Age: 70.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Arthritis, Blood creatinine normal, Blood potassium increased, C-reactive protein increased
Clinical narrative: vaccinated patient admitted for Covid Admit 8/28/2021, discharge 9/2/2021 to home  Chief Complaint: Hypoxia, SOA   History Of Present Illness PT is a 71 y.o. female presenting with history of osteoarthritis and rheumatoid arthritis who presents to the emergency department with nausea, vomiting, diarrhea, fatigue, cough productive clear sputum,  COVID positive on 08/20, 8 days ago.  She reports that since her COVID diagnosis she has had worsening of the symptoms listed above.  She is sometimes able to keep fluids down but they ?go right through her?/diarrhea.  She reports fevers at home every day up to 101.  She reports that her home pulse ox drops to the 80s and stays there whenever she exerts herself.  She denies chest pain, abdominal pain, urinary symptoms.  No blood in the stool or vomit.  Reports intermittent productive cough of clear sputum.  Denies history of heart or lung disease, never smoker.  She completed her COVID vaccination series in March of 2021. Reports over the past couple of months she has been experiencing right ear infections and has been on 3-4 courses of antibiotics. Currently she is taking clindamycin and has 2 doses left to complete the course. She sees ENT.  She reports moderate pain in the right ear, usually tolerable after Acetaminophen.   Past Medical History Osteoarthritis, rheumatoid arthritis, neuropathic pain, hyperlipidemia, recurrent right otitis media, depression Surgical History She has a past surgical history that includes Colon surgery; Brain tumor excision; and Hysterectomy.  Hospitalization Admit Date/Time: 8/28/2021  1:49 PM Admitting Attending: Syed S Shah Discharge Date: 9/2/2021 Discharge Attending Physician, Md  PCP name and Address:  No Pcp None Referring provider name and address:  No referring provider defined for this encounter.   Chief Concern, Brief History of Present Illness, and Hospital Course a 71 y.o. female presenting with history of osteoarthritis and rheumatoid arthritis who presents to the emergency department with nausea, vomiting, diarrhea, fatigue, cough productive clear sputum,  Found to be COVID positive. Vaccinated in 02/2021. Improved with steroid and remdesivir course for 5 days. Hence, being discharged to home today.     Assessment and Plan on Discharge Day   Acute hypoxic respiratory failure 2/2 COVID-19 PNA  -Vaccinated 02/2021 -Symptoms started 08/26/21, Tested positive 08/20/21 prior to admission, positive here as well on 8/28 -Inflammatory markers elevated on admission (CRP-100.6) -CXR with bilateral patchy focal opacities -S/p dexamethasone for 6 days (8/28-9/2),  remidisivir for 5 days (8/28-9/1), no need for steroid on discharge as has been off oxygen since yesterday and doing well on room air (initially required 2L NC on admission) -Supportive care for cough, continue mucinex for few days on discharge   Lymphocytopneia 2/2 due to COVID Leukopenia with neutropenia -Lymphocyte count-0.42 on 8/29 -WBCs- 2.09 with ANC of 1.56 on 8/29 -Monitor   Diarrhea (improving) Pre-renal AKI in the setting of hypovolemia 2/2 due to above s/p IVF resuscitation (resolved) -Secondary to COVID-19 -C diff + GI panel negative -Received 1 L bolus in ED on presentation for possible hypovolemia in the setting of diarrhea, hold off on further IVF for now as clinically euvolemic currently -Cr improved to 0.79 on 8/31<<1.04 on admission   Hyperkalemia (resolved) -K down to 4.6 on 8/31<<5.3 on 8/29   Rcurrent otitis media -No drainage noted, completed clindamycin 08/18-08/28   Erosive arthritis  -Psoriatric vs rheumatoid; follows rheumatology -Methotrexate held while inpatient, can resume on discharge -Continue home folic acid and hydroxycholoquine   Osteoarthritis -Topical diclofenac   Depression/ anxiety -Continue home gabapentin 300mg TID, duloxetine 60mg   HLD  -Continue home Pravastatin 40mg every day   Restless leg syndrome -Continue home pramipexol 1mg at bedtime   Morbid Obesity -BMI-40.3, complicates care