Age: 65.0
Sex: M
Vaccine: COVID19
Symptoms: Pericardial effusion, Platelet count normal, Pleural effusion, Pleural fluid analysis abnormal, Pulmonary congestion
Clinical narrative: Discharge Provider: MD Primary Care Provider: MD Admission Date: 2/8/2023 Discharge Date: Feb 12, 2023  PRESENTING PROBLEM: Acute renal failure, unspecified acute renal failure type  [N17.9] Acute kidney injury superimposed on chronic kidney disease  [N17.9, N18.9]   HOSPITAL COURSE: Patient is a 66 y.o. male with past medical history significant for chronic combined systolic dysfunction and diastolic dysfunction CHF, severe RV dysfunction, valvular heart disease with repair for mitral valve, ASD repair, tricuspid valve annuloplasty  8/19, atrial fibrillation on Coumadin, CAD s/p CABG, type 2 diabetes, CKD III, malignant melanoma on left eye '19, iron deficiency anemia who was sent to ER by his cardiologist due to elevated creatinine, INR during routine check on the day of admission  Patient recently had right thoracentesis on January 26 and pleural fluid study was suspicious for small B-cell lymphoma or CLL.     In he ED;   Vitals in ER showed blood pressure 97/53, pulse 58, temperature 5, respiration 18, O2 sat 98% on room air. Labs showed BUN 89, creatinine 3.84 which is elevated from his baseline, INR 2.7, potassium 5.2, hemoglobin 10.8, white count 7.3 platelet 172. BMP 1218. He was also positive for COVID-19.  CXR showed pulmonary congestion and small to moderate right pleural effusion. Patient reported recently finishing a course of antibiotics for his abscess on his left buttock and has subsequently developed watery diarrhea after he finished antibiotics.            Patient had a echocardiogram, which showed left ventricular ejection fraction 60% and small pericardial effusion.  Patient stated that he has been taking home diuretics on time and has been making urine without decreased urine output noted.  He also denies weight gain or weight loss or lower extremity edema.   He was admitted to hospitalist service, and was started on fluid, and diuretics were held.  His creatinine improved from 3.84 on admission to 1.68.  The patient was also had hyperkalemia following improved after restricting his potassium intake as well as giving Kayexalate and coma.   Chronic combined CHF was stable, he continued Coreg, but was advised to restart Torsemide in 2-3days as well as his Lisinopril and metolazone.  He was instructed not to continue with spironolactone at this time due to hyperkalemia and was advised to follow-up with his primary care doctor or cardiologist in order to assess reassess restarting the medications.     He was not interested in repeating thoracocentesis. Diarrhea resolved prior we were able to test for C. Diff.  Chronic A. Fib with well controlled rate. He was discharged on warfarin    He has known history of iron deficiency anemia and he received Ferrlecit 125 mg 5 infusion during this hospitalization.  He will follow-up with hematologist as scheduled before for her this study to exclude small B-cell lymphoma CLL.   The patient was discharged home in a stable condition.  He was instructed to for 2 weeks.  He was also given a prescription for repeating his BMP.