Age: 65.0
Sex: M
Vaccine: COVID19
Symptoms: Gastrostomy, Lethargy, Leukocytosis, Magnetic resonance imaging head abnormal, Magnetic resonance imaging spinal abnormal
Clinical narrative: Acute respiratory failure with hypoxia--Resolved Aspiration pneumonia  COVID -19 Virus infection -Developed acute decompensation on 12/2 following aspiration event -CTPA negative for PE -Positive test at RMH 11/27/22 -O2 demand improving, weaned off of HHF and now on LFNC intermittently -completed Decadron 12/8  -Completed remdesivir 12/5 -Completed antibiotic therapy with Vanc/Cefepime/Unasyn    Weakness/Fall UE Tremor Confusion -Presented to the ED from home with worsening confusion, generalized weakness, shuffling gait, UE tremor, and mechanical falls -Etiology uncertain, possible acute illness (COVID), meds (depakote), possible NPH -CTH on admission with dilated ventricles, most likely d/t cerebral volume loss but possible NPH -MRI brain showing mild ventriculomegaly should be closely clinically correlated to exclude NPH. -Neuro Dr consulted and rec possible dc depakote but defer to OP neurologist; possible NPH eval once recovers from illness -Outpatient Movement Disorders referral and neurology department will arrange -MRI C-spine showing neuroforaminal stenosis, recommended following up with Dr. in 6 weeks   Metabolic encephalopathy related to infection, resolved -noted since admission. Possible underlying neurological condition, with superimposed metabolic encephalopathy 2/2 covid 19 infection -supportive care, meds as above   Leukocytosis, resolved -Patient with increasing WBCs, recently completed IV steroids on 12/8.  WBC increased to 32, now 7.82. -No signs of diarrhea to indicate C. Difficile -sputum cx 12/4 neg. Blood cx 12/2 and 12/10 neg. Neg MRSA swab -CT chest, abd and pelvis 12/11 neg for obvious infection -will hold on further antibiotics given no indication of infection.   -UA and urine cx negative   Rhabdomyolysis, resolved -CPK noted to be >6K on admission, possibly in setting of fall, acute illness -Resolved  Malnutrition Dysphagia -Patient with dysphagia and signs of ongoing aspiration. SLP following -Pt had NG, removed 12/10 due to coiling. Repeat MBS 12/13 and failed. New Corflo placed 12/14 and back on tube feeding -Repeat MBS on the 20th still with persistent aspiration risk. - Discussed with patient and spouse, PEG placed 12/22 -Continue speech therapy and tube feeds on discharge   Essential Hypertension - Noted, was previously on Losartan 100mg daily. - Orthostatics positive on 12/20, holding for now. - Orthostatics improved 12/21. - Will continue to titrate as necessary.   CAD -Per history, continue aspirin and statin   Diabetes Mellitus, Type 2 -Hold metformin, cont SS. Controlled.   Bipolar Disorder -home meds: Depakote 1000 mg bid. Seroquel 3 tabs(75 mg) q hs. Meds currently reduced due to lethargy-now on Depakote 250mg nightly, Seroquel 25mg nightly. Behavioral med followed.   Left sided abdominal tenderness Constipation -ongoing for a few days since PEG tube placement near site of PEG tube -PEG tube in appropriate position with small amount of dried blood, no clinical suggestion of infection -abdominal x ray 12/26  showing large stool load in colon, with PEG tube in position -suppository x1, continue bowel regimen