Age: 56.0
Sex: F
Vaccine: COVID19
Symptoms: Hypomagnesaemia, Immature granulocyte count, Intensive care, Intensive care unit delirium, Klebsiella bacteraemia
Clinical narrative: Date of Admission: Admit Date: Feb-02-2022. Date of Discharge: Date of discharge Feb-09-2022, Allergies, pomegranate fruit extract - Not Specified, grapefruit - Not Specified, CRANBERRY FRUIT - interferes with medications, Hydrocodone-Acetaminophen - Not Specified. SULFA ANTIBIOTICS - Rash, Chief Complaint: Shortness of breath. Final Diagnoses: COVID-19, Acute hypoxemic respiratory failure. Procedure(s) Performed: None. Lab Results: Feb-09-2022 0420, Serology, PROCALC 3.70- Feb-09-2022 0420. Hematology: WBC 8.5 RBC 2.65 (L) HGB 8.1 (L) HCT 26.1 (L) MCV 98.5 MCH 30.6 MCHC 31.0 RDW 18.5 (H) RDWSD 66.3 PLT 114 (L) MPV 10.8 (H) AUTONEU% 86.4 (H) AUTOLYM% 5.7 (L) AUTOMON% 3.6 AUTOEOS% 0.1 AUTOBAS% 0.1 AUTONEU# 7.4 (H) AUTOLYM# 0.5 (L) AUTOMON# 0.3 AUTOBAS# 0.0 AUTOEOS# 0.0 NRBC% 0.0 NRBC 0.0 HGB/HCT 3.2 IG# 0.35 IG% 4.1. Feb-09-2022 0420- Chemistry: GLUCOSE 109 BUN 15 CREAT 1.4 (H) MDRD GFR 39 (L) NA 146 (H) K 3.7 CL 112 (H), CALCIUM 6.8 (L) CO2 24.3 OSMO 292.0 ANION GP 13.4 BUN/CRE 10.7 CRP 17.60 (H). Feb-08-2022 0535- Serology, PROCALC 2.68. Feb-08-2022 0535- Hematology: WBC 9.9 RBC 3.00 (L) HGB 9.1 (L) HCT 29.2 (L) MCV 97.3 MCH 30.3 MCHC 31.2 RDW 18.2 (H) RDWSD 64.4 PLT 136 (L) MPV 11.2 (H) AUTONEU% 80.5 (H) AUTOLYM% 13.6 (L) AUTOMON% 2.9 AUTOEOS% 0.9 AUTOBAS% 0.1 AUTONEU# 7.9 (H) AUTOLYM# 1.3 AUTOMON# 0.3 AUTOBAS# 0.0 AUTOEOS# 0.1 NRBC% 0.0 NRBC 0.0 HGB/HCT 3.2 IG# 0.20 IG% 2.0 1 of5. Name PRIVATE- DOB Dec-05-1964 (F), MRN. Feb-10-2022 1222. Attending Encounter Unknown. Discharge Summary: Reg Medical Ctr.- Admitted, Discharged- Feb-02-2022- Feb-09-2022. Date of Service: Primary DO. Feb-08-2022 0535- Coagulation, D-DIMER 14.43 (H). Feb-08-2022 0535- Chemistry: GLUCOSE 89 BUN 14 CREAT 1.3 (H) MDRD GFR 42 (L) NA 144 K 3.1 (L) CL 111 (H) CALCIUM 6.8 (L) ALK PHOS 177 (H) CO2 23.4 AST 29 ALT 7 (L) AST/ALT 4.1 (H) TL PROT 4.5 (L) ALBUMIN 1.1 (L) TBILI 0.3 DBILI 0.1 OSMO 286.8 ANION GP 12.7 BUN/CRE 10.8 LDH 400 (H) CRP 16.80 (H) FERRITIN 1377 (H) MAGNESIU 1.7 (L). Feb-07-2022 0556- Serology: PROCALC 2.83 Feb-07-2022 0556. Hematology: WBC 12.2 (H) RBC 3.36 (L) HGB 10.4 (L) HCT 33.5 (L) MCV 99.7 (H) MCH 31.0 MCHC 31.0 RDW 18.7 (H) RDWSD 68.7 PLT 208 MPV 10.4 AUTONEU% 58.5 AUTOLYM% 33.6 AUTOMON% 3.6 AUTOEOS% 0.5 AUTOBAS% 0.2 AUTONEU# 7.2 (H) AUTOLYM# 4.1 (H) AUTOMON# 0.4 AUTOBAS# 0.0 AUTOEOS# 0.1 NRBC% 0.0 NRBC 0.0 HGB/HCT 3.2 IG# 0.44 IG% 3.6. Feb-07-2022 