Age: 77.0
Sex: M
Vaccine: COVID19
Symptoms: Metabolic acidosis, Metabolic encephalopathy, Nausea, Neoplasm malignant, Nothing by mouth order
Clinical narrative: Moderna Dose 1 4/7/21 (031B21A); Moderna Dose 2 12/2/21 (030H21B); COVID Positive 1/8/22. 1/8/22: Patient is a 77-year-old male with history of multiple myeloma, CKD(IIIB), chronic pancreatitis,T2DM, recent proximal small bowel perforation, s/p ex lap.  He reports abdominal pain and nausea over a period of several days.  No BM in 2-3 days.  He is fully vaccinated and boostered against COVID.  Vitals have been stable in the ED.  The patient has not required any supplemental oxygen. CXR showed no acute processes.  CT of the abdomen and pelvis showed no obstruction, free air, free fluid, abscess, or definite acute process.  Did show soft tissue enlargement or fullness involving the tail of the pancreas, suspicious for primary neoplasm.  Also showed wall thickening of the stomach and proximal duodenum which may be related to gastritis and peptic ulcer disease with postoperative changes.  Surgery was consulted from the ED. Dr.  saw the patient in the ER, and recommended the patient stay NPO with Protonix b.i.d., Unasyn, gallbladder ultrasound, and possible EGD in the a.m..  Labs were significant for BUN 89, creatinine 3.27, protein 4.2, calcium 6.7, troponin 0.07, WBC 24.53, hemoglobin 10.5, INR 1.4, CRP 13.94.  2 hour troponin was 0.06.  COVID screening was positive.  1/21/22: The patient is a 77-year-old gentleman was admitted to the emergency room on January 9, 2021. He had initially presented on January 8, 2022 with abdominal pain.  He had colon resection done in the past but.  He was admitted by hospitalist and was found to have COVID-19 infection.  He also had acute kidney injury on top of the CKD.  He also had low calcium levels.  His creatinine was 3.27 when he came and 2.34 at discharge.  He also had anemia for which he did get 2 units of packed RBCs in the hospital.  He also developed thrombocytopenia which subsequently started to improve.  There was some concern that PPI could be contributing due to which it was stopped and he was discharged on Pepcid.  His platelet count was as low as 33,000 and was 94,000 at discharge.  His hemoglobin was 8.2.  He also had mildly elevated troponins were thought to be from kidney disease.  Was given calcium due to low calcium and calcium level was 7.6 with albumin of 2.2 at discharge.  He also had evaluation in the hospital by Nephrology who will arrange outpatient follow-up.  He also developed gross hematuria after Foley catheter and was thought to be from trauma and thrombocytopenia but were resolved by discharge.  Foley catheter was removed and he had some unit tension but it was thought that he will be okay with Flomax that  was started in the hospital on the day of discharge and continued.  He also had hypotension due to which he was given midodrine continued on discharge. His blood pressure was as low as 90 systolic but he was asymptomatic.  He had some hypoxia initially but then it resolved.  He also had some deconditioning and he thought that he will need to go to skilled initially but then he was good and could go home.  Had a DVT in the past for which she has had requests but not currently.  He was also seen by Hematology Oncology in the hospital with planned follow-up with Dr. as previously planned with the next week or two.  He was also seen by General surgery for abdominal pain who did EGD for anemia that showed gastritis and duodenitis.  There is also some spastic esophagitis. No follow-up with General surgery was recommended.  He did have some urinary retention after void of around 350 mL on the day of discharge but per my discussion with Urology since he was not having symptoms and started on Flomax should help.  He will follow up with Urology on discharge. He was discharged when was medically stable and cleared by consultants.  His Lasix 20 mg daily was continued at discharge due to leg edema. Discussions were also made recur coordination in detail and they willing to talk to daughter.   He also had some metabolic encephalopathy that was resolved by discharge.  He was given Unasyn earlier than showing to Levaquin.  He finishes antibiotics in the hospital.  He had metabolic acidosis when he came along with hypernatremia but that resolved by discharge.  He also had a pancreatic mass in the tail of pancreas which will be worked up by Hematology Oncology as outpatient.  His blood sugars were good in the hospital and he also history of chronic pancreatitis.   He is having some sundowning due to which she was given Seroquel 25 mg at night and was to be continued for seven days at discharge.  He was given some iron and folic acid in the hospital that was continued at discharge.