Age: 75.0
Sex: M
Vaccine: COVID19-2
Symptoms: Blood creatinine normal, Blood folate normal, Blood iron normal, Blood lactic acid increased, COVID-19
Clinical narrative: Patient is a 76 y.o. male patient of MD with history of OSA not on CPAP, Paroxysmal atrial fibrillation, Complete heart block s/p pacemaker, Hypertension, Diabetes type 2, Hyperlipidemia, Hypothyroidism, Nash, CKD, Anemia, Thrombocytopenia, BPH, Essential tremor, Anxiety, presented to Hospital with dyspnea.   Covid-19 Virus Infection Date of onset of symptoms: Approximately 11/21 Symptoms present on admission: Dyspnea, cough, rhinorrhea, chills Date of covid positive test: 11/27 Vaccination status: vaccinated Imaging: CXR slightly increased density left lower lung and left costovertebral angle, consistent with small effusion Oxygen requirements on admission: Room air Current oxygen requirements: Room air Medical therapy: Initially was treated with broad-spectrum antibiotics, but now on hold as procalcitonin was negative Consultants following: None Anticipated special isolation end date: 12/7   Fever Community-acquired pneumonia Tmax 100.1 overnight Chest x-ray showed questionable perihilar, bilateral lower lobe patchy density Concerning for multifocal infiltrative changes Will cover with short course of ceftriaxone Will complete ATBx with cefdinir     Severe sepsis Present with tachycardia, tachypnea, elevated lactic acid Source likely COVID-19 infection Chest x-ray suggestive of small pleural effusion Urinalysis is normal, patient has no cough, no congestion No compelling evidence of bacterial infection Normal procalcitonin level, received IV fluids in ED Initially antibiotics was on hold, restarted due to fever curve     AKI on CKD stage III Suspect prerenal etiology secondary to dehydration from decreased oral intake Baseline creatinine 1.2-1.5 range Scr 1.04 on discharge       Metabolic acidosisresolved Lactic acidosis Resolved   Macrocytic anemia No evidence of hemolysis, normal folate/B12/iron studies Hemoglobin appears to be stable now Likely significant component of dilutional effect Combined with blood loss from epistaxis No clear evidence of bleeding at this time Hemoglobin remained stable on Eliquis Will benefit from outpatient formal C-scope total without addition causes of blood loss Information for follow-up with Dr. is in the chart   Thrombocytopenia Chronic, not on heparin products, Recheck CBC early next week Close follow-up with PCP   Epistaxisresolved S/p Rhino Rocket placement and  now removed Appreciate ENT recommendations       Elevated bilirubin Total bilirubin 1.5/direct bilirubin 0.5 (11/10/2023 in setting of NASH) -- > 2.9/1.2 on admission Suspect component of dehydration Improved     Generalized weakness PT/OT evaluation   Paroxysmal atrial fibrillation Complete heart block S/P pacemaker Heart rate is fairly well-controlled Was on anticoagulation while in the hospital, hemoglobin remained stable       Essential hypertension Continue Toprol Blood pressures are soft, will continue to hold losartan/HCTZ after DC Restarted blood pressure would tolerate   Diabetes type 2 uncontrolled with hyperglycemia Hemoglobin A1c 7.1 11/10/2023 Restart home antidiabetic medications     Hyperlipidemia Continue pravastatin   Hypothyroidism Continue Synthroid     Thrombocytopenia Chronic thrombocytopenia Platelets are stable