Age: 82.0
Sex: M
Vaccine: COVID19
Symptoms: Blood bilirubin, Blood sodium decreased, COVID-19, Chest X-ray, Differential white blood cell count
Clinical narrative: Date of Admission:  10/22/2023   Date of Discharge:  10/23/2023    Issues to be Addressed on followup with PCP: ?Follow-up sodium ordered for 10/3/2023, see patient instructions below   Patient instructions: ?You had low sodium, in the setting of nausea and poor p.o. intake while recovering from COVID. ? Drink 2 to 4 L of water per day; eat some pretzels or small amount of other salty snack while drinking water. ? Recheck Chem-7 panel in 1 week, i.e. 10/30/2023; results to be forwarded to your primary care team. ?Use Zofran ODT for nausea.   Diagnoses:  Hyponatremia COVID, isolation through 10/23/2023   Consults:  PT   Primary Procedures:  Chest x-ray X-ray abdomen       Hospital Course:    See history and physical for full detail.  Briefly, 85-year-old male, history of DM 2, hypertension, BPH, recent COVID-19 infection presented 10/22 with nausea vomiting and admitted with hyponatremia sodium level 124.  Sodium level improved nicely with normal saline infusion ultimately up to 132 over 24-hour period.  Symptoms are basically attributed to GI symptoms in setting of COVID compounded by the hyponatremia and he showed nice improvement with near normalization of the sodium.  He felt ready for discharge as of 10/23 and was discharged in satisfactory condition with instructions and follow-up Chem-7 panel ordered as per patient instructions above.   He was seen by physical therapy, who recommended outpatient PT, for which he consult was submitted.   BP 141/73  | Pulse 92  | Temp 98.5 °F (36.9 °C)  | Resp 18  | Wt 77.1 kg (170 lb)  | SpO2 95%  | BMI 24.39 kg/m²        Exam: General: Male, partially reclined, speaking in short sentences, no acute distress. Eyes: Sclera anicteric, pupil 3 mm bilateral. HEENT: Mucous membranes moist, dentition fair. Lungs: Good airflow bilateral anterior no wheeze or crackle. Heart: No murmur appreciated. Abdomen: Nondistended no guarding. Neuro: No gross motor deficit. Skin: Nonjaundiced warm and dry.   Condition on Discharge:  stable    Code Status : Full Code    Discharge Disposition:  Home    Medications:  See discharge instructions for discharge medications            Note Details  Author  (D.O.) File Time 10/24/2023  5:28 PM Author Type PHYSICIAN (D.O.) Status Signed Last Editor  (D.O.) Specialty Hospital Medicine Hospital Acct #  Admit Date 10/22/2023  ED on 10/22/2023  ED on 10/22/2023   Detailed Report  Note shared with patient Clinical Impressions   HYPONATREMIA  NAUSEA AND VOMITING  ABDOMINAL BLOATING Disposition   Discharge to Home or Self Care   ED After Visit Summary (Printed 10/23/2023)   Discharge Orders  BICARBONATE  CHLORIDE  SODIUM  BUN  CREATININE W GFR, CALCULATED  GLUCOSE  POTASSIUM Care Timeline  10/22   1228   Arrived 1243   WBC AUTO DIFF    CHEM 7 (NA, K, CL, CO2, BUN, GLUC, CR)    CBC W AUTOMATED DIFFERENTIAL    OSMOLALITY, SERUM    CBC + DIFF (FAC LAB).  1811   0.9 % sodium chloride 500 mL   ondansetron HCl/PF 4 mg   famotidine/PF 20 mg 1812   0.9 % sodium chloride 125 mL/hr 1915   URINALYSIS, AUTOMATED    OSMOLALITY, URINE   SODIUM, URINE   URINALYSIS W REFLEX TO MICROSCOPY PANEL  2028   Placed in Observation 2208   XR ABDOMEN 2226   simvastatin 20 mg 2227   lisinopril 20 mg   tamsulosin HCl 0.4 mg   chlorhexidine gluconate 15 mL   melatonin 3 mg 10/23   0314   0.9 % sodium chloride 125 mL/hr 0330   MAGNESIUM   WBC AUTO DIFF   CHEM 7 (NA, K, CL, CO2, BUN, GLUC, CR)    CBC W AUTOMATED DIFFERENTIAL    BILIRUBIN, TOTAL   ALKALINE PHOSPHATASE   AST   ALT   CBC + DIFF (FAC LAB).  0649   glipizide 2.5 mg 0650   sodium chloride 0.9 % (flush) 3 mL 0900   amlodipine besylate 5 mg   ciclesonide 1 Puff   finasteride 5 mg 1110   CHEM 7 (NA, K, CL, CO2, BUN, GLUC, CR)  1323   Discharged