Age: 56.0
Sex: M
Vaccine: COVID19
Symptoms: Mental status changes, Metabolic acidosis, Plasma cell myeloma, Pneumonia, Pneumonia bacterial
Clinical narrative: DISCHARGE DIAGNOSES: Principal Problem:   AKI (acute kidney injury)  Active Problems:   Essential hypertension, benign   Pneumonia, suspected bacterial   ATN (acute tubular necrosis)    Suspected HAP/VAP (gram negative or MRSA pneumonia)HOSPITAL COURSE: Briefly, This is a 57 y.o. male with a past medical history of Alport's Syndrome, HTN, renal disease w hx renal transplant (2006), recent COVID PNA, HLD, GERD who presented to the ED on 1/14/21 with the chief complaint of shortness of breath and confusion, found to have acute on CKD, multifocal CAP in setting of recent COVID+, subsequently admitted for further cares.     For more detail, please see admission H&P.  Hospital course dictated by problem: Sepsis 2/2 Below, Present on Admission Multifocal Bacterial PNA Acute Hypoxic Resp Failure Fever, Improved COVID 19 PNA Reports tested positive on 1/3, repeat here positive, was seen in ED on 1/10, CXR w bilat infiltrates, was not hypoxic at that time, started on Ceftin/Azithromycin, no dex as non-hypoxic. Ongoing SOB, febrile to 103 in ED, altered mental status. WBC nml, lactate neg. CXR with multifocal PNA, worse than prev. Started on IV CTX/Azithro/Vanc on admit, Required 2L O2 11/16-11/18, since weaned and stable. Will switch back to PTA Prednisone from Dex 6mg QD at DC. Neph supported diuresis process. Asymptomatic from respiratory status today and stable for DC to home.  - s/p 6-days IV ABX ( -> Cefepime/Azithromycin), will complete 7 day course w/ Cefdinir + Azithromycin x1d - Restart PTA prednisone 5mg QD   Acute on Chronic CKD Hx Renal Transplant (2002) Alport's Syndrome Metabolic Acidosis Worsening confusion in setting of worsening renal function. Baseline Cr 3.4, 3.92 on admit.Transplant renal US nml. Repeat Cr 3.92->3.61->4.24 -> 4.6 -> 4.52 -> 4.38 today. Ongoing metabolic acidosis, bicarb 16->17->19. Could have component of Vanc nephrotoxicity, since DC'd. Nephrology consulted and diuretics held, slow improvement in renal function, cleared for DC to home today with outpatient f/u transplant team - Cont PTA Sirolimus, Prednisone - Hold PTA ACE/ARB, Bumex - Avoid nephrotoxic mds - f/u outpatient within 1 week advised   Elevated D-dimer Checked w Covid as above, elevated at 1.33,  LE DVT US neg. Was not on O2 but now is, unclear if process being driven more so by bacterial PNA vs COVID PNA. Switched to therapeutic lovenox as started tx for COVID as above. Weaned to room air by 1/17 and denies resp sxs Repeat d-dimer .81, switched to heparin sq for ppx, none needed at DC.    Confusion, Poss Metabolic Encephalopathy, Improved May be related to worsening CKD vs PNA vs COVID. CT head neg. Mentation normalized with treatment of PNA, fever control and metabolic stability.    Anemia Smoldering MM Per chart review, seen at hospital in August, supposed to follow up in 6 months. Hgb 10.0->8.8->8.5->9.2, baseline 10.  -Onc follow up as prev scheduled   HTN BP 136/66 on admit. 160/88 this AM. was 118-152/70-90s yesterday. cont PTA coreg, clonidine patch. holding PTA Bumex, irbesartan, avoiding hypotension and renal insult. F/u PCP this week.    GERD: cont PTA PPI   HLD: cont PTA statin