0556- Chemistry: GLUCOSE 111 (H) BUN 13 CREAT 1.5 (H) MDRD GFR 36 (L) NA 146 (H) K 3.1 (L) CL 109 (H) CALCIUM 7.1 (L) CO2 26.0 OSMO 291.4 ANION GP 14.1 BUN/CRE 8.7 (L) CRP 13.50 (H). Feb-06-2022 0425- Serology: PROCALC 0.44. Feb-06-2022 0425- Hematology: WBC 5.2 RBC 2.96 (L) HGB 8.9 (L) HCT 28.8 (L) MCV 97.3 MCH 30.1 MCHC 30.9 (L) RDW 18.7 (H) RDWSD 66.6 PLT 198 MPV 10.1 AUTONEU% 69.0 AUTOLYM% 22.5 AUTOMON% 3.5 AUTOEOS% 0.2 AUTOBAS% 0.2 AUTONEU# 3.6 AUTOLYM# 1.2 AUTOMON# 0.2 AUTOBAS# 0.0 AUTOEOS# 0.0 NRBC% 0.4 NRBC 0.0 HGB/HCT 3.2 IG# 0.24 IG% 4.6. Feb-06-2022 0425- Chemistry: GLUCOSE 90 BUN 15 CREAT 1.3 (H) MDRD GFR 42 (L) NA 145 K 3.4 CL 113 (H) CALCIUM 6.9 (L) CO2 25.3 OSMO 289.1 ANION GP 10.1 BUN/CRE 11.5 CRP 6.80 (H) MAGNESIU 1.9. Feb-05-2022 1045- Serology: PROCALC 0.65. Feb-05-2022 1045- Hematology: WBC 5.34 RBC 3.00 (L) HGB 9.1 (L) HCT 29.5 (L) MCV 98.3 MCH 30.3 MCHC 30.8 (L) RDW 18.9 (H) RDWSD 67.3 PLT 217 MPV 9.9 AUTONEU% 81.5 (H) AUTOLYM% 10.1 (L) AUTOMON% 4.5 AUTOEOS% 0.2 AUTOBAS% 0.0 AUTONEU# 4.35 AUTOLYM# 0.54 (L) AUTOMON# 0.24 AUTOBAS# 0.00 AUTOEOS# 0.01 HGB/HCT 3.2. Feb-05-2022 1045- Chemistry: GLUCOSE 103 BUN 15 CREAT 1.26 (H) MDRD GFR 44 (L) NA 145 K 3.2 (L) CL 112 (H) CALCIUM 6.7 (L) CO2 25.9 OSMO 289.8 ANION GP 10.3 BUN/CRE 11.9 CRP 5.1 (H) 2 of 5. Name "PRIVATE" DOB Dec-05-1964 (F). MRN 148850. Feb-10-2022 1222. Attending Encounter Unknown. Discharge Summary: Reg Medical Ctr. Admitted- Discharged Feb-02-2022/ Feb-09-2022. Date of Service, Primary DO. Feb-04-2022 0450- Serology: PROCALC 1.25. Feb-04-2022 0450 Hematology: WBC 5.0 RBC 2.95 (L) HGB 9.0 (L) HCT 29.4 (L) MCV 99.7 (H) MCH 30.5 MCHC 30.6 (L) RDW 19.5 (H) RDWSD 71.4 PLT 305 MPV 9.9 AUTONEU% 62.4 AUTOLYM% 28.4 AUTOMON% 4.6 AUTOEOS% 0.2 AUTOBAS% 0.0 AUTONEU# 3.2 AUTOLYM# 1.4 AUTOMON# 0.2 AUTOBAS# 0.0 AUTOEOS# 0.0 NRBC% 0.6 NRBC 0.0 HGB/HCT 3.3 IG# 0.22 IG% 4.4. Feb-04-2022 0450- Chemistry: GLUCOSE 80 BUN 16 CREAT 1.4 (H) MDRD GFR 39 (L) NA 146 (H) K 3.5 CL 112 (H), CALCIUM 6.8 (L) CO2 27.1 OSMO 290.7 ANION GP 10.4 BUN/CRE 11.4 CRP 5.00 (H) MAGNESIU 1.7 (L). Feb-03-2022 0357- Serology: PROCALC 1.98. Feb-03-2022 0357- Hematology: WBC 4.1 (L) RBC 2.21 (L) HGB 6.9 (L) HCT 23.0 (L) MCV 104.1 (H) MCH 31.2 (H) MCHC 30.0 (L) RDW 18.9 (H) RDWSD 71.0 PLT 284 MPV 9.6 AUTONEU% 80.8 (H) AUTOLYM% 11.9 (L) AUTOMON% 4.9 AUTOEOS% 0.0 AUTOBAS% 0.0 AUTONEU# 3.3 AUTOLYM# 0.5 (L) AUTOMON# 0.2 AUTOBAS# 0.0 AUTOEOS# 0.0 NRBC% 0.0 NRBC 0.0 HGB/HCT 3.3 IG# 0.10 IG% 2.4. Feb-03-2022 0357- Chemistry: GLUCOSE 111 (H) BUN 15 CREAT 1.4 (H) MDRD GFR 39 (L) NA 145 K 