Age: 77.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Anion gap, Arteriosclerosis, Aspartate aminotransferase normal, Bacterial test negative, Basophil count decreased
Clinical narrative: 1/13/22  78 yr/o  male with a history of hypertension, hyperlipidemia, presenting to the ED for diarrhea that is progressively worsened over the past week, reports over 6 episodes daily with associated nausea, vomiting, and epigastric abdominal pain described as soreness.  States has not been doing well since he was released from the hospital after being admitted for COVID-19, discharged on oxygen.  Denies experiencing chest pain, shortness of breath, cough, fever, blood in stool, black stool, urinary symptoms.  Reports history of DVT in his right lower extremity that was diagnosed 2 years ago.  On aspirin, denies anticoagulation use. Review of Systems  Constitutional: Negative for chills and fever.  Review of Systems  HENT: Negative for sore throat and neck pain.   Eyes: Negative for visual disturbance.  Respiratory: Negative for cough and shortness of breath.   Cardiovascular: Negative for chest pain.  Gastrointestinal: Positive for abdominal pain, diarrhea, nausea and vomiting. Negative for blood in stool.  Genitourinary: Negative.   Musculoskeletal: Negative for myalgias.  Skin: Negative for rash.  Neurological: Negative for syncope and headaches.  Psychiatric/Behavioral: Negative for agitation and behavioral problems.  Additional information for Item 19: URINALYSIS - Abnormal     Result Value Ref Range   Color-Urine Yellow      Clarity-Urine Clear      Specific Gravity Urine >1.050  1.005 - 1.030     pH-Urine 5.5  5.0 - 9.0 (pH)   Protein-Urine 30 (*) Negative mg/dL   Glucose-Urine Negative  Negative mg/dL   Ketone-Urine TRACE (*) Negative mg/dL   Bilirubin-Urine Negative  Negative mg/dL   Occult Blood-Urine Negative  Negative (arb'U)   Nitrite-Urine Negative  Negative (arb'U)   Urobilinogen-Urine Normal  Normal (EhrlichU)/dL   Leukocyte Esterase-Urine Negative  Negative (arb'U)   Source-Urine Urine Midstream      Reflex Microscopic? Microscopic performed      RBC-Urine 3 (*) 0 - 2 (HPF)   WBC-Urine 1  0 - 3 (HPF)   Squamous Epithelial-Urine 2  0 - 4 (HPF)   Bacteria-Urine None Seen  None Seen (HPF)   Mucus-Urine 3+ (*) None Seen (LPF) CBC W/DIFF - Abnormal   White Blood Count 11.66 (*) 4.5 - 11.0 10*3/uL   Red Blood Count 4.41 (*) 4.5 - 5.9 10*6/uL   Hemoglobin 13.5  13.5 - 17.5 g/dL   Hematocrit 41.0  41.0 - 53.0 %   Mean Corpuscular Volume 93.0  80.0 - 100.0 fL   Mean Corpuscular Hemoglobin 30.6  26.0 - 34.0 pg   Mean Corpuscular HGB Conc 32.9  31.0 - 37.0 g/dL   Red Cell Distribution Width-CV 12.7  12.0 - 16.8 %   Platelet Count 263  140 - 440 10*3/uL   Mean Platelet Volume 10.3  8.4 - 12.4 fL   Diff Type Hospital CBC w/AutoDiff  (arb'U)   Neutrophils % 81.1 (*) 45 - 80 %   Lymphocyte % 7.7 (*) 15 - 50 %   Monocyte % 9.9  0 - 15 %   Eosinophil% 0.3  0 - 7 %   BASO% 0.3  0 - 2 %   Immature Granulocyte% 0.7  0.0 - 1.0 %   Nucleated RBC % 0  0 /100(WBC)   Neutrophil Abs 9.44 (*) 2.0 - 8.8 10*3/uL   Lymphocyte-Absolute 0.90  0.7 - 5.5 10*3/uL   Monocyte Absolute 1.16  0.0 - 1.7 10*3/uL   EOS-Absolute 0.04  0.0 - 0.8 10*3/uL   Basophil Abs 0.04  0.0 - 0.2 10*3/uL   Immature Granulocyte Abs 0.08  0.00 - 0.10 10*3/uL COMPREHENSIVE METABOLIC PANEL (CMP) - Abnormal   Sodium 132 (*) 136 - 145 mmol/L   Potassium 3.9  3.5 - 5.1 mmol/L   Chloride 104  98 - 107 mmol/L   Carbon Dioxide 19 (*) 22 - 29 mmol/L   Anion Gap 9  5 - 13 (arb'U)   Glucose 123 (*) 74 - 99 mg/dL   Blood Urea Nitrogen (BUN) 18  8 - 26 mg/dL   Creatinine-Blood 0.80  0.73 - 1.18 mg/dL   BUN/Creatinine Ratio 22.5  RATIO   Estimated GFR >60  >60 /1.73 m2   Estimated GFR if (Privacy) >60  >60 /1.73 m2   Total Protein 6.2  6.2 - 8.0 g/dL   Albumin 2.8 (*) 3.2 - 4.6 g/dL   Globulin 3.4  1.5 - 4.5 g/dL   Albumin/Globulin Ratio 0.8 (*) 1.1 - 2.5 RATIO   Calcium 7.9 (*) 8.4 - 10.2 mg/dL   Total Bilirubin 0.5  0.2 - 1.2 mg/dL   AST/SGOT 18  5 - 34 U/L   ALT/SGPT 15  0 - 55 U/L   Alkaline Phosphatase 50  40 - 150 U/L STOOL CULTURE AND SHIGA TOXIN ASSAY C. DIFFICILE PCR /TOXIN DETECTION OVA AND PARASITE EXAMINATION LIPASE   Lipase 8  4 - 39 U/L  CT Angiogram Chest For PE  1/13/22  IMPRESSION: 1. No pulmonary embolism. 2. Increase in mild multifocal peripheral and basilar predominant infiltrate typical for COVID-19 infection. 3. Advanced atherosclerosis. 4. Advanced emphysema. 5. Advanced diffuse colonic wall thickening with associated pericolonic inflammatory stranding and edema. These findings are characteristic for severe colitis. Consider infectious etiologies such as C. Difficile colitis highest in the differential. 6. Cholelithiasis.