Age: 55.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Opiates positive, Refusal of treatment by patient, SARS-CoV-2 test positive, Substance use, Urinary incontinence
Clinical narrative: a 56 y.o. female  with past medical history per below presented to the emergency room by police with complaints of problems with her boyfriend at home. The patient reportedly called the police 10 times today complaining of having conflicts with her boyfriend at home. She reports that he maintain his control on her medications which he keeps locked up. She reports that he will diffuse giving her pain medications per her request. She complains of chronic right hip pain followed by orthopedics. She denies any recent injuries or falls. She denies any suicidal or homicidal ideation. In the emergency room the patient more confused and delirious. She was assessed by psychiatry who advised admission to the hospital for treatment of polypharmacy. Patient tested positive for covid-19 infection 6 days ago. She denies any fever or chills. Denies any shortness of breath or cough. Denies any chest pain or any GI symptoms. There is a burning upon urination and recurrent urinary incontinence. Repeat carotid 19 test in the ED was positive and UA showed innumerable white blood cells. Patient does not have a history of alcoholism and alcoholic liver disease but denies any intake of alcohol for a while. Alcohol serum level in the ED was negative and CBC and CMP were unremarkable except for a potassium of 3.4 and mildly elevated AST at 54. Magnesium is low at 1.6 and tox screen is positive for cannabis in addition to opiates and benzodiazepines."   Hospital Course:  The patient was admitted to the hospital and was evaluated and treated per below.      * Delirium Description of the Problem/Progression:  Plan:  o Delirium. Appears to be due to polypharmacy/drug absue. Resolved. Psychiatry followed and adjusted meds and feeling much better. Continues to refuse Labs today. Would like to go home as she was declined by all local NH facilities. Would like to go back to her own outpatient physical therapist. Discharged accordingly. Referral for outpatient rehab given.  o Covid- 19 virus infection. Possibly contributing to the above. However patient  denied any respiratory symptoms. Remains with No hypoxia. NO IV Remdesivir or IV Steroids given. Encourage incentive spirometry use and pronating. Started on supplements per COVID-19 order set. Lovenox subcutaneous for DVT prophylaxis. Pepcid for GI prophylaxis. Follow up inflammatory markers and d-dimer on daily basis. Supportive/symptomatic treatment. Continues to refuse labs.  o Acute cystitis. Ruled out. Urine culture showed no growth. IV antibiotics discontinued.  o History of alcoholic liver cirrhosis. Patient denies any alcohol intake for a while. Serum ammonia level remained normal.  o Drug abuse. Tox screen is positive for cannabis in addition to Benzos and narcotics. Patient otherwise is known to be on prescribed narcotic pain medication and benzodiazepines as tested. Was counseled per psychiatry.  o COPD. Remains controlled. Continue nebs, inhalers, and use oxygen as needed to keep pulse ox more than 92%.  o Hypomagnesemia. Treated. Continue to monitor lab closely and treat as needed with IV/oral Mag replacement until normalized. o Hypokalemia. Treated. Continue to monitor lab closely and treat as needed with IV/oral K replacement until normalized. o Hypertension. Controlled. Continue same treatment. Follow up daily labs.