Age: 69.0
Sex: F
Vaccine: COVID19
Symptoms: Abdominal pain, Acute myocardial infarction, Angiogram abnormal, Anticoagulant therapy, Blood loss anaemia
Clinical narrative: Patient is a 69-year-old female with a past medical history significant for type 2 diabetes, hypertension, RA, GERD who presented from a rehab facility with fevers, hypotension, tachycardia and diarrhea.  This is the patient's third hospitalization in the last month.  She was initially admitted on 5/4/2021 for she suffered to syncopal episodes resulting in a motor vehicle accident x 2.  From 5/4-5/6.  During that admission her gabapentin dose was decreased and she was given 5 days of Macrobid on discharge for a possible urinary tract infection.  We also arrange follow-up with cardiology for loop recorder and to see orthopedics as an outpatient the etiology for her syncopal episode was unclear.  It was not felt to be seizure related.  She went home with home health care.  She unfortunately was readmitted on 5/29-6/3 new onset acute pancreatitis with an unknown etiology and was ultimately discharged to rehab.  During that hospitalization patient reported that she was seen by cardiology for her 2 syncopal episodes that occurred earlier in the month and a cardiac cause of her syncope was ruled out and they recommended she be referred to neurology.  She returns back again for admission on 6/8 for encephalopathy, hypotensive, septic shock, NSTEMI and was subsequently admitted to the intensive care unit on pressor support.  She was given Cipro, Flagyl, Vanco and Levophed and IV fluids.  Her septic shock was felt secondary to urinary tract infection.  The urine culture that was resulted on 5/30 grew Klebsiella pneumonia that was resistant to Macrobid.  She was not sent out on any antibiotic therapy as she was not felt to be symptomatic during her last hospital course.  She also had a CAT scan during this hospital course which showed colitis.  Urine culture from this admission was of mixed flora Greater than 100,000 colony-forming units no organisms were grown out however.  She was treated with 7 days of Cipro.  Again patient's CAT scan of the abdomen and pelvis done on admission showed colitis she was seen by gastroenterology during her hospital stay and underwent an endoscopy.  It was ultimately felt that the patient's colitis was likely ischemic in nature.  Patient was also noted to be thrombocytopenic on admission which was felt to be possibly from sepsis or dilution was ultimately resolved at the point of discharge.  She also again was found to have acute blood loss anemia with no source found.  she had hematochezia noted on admission but resolved by the point of discharge.  EGD did not reveal any source of bleeding other than a tiny esophageal ulcer.  Aspirin therapy was discontinued.  She did not need transfusion during her hospital stay.  The lowest her hemoglobin went was to 7.3.  Patient's acute tubular necrosis resolved her metabolic acidosis and metabolic encephalopathy resolved and at this point she is stable for discharge to rehab.  Patient's lisinopril aspirin, hydrochlorothiazide have been discontinued at this point.  Her blood pressure is 121/61 she is afebrile respirations are normal O2 sat is 95% on room air.  Patient's hemoglobin  is 8.1.  She is no longer having an abdominal pain and is tolerating p.o.  She is not having any diarrhea.   the cause for the patient's colitis is likely ischemic in nature.  she was discharged to rehab on 6/15