Age: 76.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Alanine aminotransferase normal, Anion gap, Aspartate aminotransferase normal, Asthma
Clinical narrative: Discharge Summary Hospital Medicine Medical Center      Date of Admission: 12/10/2023 Date of Discharge: anticipate d/c 12/16/23 if not hypoxic, eating and normoglycemic   Primary Care provider:  MD Studies pending at the time of discharge: None   Issues to be addressed on follow-up: Glycemic control   Referrals sent on discharge: None   Admission diagnosis:  COVID 19 with mild respiratory failure Steroid induced hyperglycemia   Summary of Hospital Course: 79 yo F with COVID19 diagnosed 12/10/23, with asthma, Dm2, HTN, who was admitted with respiratory failure and treated with RDV and steroids.  She improved, though has suffered some hyperglycemia from steroids.  She was weaned off O2 by 12/13/23.  I assumed care on hospital day 4 from Dr. On my first day with her, I stopped her steroids (she received the dose in the AM before I stopped it) due to improved oxygenation.  Glipizide was added and insulin continued. She ate poorly at dinner, was hypoglycemic.  This morning, hypoglycemic again and NPH/glipizide held.  I suspect she's close to d/c once we can demonstrate normoglycemia and adequate PO intake (she didn't want to eat this morning.).   COVID-19 ACUTE BRONCHITIS (12/10/2023) ACUTE HYPOXEMIC RESPIRATORY FAILURE (12/10/2023) MODERATE PERSISTENT ASTHMA (9/9/2010) Swabbed positive 12/10/23.  CXR with chronic appears bilateral lower lobe infiltrates.  Required 2L O2 at most, now on room air with minimal SOB. -Stopped decadron after day 5 on 12/13 due to hyperglycemia and improved o2 saturations -RDV day 5 today. -Continue inhalers. -Isolate x21 days.  DM 2  A1c 8. At home takes metformin 1g/500mg. Requiring high doses insulin here for steroid induced hyperglycemia.  Glipizide added yesterday and NPH increased.  Steroids given in the AM (at a tapered dose) and stopped subsequently. Hypoglycemic last night after poor PO intake at dinner. Still eating poorly today. -Reduce SSI.  Stop NPH. -Stop glipizide (added this admit). -Hold metformin in house.   DM 2 W CKD STAGE 1 (GFR >= 90 W OTHER KIDNEY DAMAGE MARKER) (7/5/2012) Baseline Cr ~0.8.   HTN (HYPERTENSION) (3/20/2008) -Continue losartan. -Continue simvastatin.     Anticipate d/c home tomorrow if oxygenation, blood sugars, and oral intake are appropriate.       Final Diagnoses:  Active Hospital Problems   Diagnosis   ? (Principal) ACUTE HYPOXEMIC RESPIRATORY FAILURE   ? COVID-19 ACUTE BRONCHITIS   ? DM 2 W CKD STAGE 1 (GFR >= 90 W OTHER KIDNEY DAMAGE MARKER)   ? MODERATE PERSISTENT ASTHMA   ? HTN (HYPERTENSION)     Resolved Hospital Problems No resolved problems to display.   Primary procedures:  None    Consults obtained:  HOSPITAL MEDICINE - ONGOING INPATIENT CONSULTATION.   Code status:    Full Code  Discharge disposition:  Home   MD Hospital Medicine Medical Center     Note forwarded to MD and/or involved subspecialists.     