Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: Dyspnoea, Fibrin D dimer increased, Gastrointestinal tube insertion, Hypoxia, Intensive care
Clinical narrative: Hospitalized 01/21/2022; COVID-19 positive 01/18/2022; fully vaccinated  Discharge Physician: medical doctor Primary Care Physician: doctor of osteopathic medicine Date of Admission: 1/21/2022 Discharge Date: 1/31/2022 Room Number: -- PRESENTING PROBLEM: AKI (acute kidney injury)  Pneumonia due to COVID-19 virus COVID-19 Acute respiratory failure due to COVID-19   HOSPITAL COURSE: The patient is a 67 y.o. female who presents today with shortness of breath. pmh copd, former smoker just quit 11/2021, hx severe disabling tremor , severe pad with lower ext stenting . Dual antiplatelet rx with asa / plavix on hold for upcoming hip surgery 2/3/22 . She is vaccinated with x2 doses however has not received a booster as yet . One week ago with onset cough that has remained largely non productive . Testing positive for covid on 1/18 since that time has progressively become more sob.   In ed today found to be hypoxemic with o2 titrated , cxr showing New left upper lobe opacity suspicious for pneumonia with additional airspace opacities or atelectasis in the lung bases. procalcitonin elevated at 3.93 was given decadron and iv rocephin / Azithromycin . crp elevated at 3.26 d dimer 1130. Lactic 1.4 , wbc 9.13 renal function with creat 2.50 was given 500 ml fluids bolus . Given inderal for tremor that has not been taking at home .  Hospitalist service consulted for admission further evaluation.  Patient was continued on systemic steroids and initiated on Remdesivir.  She was noted to have AKI which improved with gentle hydration.  Concerns for secondary bacterial pneumonia for which she was continued on complete course of ceftriaxone azithromycin.  Patient developed worsening shortness of breath with IV hydration and was transition to diuresis.  She had a mental status decline in for which CT head evaluations were performed with no significant findings.  Concern for elevated D-dimer with negative CTA thorax and ultrasound venous Dopplers.  She had increased oxygen requirements and escalation of oxygen support up to HFNC.  She became agitated and self removed oxygen as well as agitation and restlessness.  She received anxiolysis and subsequently developed somnolence for which code stroke was activated twice for each Ativan administration.  She was transition to intensive care unit for Precedex infusion.  Altered mental status workup negative for reversible causes.  Medications were reviewed but patient NPO due to confusion as well as requiring HFNC.  NGT unable to be placed while on HFNC for which small bore Corpak was placed.  She had significantly elevated blood pressures and was started on nicardipine drip as her propranolol and losartan were held.  She was resumed on home medications including gabapentin with subsequent improvement of mental status and orientation which was suspected to be related to gabapentin withdrawals.  Supplemental oxygen was weaned while on Precedex drip and with return to mental status further weaned to nasal cannula.  SLP cleared patient for resuming diet.  PT/OT evaluated advised home with assist home health PT/OT.  Systemic steroids were weaned and remainder of home medications continued.  Precedex and nicardipine drip were discontinued with return to mental status. Patient continued to improve and oxygen was weaned. Home O2 evaluation was performed and qualified for 2L at rest and 4 L with exertion. Patient clinically improved and hemodynamically stable for discharge.  Discussed plan of care discharge with patient including outpatient follow-up PCP within 7 days. She will continue steroid taper, antitussives and supplemental O2. Patient voiced understanding was agreeable with plan of care discharge.