral EVERY 12 HOURS AS NEEDED  8.6 mg Tab, Take 1 tablet by mouth with each narcotic dose for bowel regularity. Do not exceed 8 tablets in 24 hours. Hold for loose stools  sodium chloride 1 g Oral 3 TIMES A DAY  syringe w-needle,disposab,3 mL 3 mL 23 x 1" Use for injection as directed  tamsulosin HCl 0.4 mg Oral DAILY