Age: 70.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Acute respiratory failure, Anticoagulant therapy, Aspartate aminotransferase increased, Asthenia, Blood creatinine increased
Clinical narrative: Hospitalized 10/18/2021; COVID-19 positive 10/18/2021; fully vaccinated  Chief Complaint: Dyspnea Reason for Admission: Pneumonia due to covid-19 Admission Date: 10/18/2021 Length of Stay: 0 day(s)   History of Present Illness: Patient is a 70 y.o. female with a past medical history of Type II diabetes on basal bolus insulin c/b retinopathy, CKD4 s/p renal txp in 2010 at hospital, hypertension, presenting with shortness of breath.   Today she states that she has been feeling very weak and and short of breath. Approximately 8-10 days ago ago she noticed she was becoming weak and having vomiting, difficulty keeping food down. She developed chills and shaking, as well. She has received all 3 doses of the pfizer vaccine. Today, she developed shortness of breath and was unable to further care for herself at home and thus she called EMS. No chest pain, mild intermittent diarrhea which she states is infrequent. She does report mild cough with clear mucous. Her son recently had covid and she suspects she may have contracted it from him.  She did fall one month ago but is unsure if she hit her head.   In the emergency department she was febrile to 39.2, HR 89, BP 145/50, hypoxic and requiring 5L NC. Labs were significant for Cr 1.72, glucose 307, AST 47, hgb 10.4.  CXR showed patchy bilateral reticular airspace disease most confluent in the mid left lung zone c/w covid-19. She was given vancomycin and zosyn and subsequently admitted to the internal medicine service for further care. 10/21/2021 note: ASSESSMENT / PLAN: Principal Problem:   Pneumonia due to COVID-19 virus   70 yo woman with hx of renal transplant here w/ SOB, dx w/ Covid PNA and acute hypoxic respiratory failure. Sepsis criteria not met. Covid-19 PNA Acute hypoxic respiratory failure Fever last 10/18 PM HA N/V/D Vaccinated x3 (Pfizer) but immune suppressed with renal transplant Sx start 10/8 - 10/21 weakness, vomiting, chills and rigors Covid + 10/18/21 CRP 160 -> 93 D-dimer 3160 -> 2450 Unable to give remdesivir due to renal dysfunction, GFR consistently <30 MAb not given due to O2 use but ID questioned if it could be given under compassionate use protocol; have not heard back as yet? Decadron 6 mg d x10 days; holding daily prednisone 5 while on Decadron Lovenox for DVT ppx Prone as able Goal O2 sat >92% High flow at 100% FiO2 and 60 L/min with 97 - 100% saturations; decreasing support is indicated 10/25/2021 note: ASSESSMENT / PLAN: Principal Problem:   Pneumonia due to COVID-19 virus   70 yo woman with hx of renal transplant here w/ SOB, dx w/ Covid PNA and acute hypoxic respiratory failure. Sepsis criteria not met. Orthostatic hypotension, increased creatinine and subdued with dry mm, suspect Lasix effective, in use for edema, currently on hold per Nephrology; strongly agree IVFs, 1 L, given back slowly 10/22/21 but appreciate we want a "dry lung"; she improved with this Depression, acute She declines to discuss what is bothering her or that she is willing to talk with someone about it  Covid-19 PNA Acute hypoxic respiratory failure Fever last 10/18 PM HA N/V/D Vaccinated x3 (Pfizer) but immune suppressed with renal transplant Sx start 10/8 - 10/21 weakness, vomiting, chills and rigors Covid + 10/18/21 CRP 160 -> 93 -> 40 D-dimer 3160 -> 2450 -> 1620 Unable to give remdesivir due to renal dysfunction, GFR consistently <30 MAb given despite O2 use under compassionate use protocol, pursued; labor appreciated Decadron 6 mg d x10 days; holding daily prednisone 5 while on Decadron Lovenox for DVT ppx Prone as able Goal O2 sat >92% High flow support decreasing, 50% FiO2 and 40 L/min with 98% saturations; decreasing support is indicated         Dispo:       7-10 day stay anticipated but will be based on progress and has potential for         prolonged stay. Multiple recent surgeries and now Covid infection with progressive weakness and debility demand rehab.