3.6 CL 112 (H) CALCIUM 6.1 (L) ALK PHOS 159 (H) CO2 25.9 AST 29 ALT 21 AST/ALT 1.4 TL PROT 4.4 (L) ALBUMIN 1.2 (L) TBILI 0.2 DBILI <0.1 OSMO 290.2 ANION GP 10.7 BUN/CRE 10.7 CRP 10.00 (H) MAGNESIU 1.6 (L). Feb-02-2022 1009- Chemistry: GLUCOSE 111 (H) BUN 14 CREAT 1.2 (H) MDRD GFR 46 (L) NA 147 (H) K 3.4 CL 111 (H) CALCIUM 6.3 (L) ALK PHOS 203 (H) CO2 23.8 AST 40 (H) ALT 22 AST/ALT 1.8 TL PROT 4.7 (L) ALBUMIN 1.5 (L) TBILI 0.3 OSMO 293.6 ANION GP 15.6 BUN/CRE 11.7 PHOSPHOR 2.9. Imaging Results: Chest X-ray, 02/02/2022, per radiology report: "IMPRESSION: Development of severe pulmonary consolidation consistent with pneumonia." Chest x-ray, 02/07/2022, per Radiology report "IMPRESSION: Interval increase in severe bilateral pulmonary opacities consistent with worsening pneumonia." Social History: tobacco use, Never Smoked, 0 yrs, Smoking Cessation Not Applicable, NA alcohol use 3 of 5. Name "PRIVATE" DOB Dec-05-1964 (F). MRN Unknown. Feb-10-2022 1222. Attending Encounter Unknown. Discharge Summary: Reg Medical Ctr. Admitted/ Discharged: Feb-02-2022- Feb-09-2022. Date of Service: Primary DO. No Known drug use, No Known Use, marital status, Single. Health Concerns: COVID-19, Acute hypoxemic respiratory failure, Bacteremia, Father Deceased Heart disease @ 66, Mother alive 80y Endemic osteoarthritis, Brother alive 59y Problem drinker. Vital Signs. Feb-09-2022 1100- HR 0 (L) RR 0 (L) O2Sat 0 (L). Feb-09-2022 1059, HR 25 (L) RR 0 (L) O2Sat 0 (L). Feb-09-2022 1030, BP 118 / 82. Feb-09-2022 1000, BP 99 (L) / 68. Feb-09-2022 0730- HR 85 RR 36 (H) BP 116 / 81 O2Sat 85 (L) O2L 90. Feb-09-2022 0700, T 98.6. Feb-09-2022 0400, T 98. Feb-08-2022 0000, HR 98 RR 27 (H) BP 132 / 102 (H) O2Sat 72 (L) MAPBP 113 O2L 90. Feb-06-2022 0005, HR 104 (H) RR 24 (H) BP 135 / 85 O2Sat 87 (L) MAPBP 99 O2L 60. Feb-05-2022 2100 HR 87 RR 23 (H) BP 108 / 79 O2Sat 83 (L) MAPBP 89 O2L 60. Hospital Course: Patient is a 57 year old female who presented to the ED on 02/02/2022 with shortness of breath. She was admitted to the internal medicine service with the diagnosis of sepsis and acute hypoxic respiratory failure secondary to COVID-19. She has a past medical history significant for liver and kidney transplant on immunosuppressants, GERD, chronic kidney disease, anemia, and anxiety. Her total hospital course was 8 days. Her stay was complicated by agitation, delirium, and anxiety. Patient required Precedex up to 1.4 mcg/kg/hr. during her stay. This led to intermittent second degree type II heart block intervals secondary to the Precedex-induced bradycardia. Patient