Age: 52.0
Sex: F
Vaccine: COVID19-2
Symptoms: Abdominal distension, Acute kidney injury, Acute respiratory failure, Anti-cyclic citrullinated peptide antibody negative, Antineutrophil cytoplasmic antibody negative
Clinical narrative: Patient is a 53 y.o. female past medical history of morbid obesity, OSA, DM, HFpEF who presented from outside hospital on 10/28/2023 with COVID-pneumonia resulting in respiratory failure requiring intubation.  She had a complicated ICU course requiring proning, paralysis and eventual trach/PEG. Patient was transferred out of the ICU on 11/14.  With issues initially tolerating tube feedings however improved and resolved with tolerance by the time of discharge.   Acute on chronic hypoxic respiratory failure - Secondary to COVID-pneumonia with underlying OSA, heart failure, asthma.  Home 4 L nasal cannula - Intubated and required pronation, paralysis while in ICU.  S/p trach 11/13 - Continue vent weaning per pulm   Recurrent emesis - She reported adverse reaction to Seroquel, KUB obtained showing possible early bowel obstruction but she is passing gas and having Bms -KUB on 11/17 showing resolution of small bowel gas.  KUB on 11/15 was showing gaseous distention 4.2 cm with concern for possible small bowel obstruction. -This improved with stopping tube feedings overnight 11/16, was able to tolerate overnight and into 11/17.   Rash -Macular rash noted on legs and trunk of unclear etiology. DRESS syndrome is a possibility with  noted mild peripheral eosinophilia. Though given her critical illness her "systemic symptoms" have other explanations.  - Rheumatoid factor wnl. HIV, hepatitis panel negative. C3, C4 wnl. - Autoimmune work up. ANCA, Anti-DSA, ANA, RF, CCP negative - if drug reaction, will be difficult to delineate the causative agent as she has been hospitalized for 17 days with multiple medications, antibiotics, etc. Unclear date of rash onset.  - continue to monitor closely, may need to consider derm eval if worsens   Sinus tachycardia - Noted after transfer out of critical care and Precedex weaned off.  Suspect anxiety possibly delirium playing a role -Likely in the setting of critical care setting in class III obesity and deconditioning.   COVID pneumonia-resolved - Tested positive 10/21/23.  - Completed Remdesivir and Solu-Medrol.  Completed isolation 11/10.   Severe sepsis-resolved - Felt to be due to COVID infection.  Patient intermittently favoring with no evidence of DVT on duplex.  Multiple pancultures negative.  Fungitell assay negative.  CT chest abdomen pelvis 11/17 with lower lobe opacification. - Antibiotics have been completed and ID has signed off Diabetes mellitus type 2 - Home Tresiba, lispro insulin and metformin -Patient will be discharged on home Tresiba regimen and insulin and metformin. - Nutrition via PEG tube   Urinary retention - Noted while in ICU with bladder scans greater than 900 cc requiring multiple straight caths - Foley was placed 11/11, voiding trial when more mobile, discharged with Foley.   Thrombocytopenia - Likely secondary to critical illness.  Schistocytes negative.  DIC screen negative - low suspicion for HIT - Platelets stabilizing around 120s   Facial abrasions - Secondary to proning, critical illness, ET tube - Wound care assessed the patient while hospitalized.   AKI-resolved - Secondary to critical illness.   Hypothyroidism - Most recent TSH within normal limits.  Continue home Synthroid   Hyperlipidemia Hypertriglyceridemia - Triglycerides markedly elevated, likely secondary to propofol use.  TG with significant improvement after propofol discontinuation - Resume home statin, Zetia   Class III obesity - BMI 52 - tube feeds via PEG   OSA/OHS -Trach/vent as above