Age: 77.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Bacteriuria, Blood creatinine increased, Blood culture, Blood glucose increased, Blood magnesium decreased
Clinical narrative: Provider hospital summary "Per HPI 78 year old female with a history of CAD s/p PCI, CKD Stage III, DM type I, Emphysema, hypertension, hyperlipidemia, and hypomagnesemia who presents to the ED with low oxygen. History is obtained by patient at bedside and son in room. Patient reports her symptoms started seven days ago and she believed she had a "bad cold." Her family was together on Holiday and four of them were sick last week including her. They all were tested positive for COVID. She was tested two days ago and was positive. She endorses headache, diarrhea, chills, nasal congestion, congested cough, lack of appetite, and dizziness. She started to feel better yesterday but today she felt worse. Patient states when she would exert herself today she became lightheaded and dizzy. She was very lethargic and weak today according to family. She lost her sense of smell and taste today. Son brought a pulse oximeter and noted her oxygen was in the 60s so he called EMS. She also reports her blood glucose has been reading high on her Dexcom. She is fully vaccinated for COVID but is due for her booster. Hx of tobacco abuse for 30 years but quit 18 years ago; never diagnosed with COPD or asthma. She denies dyspnea, wheezing, nausea, vomiting, urinary symptoms, or abdominal pain.             In the ED, patient was hypoxic upon arrival and febrile.  EMS reported oxygen levels were 57% and she was placed on a non-rebreather. She was placed on a venti mask in the ED. Lab work revealed hyperglycemia, elevated creatinine, and elevated pro-calcitonin. She was given 250 mg of Solumedrol. She was also given Ceftriaxone for a presumed UTI. UA with pyuria, bacteruria, and moderate blood. Blood cultures were obtained. Chest xray revealed patchy airspace opacities, greatest in the right lung. She will be admitted for acute respiratory failure with hypoxia.   Labs- Glucose 271, Creatinine 1.6, Pro-Calcitonin 2.64   Chest Xray- The heart, mediastinum, and pulmonary vasculature are normal patchy airspace disease throughout the periphery of the right lung with a few scattered opacities in the left lung. No sizable pleural effusion. No pneumothorax.   She was gradually weaned off of significant oxygen support during her hospitalization. Due to her being slow to wean, repeat Ddimer completed and demonstrated a level of 3120 (increased from 1720). Underwent bilateral LE US which demonstrated a left infrapopliteal DVT. She was initiated on Eliquis BID and to continue on discharge. She completed steroid, remdesivir and antibiotic therapy during her admission. She was eventually weaned to 4L NC and doing well. She was able to participate with PT/OT and she was deemed safe to discharge home. She will have COVID at home program. Her blood sugars were labile, recommended she contact her endocrinology office for closer follow up.   She did have an episode of NSVT in setting of significantly low Magnesium. She required IV repletion with resolution of her NSVT. ECHO completed demonstrated normal EF. Her home Mag supplementation was increased to 400mg BID and follow up labs ordered.    Hospital Course:  Acute Hypoxic Respiratory Failure 2/2 COVID 19 and secondary bacterial pneumonia, stable - Weaned to 4L NC, appears to be tolerating well - Completed 10 days of Dexamethasone, d/c on 12/13 - Completed Remdesevir - Completed empiric antibiotic therapy - Albuterol inhaler with MDI prn - RT following - Prone as tolerated   NSVT, resolved Hypomagnesemia - NSR overnight - Mg 1.8 this am             - required IV supplementation x2 during admission             - Recommend increasing home Mag to 400mg BID and follow labs - ECHO demonstrated normal EF   Acute Infrapopliteal DVT - Likely due to COVID infection v other etiology - Continue Apixaban 5mg BID on discharge - Recommend at least 3 months of therapy, further duration to be determined   Hx of CAD HLD - Continue home ASA and Statin   HTN - Continue Amlodipine   DMII, uncontrolled - A1c: 8.9 - Hold home PO medications - Labile blood sugars - Adjusting Lantus and prandial insulin accordingly               - Lantus 15u, prandial 8u - ISS and accuchecks - CC diet - Resume home regimen - Advised she call the endocrinology office to be seen sooner    CKD III - Cr stable   Initiated PPI given need for ASA and Eliquis"