Daily Progress Note Hospital Medicine Medical Center      Date of admission: 12/10/2023   Hospital Day(s): 5 Daily Events: 12/14 - assumed care, leukocytosis improving, glucoses 200s (required 77 units insulin yesterday) 12/15 - 93% on RA, afebrile, hypoglycemic in the evening yesterday after eating 15% of dinner   Subjective: Wants to go home No appetite   Assessment & Plan:  Active Hospital Problems   Diagnosis   ? (Principal) ACUTE HYPOXEMIC RESPIRATORY FAILURE   ? COVID-19 ACUTE BRONCHITIS   ? DM 2 W CKD STAGE 1 (GFR >= 90 W OTHER KIDNEY DAMAGE MARKER)   ? MODERATE PERSISTENT ASTHMA   ? HTN (HYPERTENSION)     Resolved Hospital Problems No resolved problems to display.     Consultants:  HOSPITAL MEDICINE - ONGOING INPATIENT CONSULTATION.     Diet: ADA DVT prophylaxis heparin Tubes / Lines: none Level of Care MS Code Status: full Expected length of stay: one more night Discharge disposition: home   MD Hospital Medicine Medical Center   Objective: BP 139/61  | Pulse 80  | Temp 97.8 °F (36.6 °C)  | Resp 18  | Wt 44.7 kg (98 lb 8.7 oz)  | SpO2 92%  | Breastfeeding No  | BMI 21.26 kg/m²    Intake/Output Summary (Last 24 hours) at 12/15/2023 1313 Last data filed at 12/14/2023 2139  Gross over last 24 hours Intake 630 ml Output ? Net 630 ml     Physical Exam: General appearance -  alert, well appearing, and in no distress Mental Status -  alert, oriented x 3 Chest - rales/rhonchi noted bases Heart - regular rate and rhythm Abdomen - soft, nontender, nondistended, no masses or organomegaly Extremities - no clubbing, cyanosis or edema Skin -  warm and dry Neurological - motor and sensory grossly normal bilaterally   Labs:  Recent Labs Recent Results (from the past 24 hour(s)) GLUCOSE, RANDOM, BLOOD, GLUCOMETER, FDA APPROVED   Collection Time: 12/14/23  4:19 PM Result Value Ref Range   GLUCOSE, BLOOD, GLUCOMETER 60 60 - 159 mg/dL   POCT CLIA SEE COMMENT   GLUCOSE, RANDOM, BLOOD, GLUCOMETER, FDA APPROVED   Collection Time: 12/14/23  8:44 PM Result Value Ref Range   GLUCOSE, BLOOD, GLUCOMETER 379 (H) 60 - 159 mg/dL   POCT CLIA SEE COMMENT   ALT   Collection Time: 12/15/23  7:40 AM Result Value Ref Range   ALT 28 0 - 41 U/L AST   Collection Time: 12/15/23  7:40 AM Result Value Ref Range   AST 29 10 - 40 U/L CHEM 7 (NA, K, CL, CO2, BUN, GLUC, CR)   Collection Time: 12/15/23  7:40 AM Result Value Ref Range   Sodium 140 135 - 145 mEq/L   Potassium 3.9 3.5 - 5.3 mEq/L   Chloride 105 100 - 111 mEq/L   CO2 28 24 - 33 mEq/L   Anion gap, ser/plas 7 5 - 16 mEq/L   BUN 25 7 - 27 mg/dL   GLUCOSE, RANDOM 56 (L) 60 - 159 mg/dL   Creatinine 0.79 <=1.11 mg/dL MAGNESIUM   Collection Time: 12/15/23  7:40 AM Result Value Ref Range   MAGNESIUM 2.0 1.7 - 2.3 mg/dL WBC AUTO DIFF   Collection Time: 12/15/23  7:40 AM Result Value Ref Range   Neutrophils, Automated Count 9.8 (H) 1.8 - 7.9 K/uL   Lymphocytes, Automated Count 1.5 0.9 - 3.2 K/uL   Monocytes, Automated Count 1.3 (H) 0.3 - 0.9 K/uL   Eosinophils, Automated Count 0.0 0.0 - 0.4 K/uL   Basophils, Automated Count 0.0 0.0 - 0.1 K/uL   Immature Granulocytes, Automated Count 0.1 0.0 - 0.1 K/uL   Neutrophils %, Automated count 78 %   Lymphocytes %, Automated count 12 %   Monocytes %, Automated Count 10 %   Eosinophils %, Automated Count 0 %   Basophils %, Automated Count 0 %   Immature Granulocytes %, Automated Count 0 % CBC W AUTOMATED DIFFERENTIAL   Collection Time: 12/15/23  7:40 AM Result Value Ref Range   WBC COUNT 12.6 (H) 3.7 - 11.1 K/uL   Red blood cells count 4.18 3.60 - 5.70 M/uL   Hgb 10.8 (L) 11.5 - 15.0 g/dL   Hematocrit 33.8 (L) 34.0 - 46.0 %   MCV 81 80 - 100 fL   RDW, RBC 16.0 12.0 - 16.5 %   Platelets count 193 140 - 400 K/uL   RBC's, nucleated 0 <=0 /100WC GLUCOSE, RANDOM, BLOOD, GLUCOMETER, FDA APPROVED   Collection Time: 12/15/23  9:38 AM Result Value Ref Range   GLUCOSE, BLOOD, GLUCOMETER 55 (L) 60 - 159 mg/dL   POCT CLIA SEE COMMENT   GLUCOSE, RANDOM, BLOOD, GLUCOMETER, FDA APPROVED   Collection Time: 12/15/23 10:27 AM Result Value Ref Range   GLUCOSE, BLOOD, GLUCOMETER 95 60 - 159 mg/dL   POCT CLIA SEE COMMENT   GLUCOSE, RANDOM, BLOOD, GLUCOMETER, FDA APPROVED   Collection Time: 12/15/23 11:56 AM Result Value Ref Range   GLUCOSE, BLOOD, GLUCOMETER 76 60 - 159 mg/dL   POCT CLIA SEE COMMENT          Note Details  Author (M.D.) File Time 12/15/2023  1:13 PM Author Type Physician Status Signed Last Editor  (M.D.) Specialty Hospital Medicine Hospital Acct # Admit Date 12/10/2023  ED to Hosp-Admission (Discharged) on 12/10/2023  ED to Hosp-Admission (Discharged) on 12/10/2023   Detailed Report  Note shared with patient Additional Orders and Documentation   Results Imaging   Meds    Orders    Flowsheets   Encounter Info:  History, Allergies, Education, Care Plan, Detailed Report   Hospital Problem List   HTN (HYPERTENSION)  MODERATE PERSISTENT ASTHMA  DM 2 W CKD STAGE 1 (GFR >= 90 W OTHER KIDNEY DAMAGE MARKER)  ACUTE HYPOXEMIC RESPIRATORY FAILURE Resolved  COVID-19 ACUTE BRONCHITIS Care Timeline  12/10   Admitted from ED (Observation) 2245 12/14   Admitted 1143 12/16   Discharged 1415  Discharge   Home or Self Care.   Discharge Instructions (AVS) (Printed 12/16/2023) Medication List at Discharge   albuterol sulfate   90 mcg/actuation Hfaa, Inhale 2 Puffs By Mouth Every 4 Hours As Needed For Symptoms . Rinse Mouthpiece At Least Every Week With Warm Water (Note: Different Manufacturer)  2.5 mg NEBULIZATION -UNSPEC EVERY 4 HOURS AS NEEDED  cholecalciferol (vitamin D3) 25 mcg (1,000 unit) TAKE 1 TABLET ORALLY DAILY  fluticasone propion/salmeterol 230-21 mcg/actuation 2 Puffs Inhalation 2 TIMES A DAY, . Shake well before use. Rinse mouth well after use  guaifenesin/dextromethorphan 10-100 mg/5 mL 10 mL Oral EVERY 4 HOURS AS NEEDED, for chest congestion. Do not exceed 6 doses in 24 hours  ipratropium bromide 0.5 mg NEBULIZATION -UNSPEC 4 TIMES A DAY  losartan potassium 25 mg Oral DAILY  meclizine HCl 25 mg Take 1 tablet by mouth once daily as needed for vertigo  metformin HCl 500 mg Take 2 tablets by mouth in the morning and 1 tablet by mouth in the evening with food. NOTE: Different directions.  montelukast sodium 10 mg Oral EVERY BEDTIME  simvastatin 20 mg Oral EVERY EVENING