Age: 64.0
Sex: M
Vaccine: COVID19
Symptoms: Glycosylated haemoglobin increased, Hypervolaemia, International normalised ratio increased, N-terminal prohormone brain natriuretic peptide increased, Palpitations
Clinical narrative: Patient is a 66 y.o. male patient of, DO with history of atrial fibrillation, type 2 diabetes, essential pretension, hyperlipidemia presented to Hospital with palpitations and found to be in A-fib with RVR.   A-fib with RVR Fluid overload Essential hypertension Heart rate in the 120s on admission, improved and in 90's. Status post boluses of Lopressor EKG with A-fib with RVR Troponin 25>26, neg delta  Elevated proBNP at 1853. TSH within normal limit X-ray with signs suggesting pulmonary edema Last echo 2018 with a EF 50 to 55% with global hypokinesis Nuclear medicine 2018 With normal myocardial perfusion Likely triggered by COVID pneumonia Resumed home Coreg.  Resume home Coumadin an Resume home Coumadin and ramipril Lasix 20 mg IV BID. Echo with EF 59% Strict I's and O's with daily weight monitoring, - 10 L negative balance Increase ramipril to 10 mg secondary to uncontrolled blood pressure and Added amlodipine 5 mg on 3/29 Increase amlodipine to 10 mg on 4/1 secondary to uncontrolled blood pressure Pharmacy managing Coumadin dosing, latest INR 2.8 Continue 5 mg Coumadin on discharge until INR clinic follow-up, discussed with pharmacy Blood pressure stable and improved on 4/2/2023 Recommend PCP follow-up for close monitoring of blood pressure     Acute hypoxic respiratory failure...resolved O2 sat in the mid 80s Currently on nasal cannula with sats in 90's Likely in the setting of COVID contributed by A-fib with RVR Plan as below for COVID Weaned to RA 03/8 Covid-19 Virus Infection Possible viral PNA Date of onset of symptoms: Couple of days Symptoms present on admission: Shortness of breath, intermittent coughs Date of covid positive test: 3/24/2023 Vaccination status: vaccinated Imaging: Chest x-ray with moderate pulmonary edema and stable cardiomegaly. Oxygen requirements on admission: Nasal cannula2 L Current oxygen requirements: RA Medical therapy: steroids/remdesivir Consultants following: e-ID End isolation date on 4/3   Type 2 diabetes, non-insulin-dependent Last A1c 9.8 on 1/9/2023 Blood sugar 314 this admission On lantus 24 units nightly and glipizide and Ozempic  Ordered lantus 34units with SSI/POCTS/Hypoglycemia protocol as needed  Titrated lantus to 38 units with SSI adjused to normal from sensitive given elevated BS and steroid use, uptitrated to 42 units, changed SSI to resistant Uptitrated lantus to 50 units 03/28 Blood glucose remain elevated, appreciate endocrinology assistance Recommend to continue Lantus 50 units and start carb count prandial coverage Uptitrated lantus to 70 units by endocrine team along with carb count gradual dose 03/31 and 18 units on 4/1 Monitor BS, improving, endo following Discussed with Endo, will discharge on 70 units of Lantus to be taken on 4/3 and from there onwards 40 units of Lantus after Decadron doses finished   Elevated transaminases On remdesivir, last dose on 3/29 Will discontinue as patient stable on room air Avoid hepatotoxic agents LFTs stable and improved 03/30 Monitor CMP