Age: 75.0
Sex: F
Vaccine: COVID19
Symptoms: Blood sodium decreased, COVID-19, Chronic kidney disease, Computerised tomogram abdomen abnormal, Electrocardiogram QT prolonged
Clinical narrative: Patient  is a 76 y.o. female patient of No, Physician with history of CAD s/p PCI/stents, DM2, HTN, HLD, left breast cancer , diverticulosis, IBS, migraines, osteoporosis who presented to Hospital with a 4 day history of increased fatigue and generalized weakness, poor po intake.    Patient was found to have acute COVID-19 infection in the setting of her daughter having similar infection at home.  Symptoms remained stable during admission, did not require O2 or any increased interventions.  Patient found to have hyponatremia which improved with oral intake and IVF.  AKI resolved.     Patient also with chronic medical conditions and was not taking prescribed medications regularly.  Continued her home beta-blocker, statin, Plavix, insulin.  Patient remained stable during admission and improved clinically prior to discharge.   Recommend close follow-up with PCP at discharge.  Provided patient with resources to establish at our DMH family medicine residency clinic if she chooses to do so.   Assessment and Plan   Acute on chronic hyponatremia, improved Generalized weakness Corrected Na for hyperglycemia 129; serum osm 296 Low normal Na on previous labs Suspect 2/2 poor PO intake, improved w/ IVF Encourage PO intake PT recs no additional needs at discharge Plan for discharge later today w/ close PCP follow-up   COVID-19 infection, improving History of increased fatigue, generalized weakness, and decreased PO intake prior to admission + sick contacts (lives with daughter who also recently tested + COVID) Afebrile on admission BP hypotensive on admit with no tachycardia, improved to now hypertensive No hypoxemia, on room air No leukocytosis/leukopenia No indication for systemic corticosteroids No indication for remdesivir given AKI  Continue with supportive care for now  AKI on CKD 3a, resolved Scr 2.11 on admit, baseline Scr ~ 1.0 Suspect prerenal in setting of poor PO intake Improved w/ IVF, monitor, encourage PO intake   Elevated troponin Hx of CAD S/p remote PCI/stents (?DES) No active CP complaints Off statin, plavix and BB > 1 year ECG w/o acute ischemic changes Initial trop 18, down trended on repeat to 12 Suspect 2/2 AKI Resume plavix Resume BB and statin at discharge   Prolonged Qt No prior history  Likely acquired Suspect electrolyte driven Optimize lytes K > 4, Mg > 2  Avoid Qt prolonging medications    Hyperglycemia  Type 2 DM, medication noncompliant, previously on insulin Off basal insulin and metformin > 1 year A1C 9.2 11/10/23, it was higher in 8/20/2022 at 9.8 Glucose 169-336 over past 24 hours Accuchecks ACHS to trend blood sugars Resistant SSI ACHS , restart Lantus prior dosing of 10 units nightly  Diabetes educator consulted   Elevated LFTs Chronically elevated; mild transaminitis CT with increased liver attenuation c/w hepatic steatosis Resume statin at discharge   Elevated lipase Denied any abdominal pain, N/V, asymptomatic Serum lipase 142 No CT evidence of acute pancreatitis   Low BMI Risk of protein calorie malnutrition Body mass index is 22.79 kg/m². Consult dietician to eval/recs   Essential HTN HLD Has been off all previously prescribed medications > 1 year Previously prescribed Toprol XL, Atorvastatin Resume BB and statin at discharge    Hypotension, resolved Suspect related to above, decreased oral intake Lactate initially elevated, trended down to normal Encourage PO intake, IVF as indicated   History of L breast CA Off Femara > 1 year Will resume as according OSU oncologist long term med however pt refused 11/10, re-discuss with daughter if able to get in contact Will need to have f/u arranged; defer after discharge