Age: 49.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Agitation, Ammonia normal, Atelectasis, Blood gases normal
Clinical narrative: Patient is a 50 y.o. male patient of Physician with history of DM2, Hyperlipidemia, Hypertension, Hypothyroidism and Schizoaffective disorder presented to Emergency Department with cough, congestion and generalized flu like symptoms. Patient transferred to hospital due to hypoxia and lactic acidosis.    Sepsis due to Covid-19 Virus Infection Met sepsis criteria with T 101.1, HR 128, lactate 3.3 Date of onset of symptoms: 8/5/23 Symptoms present on admission: tachycardia, fevers, congestion, cough, shortness of breath, myalgias  Date of covid positive test: 08/07/23 Vaccination status: vaccinated Imaging: CXR- low lung volumes with pulmonary vascular congestion and bibasilar atel  Patient is a 50 y.o. male patient of Physician with history of DM2, Hyperlipidemia, Hypertension, Hypothyroidism and Schizoaffective disorder presented to Emergency Department with cough, congestion and generalized flu like symptoms. Patient transferred to hospital due to hypoxia and lactic acidosis.    Sepsis due to Covid-19 Virus Infection Met sepsis criteria with T 101.1, HR 128, lactate 3.3 Date of onset of symptoms: 8/5/23 Symptoms present on admission: tachycardia, fevers, congestion, cough, shortness of breath, myalgias  Date of covid positive test: 08/07/23 Vaccination status: vaccinated Imaging: CXR- low lung volumes with pulmonary vascular congestion and bibasilar atelectasis Oxygen requirements on admission: 2L Current oxygen requirements: RA Medical therapy: dexamethasone from 8/7, remdesivir from 8/8. Stopped after 8/9 due to resolved O2 requirement Consultants following: None Anticipated special isolation end date: 8/16 based on symptoms Acute metabolic encephalopathy, improved According to patients caregiver, patient is verbal and active at baseline  Only responsive to sternal rub on arrival Vitals were stable with unremarkable ABG TSH WNL, ammonia WNL CTH unremarkable Awake alert and interactive 8/8; resumed haldol at reduced dose 8/8 and full dose 8/9; transient sedation after full dose haldol, adjusted per below   Acute respiratory failure with hypoxia, resolved Due to COVID  Not on oxygen at home but requiring 2L NC on admission CXR as above Flu and rapid strep screens negative BNP 294, no sign of peripheral volume overload COVID per above Weaned to RA 8/9, then needed 1L again after sedation with home haldol, back to RA since   Lactic acidosis  Lactate 3.3 down to 2.0 after 2.6L bolus in total   DM2, non insulin dependent  Blood glucose 169 on labs in the ER A1c was 4.3 10/2022, repeat pending Holding home Metformin Glucose rising with steroid use and resuming diet Monitor accu checks and start SSI  Lantus QAM while on steroid Resume home regimen on discharge   Hypothyroidism  Continue home Synthroid   Schizoaffective personality disorder  MRDD Patient has 24 hour supervision with home health aids  Unsure of legal guardianship Held home Thorazine and Haldol due to lethargy VPA level 65 Resumed haldol at 5mg BID 8/8, increased back to home dose of 20mg BID 8/9 as he was becoming more agitated. Quite lethargic after first dose of 20mg; decreased to 10mg BID to resume 8/10 and continue at that dose on discharge Advised to resume thorazine in one week Further per the discretion of his outpatient psychiatrist, follows up once monthly