was given hydroxyzine and Ativan to also aid in anxiety and agitation without much relief. Patient's home dose of hydrocortisone was stressed dose on admission to address her COVID infection. Her oxygen requirements increased throughout her stay requiring Airvo at maximum settings. On admission patient voiced that she did not want to be 4 of 5. Name "PRIVTE" DOB Dec-05-1964 (F). MRN Unknown. Feb-10-2022 1222- Attending Encounter Unknown. Discharge Summary: Reg Medical Ctr. Admitted/Discharged: Feb-02-2022- Feb-09-2022. Date of Service: Primary DO- intubated or receive CPR. She also stated that she would not want to wear the BiPAP/CPAP mask if it were required. On the last day of hospitalization patient's oxygen requirements continued to increase and she was unable to maintain appropriate SpO2 levels on Airvo (dropping into the 50% range). Patient's mother was called and the decision to be made comfort care was made. Patient was placed on comfort measures and time of death was noted to be at 11:08 on 02/09/2022. Condition at Discharge: Expired. Discharge Disposition: Expired. Plan Assessments: Cardiac arrest secondary to hypoxemic respiratory failure. Sepsis likely secondary to COVID-19 pneumonia and/or Klebsiella bacteremia and/or left lower extremity cellulitis with tachycardia and tachypnea on presentation. Acute hypoxic respiratory failure secondary to COVID pneumonia requiring Airvo 60L with 54% FIO2. Acute ICU delirium, likely secondary to critical illness and hospitalization. Chronic macrocytic anemia, likely secondary to multiple nutritional deficiencies. Acute hypernatremia, Na 146 on 2/4/22, improved. Hypomagnesemia, Mg 1.6 on 2/3/22, likely chronic, replaced. Hypoalbuminemia, likely secondary to chronic disease, worsening. Adrenal insufficiency secondary to chronic corticosteroid use with noncompliance and acute illness. Dehydration. Chronic immunosuppression secondary to immunosuppressants from kidney and liver transplant. Chronic kidney disease stage 4 with rejected kidney-transplant. Chronic nephrolithiasis. Status post historic Roux-en-Y surgery. History of Klebsiella bacteremia. Non alcoholic steatohepatitis leading to end-stage liver disease with liver transplant. Severe chronic protein calorie malnutrition with severe fat and muscle depletion and energy intake less than 75% of energy requirements for greater than 3 months. Drug seeking behavior. Debility. Medical noncompliance. Plan: Patient expired at 11:08 on 02/09/2022. Her body will be released to the funeral home of the family's choosing.