Age: 60.0
Sex: M
Vaccine: COVID19
Symptoms: Decreased appetite, Dehydration, Diarrhoea, Fall, Gastroenteritis viral
Clinical narrative: Patient is a 63 y.o. male patient of No, Physician with history of dementia, CAD with remote PCI, PVD, IDDM2, presented to Medical Center with multiple falls, hypoglycemia with recent viral illness.   Multiple falls Generalized weakness Presents with multiple falls and generally weaker at home Nausea, vomiting, diarrhea at home last 4 days, all resolving but has not been eating Suspect both hypoglycemia, dehydration contributing, and COVID Hypoglycemia as below TSH, B12/folate normal Glucose 45 on VBG and 55 on BMP CPK 657 -> 120 CT Brain- Study limited by motion artifact.  Within the limitation of the study, no acute intracranial abnormality.  Mild frontal scalp hematoma, but no underlying skull fracture CT C spine- No acute abnormality of the cervical spine.  Mild frontal scalp hematoma without fractures. No acute cervical spine abnormality.  Moderate multilevel degenerative disc disease.  Xray hip/pelvis-No acute fracture, dislocation or malalignment. Moderate degenerative changes PT/OT consults Fall and delirium precautions   Covid-19 Virus Infection Date of onset of symptoms: 10/21 Symptoms present on admission: 10/26 Date of covid positive test: 10/25 Vaccination status: vaccinated Imaging: CXR-Low lung volumes without acute cardiopulmonary process identified Oxygen requirements on admission: RA Current oxygen requirements: RA Medical therapy: remdesivir x 3 days per ID recs Consultants following: None Anticipated special isolation end date: 11/6 Order set placed AKI on CKD Cr 1.92, peaked at 2.69 prior baseline Cr 2.3 Clinically hypovolemic UA pending Bladder scan - required straight cath x1 but non since  Started on Sodium bicarb 325mg BID  BMP in the 1-2 weeks with PCP    Urinary retention  Required straight cath x1 10/31 but non since  UA negative  Resolved    IDDM2 Hypoglycemia -Resolved A1c 10.7 Per sister home regimen is lantus 30u BID and a dose of 15u novolog in the afternoon; wears CGM and running into 50s while ill Glucose 55 on serum sample on admission D10 bolus in ED, up to 118 Decreased Lantus 10/27. Increased 10/29 ( pt eating some times and not others) Discharged on Lantus 10units BID with SSI  Outpatient follow up with PCP    Dementia with behavioral disturbance Calm and cooperative on admission Aox1 and nonfocal baseline per family on admit Continue home aricept, namenda, Olanzapine, and depakote  Fall and delirium precautions Capacity: Incapacitated (did not have decision-making capacity.  According to MD, four pieces are required to show capacity.  Of these, was unable to demonstrate communicate a choice, understand the relevant information, appreciate the situation and its consequences, or reason about treatment options.) No AMA- Children are LNOK   PVD Prior PTA L PT 9/2021 Continue DAPT and statin  CAD s/p MI Remote PCI 2008 Continue DAPT and statin   Anemia in CKD Hb stable 11.7 prior baseline around 9-10  Continue iron supplement   Bilateral foot wounds, POA These are chronic, none open or infected See media Wound care consulted   Hypokalemia Replaced  Resolved   Viral gastroenteritis Recent N/V/D for 4 days, all resolving per family Associated cough, no dyspnea or fever CXR clear ABDxray -Nonspecific bowel gas pattern without evidence of obstruction or other acute process.  Paucity of gas in the small bowel. HW IVF Cont zofran prn Resolved   Severe malnutrition