Age: 14.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Chest X-ray abnormal, Clostridium test negative, Condition aggravated, Cough
Clinical narrative: Discharge Provider: MD  Primary Care Physician at Discharge: DO  Admission Date: 5/2/2023  Discharge Date: 5/13/2023  DETAILS OF HOSPITAL STAY: Pneumonia due to organism  Acute respiratory failure with hypoxia (HCC)  Acute hypoxemic respiratory failure due to COVID-19 (HCC)    HOSPITAL COURSE: Patient is a 16 y.o. female with past medical history including agenesis of the corpus callosum, cerebral palsy, global developmental delay, epilepsy with VNS device, and G-tube dependence who presented on 5/2/23 with four day history of cough and one day history of increased congestion, secretions, fever, and hypoxia requiring  increased oxygen at home. Mother also noted increased seizure frequency, and she held home feeds due to poor tolerance with respiratory infection. She was admitted for hypoxia and increased seizures frequency secondary to COVID-19 and Adenovirus viral pneumonia.   In the emergency department, pt was febrile, hypoxic to 86% on room air, and mildly tachypneic.  She was placed on 2 L nasal cannula.  Chest x-ray was obtained and concerning for retrocardiac opacities. She received a dose of ampicillin for community-acquired pneumonia. She had leukocytosis WBC 13.7K.  CMP was unremarkable.  Procalcitonin 0.15.  Viral panel was positive for adenovirus and COVID-19.  Blood culture was collected, which was ultimately negative.   Upon admission, pt was continued on her respiratory Yellow Zone with albuterol 2 puffs, hypertonic saline, cough assist, and vest chest physiotherapy every 4 hours. She was started on Remdesivir and completed a 5 day course in the setting of COVID-19 infection. Antibiotics were not initially continued for CAP due to improved aeration of the left lower lobe on 5/2 CXR compared to previous imaging.    Neurology was consulted, and pt was placed on EEG overnight 5/2-5/3. She was continued on her home seizure regimen with Briviact, Onfi, Vimpat, Trileptal, and phenobarbital. Neurology increased valium to 10 mg three times daily for bridge. She remained on daily sodium chloride. No seizure activity was captured on imaging.    Patient had worsening respiratory status on 5/4 requiring escalation of care to PICU where she was initiated on BiPAP. Ceftriaxone 50 mg/kg was started for CAP coverage. She transitioned back to the floors 5/7 where she completed her 7 day course of antibiotics. She also completed a 10 day course of steroids with dexamethasone.    The patient did struggle with antibiotic-associated diarrhea through her stay. Enteric panel and C diff testing were negative. On 5/9 she began to develop urinary retention with need for straight catheterization but continued to produce appropriate amounts of urine and was euvolemic in appearence. UA and BMP were unremarkable. Increased free water flushes were added for a few days to make up for increased GI losses. The patient's urinary retention resolved prior to discharge.    Nutrition was consulted throughout the hospitalization and formula was changed to Jevity 1.5 cal with the same mixing regimen as her prior home feeds to increase total calories. A new prescription was sent for this formula.    Patient tolerated de-escalation to her home respiratory regimen.  Family was provided with discharge instructions and return precautions. She was discharged home in stable condition on 5/13/2023.