Age: 25.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Respiratory failure, SARS-CoV-2 test negative, Seizure, Sepsis, Tachycardia
Clinical narrative: Inpatient Discharge Summary         Admission Date: 4/16/2021     Discharge Date: 4/21/2021    Medical Problems     Hospital Problems        POA    * (Principal) Pneumonia due to COVID-19 virus Yes         Autism spectrum Yes         Localization-related symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticus (CMS/HCC) Yes                       Protein S deficiency (CMS/HCC) Yes           Stopped anticoag. They recommended LOVENOX not heparin if he has surgery              Sepsis, due to unspecified organism, unspecified whether acute organ dysfunction present (CMS/HCC) Unknown         Acute respiratory insufficiency Yes                Active Issues Requiring Follow-up   Acute metbaolic encephalopathy with multiple episodes of decreased responsiveness History of severe complex partial seizures with neurostimulator Seizure disorder.   -Patient is on increased dose of Depakote 1000 mg twice daily.   Continue Vimpat 300 mg twice daily.   Continue clonazepam 1 mg 3 times daily. -Patient had been on continuous EEG monitoring, will await review. -Patient is much more awake and alert and communicative today.   Severe sepsis secondary to COVID-19 pneumonia.   -Continue supplemental oxygen as needed to maintain spO2 over 90% -Patient completed remdesivir as well as a convalescent plasma. -Patient will complete 5 more days of oral dexamethasone.   Acute respiratory insufficiency with hypoxia secondary to COVID-19 pneumonia. -Wean oxygen as able. -Patient is able to wean off oxygen, currently does not require any oxygen at the time of discharge.   Hypothyroidism.  Continue levothyroxine 112 mcg daily.   History of recent superficial venous thrombosis.  Continue Eliquis 5 mg twice daily. No bleeding issues.    Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Hypoxia [R09.02] Sepsis, due to unspecified organism, unspecified whether acute organ dysfunction present (CMS/HCC) [A41.9] Pneumonia due to COVID-19 virus [U07.1, J12.82] COVID-19 [U07.1]   Hospital Course     This pleasant 25-year-old young man with known history of autism spectrum disorder, history of seizure disorder came in with acute respiratory insufficiency secondary to Covid pneumonia resulting in sepsis.  Patient also had acute metabolic encephalopathy secondary to recurrent seizure disorder.  Patient was followed by neurology during this hospitalization and his divalproex dose was increased to 1000 mg twice daily dosing and continued on Vimpat as before.  Patient also required a clonazepam and diazepam for seizure disorder.   As far as Covid is concerned patient did complete convalescent plasma as well as remdesivir.  Patient will need 5 more days of oral Decadron.   Otherwise patient remained stable and he is able to wean off oxygen to room air.  Patient did not require any oxygen support with exertion either at the time of discharge.  Otherwise patient remained stable hence he was discharged back to home with home health care.  His parents are extremely well involved in the care and able to take care of him with home health care.   His readmission potential is low to moderate.   Patient will be followed by neurologist as an outpatient basis for ongoing management of epilepsy.            Inpatient Discharge Summary          Brief Overview        Admission Date: 5/5/2021     Discharge Date: 5/8/2021   Principal Problem:   COVID-19 Active Problems:   Autism spectrum   Minimal cognitive impairment   Sepsis (CMS/HCC)    Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Sepsis (CMS/HCC) [A41.9] Fever, unspecified fever cause [R50.9] Urinary tract infection without hematuria, site unspecified [N39.0] Pneumonia due to infectious organism, unspecified laterality, unspecified part of lung [J18.9] COVID-19 [U07.1]     Hospital Course This is a 25-year-old gentleman with history of autism, seizure disorder lupus and protein S deficiency on anticoagulation on Eliquis who was brought in emergency department due to fever.  Had a fever up to 105 at home.  Patient was tachycardic and tachypneic.  He was recently discharged from the hospital at that time he was treated for COVID-19 infection with pneumonia he he was treated with convalescent plasma, remdesivir and dexamethasone.  He was admitted for work-up for his fever.  Had a CT scan of the chest which showed persistent pneumonia without any pulmonary embolism.  This pneumonia is from the previous Covid infection and not new finding. CT scan of the abdomen pelvis was unremarkable.  His procalcitonin was normal urine culture was growing E. coli.  He was evaluated by infectious disease team and case was discussed.  Source of infection was not fully clear.  He was started on broad-spectrum antibiotics his fever did settle down.  Now his antibiotics changed to p.o. Cefuroxime and doxycycline she needs to continue for 7 days.  Not sure it was true UTI versus colonization. Non specific encephalopathy and unable to determine the cause   On day of discharge patient is afebrile.  No obvious seizure-like activity.  Denies any nausea vomiting or abdominal pain.  Denies any cough sputum or shortness of breath.  No other new symptoms or acute event as per nursing staff