Age: 56.0
Sex: F
Vaccine: COVID19
Symptoms: Transaminases increased, Vomiting
Clinical narrative: 57-year-old woman with known essential hypertension and alcohol dependency who presented to local emergency department with acute onset abdominal pain, nausea, and vomiting. The patient has longstanding history of alcohol dependence and she had been sober over Christmas break; however, the patient consumed heavy amounts of alcohol 2 days prior to admission. After the patient's alcohol bender, the patient felt nauseated and developed severe, epigastric abdominal pain 24 hours later. The patient also clinically had multiple bouts of vomiting and was not able to tolerate anything to eat or drink. Because of the patient's nausea vomiting, and severe abdominal pain, the patient presented to local emergency department for ongoing treatment and evaluation. In the emergency department, the patient's lab work-up was pertinent for lipase elevated to 5843 and serum creatinine elevated to 1.21 (baseline creatinine 0.4). The patient had multiple metabolic derangements. The patient received 3 L IV normal saline for suspected dehydration and IV Zofran for nausea. While in the emergency department, the patient also reported shortness of breath and nonproductive cough. The patient reported feeling unwell since 12/18/2021 which she described as "severe cold like symptoms." At that time, the patient's husband tested positive for COVID-19 (had to take Covid test because of work). The patient never tested for COVID-19 at that time; however, the patient felt like she probably had COVID-19 as well. The patient was admitted to hospitalist medicine service from emergency department for ongoing evaluation and treatment. When I saw the patient, she reported that her shortness of breath had resolved and no longer coughing. The patient had less abdominal pain which she rated as 4 out of 10. The patient denied history of alcohol withdrawal symptoms; however, the patient reported having a seizure after quitting alcohol in the past. Patient has been in alcohol dependency programs before. Acute alcoholic pancreatitis. Alcohol use disorder with dependence. COVID-19 infection without hypoxia, Hypokalemia, Hyponatremia, Tobacco use disorder, Hypotension, Hypomagnesemia, Elevated transaminases secondary to alcohol use. Patient was admitted with acute onset abdominal pain and found to have elevated lipase and clinical picture that supported acute alcoholic pancreatitis in the setting of alcohol use disorder with dependence. She was evaluated by social work team and set up for outpatient management of her alcohol use disorder. She was made N.P.O. and given IV fluids and slowly reintroduced to a liquid diet with diet escalated during the admission to regular texture diet by the time of discharge.  She was noted to have hypokalemia and hyponatremia which were likely secondary to poor oral intake in the setting of pancreatitis and she was incidentally found to have COVID-19 infection without evidence of pneumonia. She was not hypoxic during the admission and therefore did not warrant steroid therapy. She was placed on CIWA protocol for history of alcohol use disorder but there was no evidence of alcohol withdrawal and no complications during the admission. She was noted to be hypotensive at times so we have held her PTA lisinopril at discharge recommended that she monitor her blood pressure closely at home and follow-up closely with her primary care provider to see if lisinopril should be restarted. She will be given a small quantity of oxycodone for persistent abdominal pain which we expect to resolve over the next several days. She was hemodynamically stable, afebrile, tolerating oral intake and ambulatory prior to discharge. Her pain was controlled with oral pain medications and all questions were answered and concerns were addressed prior to discharge. She verbalized understanding and was in agreement with the discharge plan prior to discharge. Close PCP follow-up has been requested and we recommend that she have her renal function, electrolytes and blood pressure reassessed at the follow-up appointment and ensure that she is abstaining from alcohol going forward. We have counseled her on the need for alcohol and tobacco cessation going forward. DISCHARGE DIAGNOSES: 1. Acute alcoholic pancreatitis, 2. Alcohol use disorder with dependence, 3. COVID-19 infection without hypoxia, 4. Hypokalemia, 5. Hyponatremia, 6. Tobacco use disorder, 7. Hypotension, 8. Hypomagnesemia, 9. Elevated transaminases secondary to alcohol use.