Age: 84.0
Sex: M
Vaccine: COVID19
Symptoms: Metabolic encephalopathy, Procalcitonin, Pyrexia, Renal failure, SARS-CoV-2 test positive
Clinical narrative: This 84 y.o. male was admitted on 1/7/2022 to the Hospital.  The following is from the admission history and physical: "HPI: The patient is a 84 y.o.  male who presents to the emergency department  for evaluation of COVID exacerbation, weakness, and confusion. Notably, the patient tested positive for COVID-19 on 1/4/22.  Per chart review he is vaccinated for COVID-19 but has not had his booster.  Patient states his symptoms started on approximately 1/3.  Patient complained of weakness and some confusion.  He states he has chronic diarrhea due to Metformin.  He denies chest pain, coughing or dyspnea.  He also denies nausea vomiting, dysuria, dizziness or headaches per chart review patient  a low grade fever of 100.7 in the emergency department.  Patient states he lived independently.    O2 sats were 88% on room air, and was placed on 2L nasal cannula.  Patient was treated with dexamethasone as listed below"   Acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient was hypoxic on room air.  Patient subsequently placed on 2 L.  Patient was treated with supplemental oxygen and was started on dexamethasone 6 mg po daily.  The procalcitonin level was 0.22 which makes the bacteria infection unlikely The proning protocol will be initiated, every other day D-dimers were ordered, daily CRP levels were ordered, and the patient was placed on full barrier precautions.  Given the fact the patient has mild symptoms and is only on 2 L.   Today the patient was weaned to room air and screened by respiratory therapy.  Patient did well and did not qualify for home oxygen.  Patient agrees with the plan to discharge home today.  Patient does not require outpatient prescription for Decadron since he is on room air and doing well   Mild confusion due to suspected mild metabolic encephalopathy due to Covid 19 pneumonia.    Patient's confusion appears to have resolved   Weakness.  This is probably due to COVID-19.  Patient was evaluated by PT and it was recommended that he discharge home with support and someone with him initially to make sure he was able to care for himself.  Per RN report the patient's family agreed to be with the patient initially as he returns home.   Diabetes type 2.  This will probably be exacerbated by the dexamethasone.  Continue Metformin.  The patient is currently on the extended release and hopefully this will decrease his diarrhea.  Will have low-dose Imodium available if needed.    Patient was treated with low intensity sliding scale.  Patient's blood sugar should return to normal since he will not require dexamethasone after discharge.  I recommended that the patient follow-up with his primary care provider to discuss other options to treat his diabetes that do not produce diarrhea.   Hypertension.  Continue amlodipine and metoprolol but hold losartan due to mild renal insufficiency.  The patient's repeat creatinine was normal and the patient can resume his normal blood pressure medications at home   Mild acute renal insufficiency.  Admission creatinine 1.33.  The repeat creatinine was normal.   Prophylaxis: Lovenox daily dosing dosing and may adjust based on D-dimer result