Age: 79.0
Sex: M
Vaccine: COVID19
Symptoms: Acute kidney injury, Acute respiratory failure, Adrenal insufficiency, Ammonia normal, Anticoagulant therapy
Clinical narrative: Patient is a 80 y.o. male patient of MD with history of CHF, CKD, Depression, DM Type 2, CAD,  Hypertension, Peripheral Neuropathy, nephrolithiasis,  TIA, Chronic diarrhea, Hyperlipidemia presented to Hospital with shortness of breath  weakness, Fever and Cough .   Pt medically ready for discharge, but lives alone with wife who is also admitted. Possible discharge of both on 3/5   Acute hypoxic respiratory failure due to   Sepsis due to COVID-19 Infection hypoglycemia, tachypnea, fever up to 102.7 on adm. Now resolved Symptoms since 2/27,  weakness, Fever and Cough. Tested positive 3/1/2023. Vaccinated x 2 plus 1 booster. Chest x-ray prominence of the bronchovascular markings Lactic acid unremarkable, CRP; 48.6. Procal nl Initially required  4 L of supplemental oxygen, now weaned to baseline room air.   Started on dexamethasone, changed to Prednisone due ot adrenal insufficiency  Received a Rocephin azithromycin, no clear signs of bacterial infection and procal nl so   discontinued Cont IS/PEP   Dizziness Intermittent for weeks now improved Orthostatic VS normal Meclizine ordered. PT/ OT consulted.  Ambulating with walker   AKI On CKD Stage 3 Hypokalemia Admission CR 2.58, baseline 1.7-2.1.  Cr  1.9 at discharge On Lasix, dose recently decreased by Nephrologist as outpt. Avoid Nephrotoxic agent Nephrology consulted, Lasix ordered IV x 2. Will cont PO lasix 40 mg daily and resume BID at discharge PO potasium   Adrenal insufficiency In context of acute infection. Hypoglycemia and hypotension on adm.  Cortisol 3.8 random Pt with hx of DM, hypoglycemic on adm, has remained off medication and with BS <180 despite steroids treatment.  Started on prednisone 40 mg, will wean to 20 mg at discharge x 7 days, then 10 x 7 days then cont 5 mg until seen by PCP    Thrombocytopenia Platelets 138k, probably due ot COVID and sepsis.  No signs of bleeding Monitor. DM with neuropathy Pt presented with hypoglycemia, required multiple doses of dextro, will stop MIVF w/ D5 now.  Etiology multifactorial, poor PO intake and noted adrenal insufficiency Hba1c 6 Pt with hx of DM, hypoglycemic on adm, has remained off medication and with BS <180 despite steroids treatment.  On Amaryl and Tresiba at baseline, will hold at this time, will not cont  at discharge as pt controlled on steroids.  Cont  SSI    Acute metabolic encephalopathy- resolved History of TIAs, cerebral infarcts stroke Does have occasional intermittent baseline confusion. Now complicated by hypoxemia COVID, acute on chronic renal failure and hypoglycemia CT head without contrast mild chronic small vessel white matter changes. Remote bilateral basal ganglia lacunar infarcts.  Remote right thalamic lacunar infarct. Ammonium nl. B12/ folic elevated   Chronic HFpEF Hx of PAF on coumadin Bradycardia, sinus Shortness of breath cough likely triggered by COVID infection. No other signs of volume overload. Does not have acute exacerbation  Echocardiogram  2/8/2023 with EF 65.0 %. ProBNP 4656.   Cont coumadin, pharmacy to dose, INR therapeutic.  Strict input and outputs, daily weights Fluid restriction.   Contaminated Blood culture BC 1/2 + Coag neg Staph. Monitor