Age: 62.0
Sex: M
Vaccine: COVID19-2
Symptoms: Leukocytosis, Liver function test normal, Metabolic encephalopathy, Nephrolithiasis, Rectal tube insertion
Clinical narrative: Patient is a 63 y.o. male patient with history of hypertension hyperlipidemia diabetes mellitus and history of atrial fibrillation, nephrolithiasis previously required lithotripsy and stents placement and CKD stage III with baseline creatinine is 1  has history of asthma previously treated for Ogilvie's syndrome and diffuse ileus who underwent a diverting loop colostomy at a hospital is here due to shortness of breath was found to be hypoxic with oxygen saturation 89% at room air, COVID-19 positive and was found also to have tachycardia being off of his home meds for the past week or 2   Ogilvie Syndrome Severe colonic ileus Status post NG, successfully removed, diet advanced as per general surgery.  Currently tolerating regular diet.    Aggressive bowel regimen Encourage ambulation Avoid narcotics General surgery consulted, s/p colonscopy and rectal tube insertion by Dr.  Rectal tube is currently out S/p neostigmine 4/25 TPN started 5/1/2023, discontinued 5/6/2023. Follow-up with general surgery as an outpatient. Ct abdomen 4/25/23 1. Severe colonic ileus with marked gaseous distention of the cecum and proximal transverse colon and milder gaseous distention of the distal ileum.  No findings of bowel obstruction.  No bowel wall thickening. 2. Prior partial proximal transverse colonic resection with intact surgical anastomosis. 3. Normal appendix and no adenopathy. 4. Colonic diverticular disease.  No findings of diverticulitis. 5. Solitary bladder stone measuring at least 1.0 x 1.7 cm, as well as multiple left nonobstructing renal calculi measuring up to 0.7 x 0.5 cm. 6. Fatty liver and hepatomegaly, stable.  Hepatic morphology is normal.  No focal hepatic lesion.  Hepatic vessels are patent.   Lactic acidosis, POA, resolved Leukocytosis, POA, secondary to above Status post IV fluids Follow cultures and trend lactic acid Daily CBC with differential and CMP magnesium.   Asthma exacerbation, present on admission, currently resolved Acute hypoxic respiratory failure COVID-19 respiratory infection Cxr Lungs: No pneumothorax, pleural effusion, or consolidation. Initially requiring 2 L of oxygen, currently on room air. S/P IV Solu-Medrol, inhalers, continue supportive care DC isolation 5/4/2023   Acute kidney injury, POA, resolved creatinine peaked 1.3  >> currently 0.7, status post discontinuation of lisinopril lisinopril S/p iv fluids for the iv contrast given on arrival to the emergency department for CT hold metformin Daily BMP and magnesium  Closely monitor urine output and kidney function test.   Atrial fibrillation with rapid ventricular response, RESOLVED Currently sinus rhythm, off cardiazem drip Initially on IV metoprolol 7.5 mg every 6 hours, currently on metoprolol succinate 50 mg twice daily.  Eliquis 5 mg twice daily.   Nonsustained V. tach 5/2/2023 Asymptomatic Replace and closely monitor electrolytes    Hypertension Currently blood pressure controlled on metoprolol succinate 50 mg twice daily. Status post discontinuation of lisinopril IV as needed hydralazine   Hyperlipidemia On statin therapy   Diabetes mellitus Insulin sliding scale and monitor the blood glucose Resume metformin on discharge.   Acute metabolic encephalopathy secondary to above Improved.