Age: 32.0
Sex: M
Vaccine: COVID19
Symptoms: Seizure, Sepsis, Staphylococcus test, Ureterolithiasis, Urine analysis normal
Clinical narrative: HBS DISCHARGE SUMMARY Date of Admission: 10/20/2023   Date of Discharge: 10/22/2023   Pending Study Results at Discharge:  Unresulted Lab Orders    Date and Time Order Name Status Specimen Source   10/21/2023  6:00 AM MRSA SCREENING CULTURE In process     10/20/2023  5:58 AM BLOOD CULTURE 2 Preliminary BLOOD   10/20/2023  5:58 AM BLOOD CULTURE Preliminary BLOOD     Patient Vitals for the past 24 hrs:    Temp Temp Source Pulse BP Resp SpO2 O2 Delivery 10/22/23 0920 97.7 °F (36.5 °C) Axillary 60 108/85 18 99 % RA 10/22/23 0435 96.4 °F (35.8 °C) Axillary 65 116/71 19 98 % RA 10/21/23 2346 98.3 °F (36.8 °C) Axillary 74 107/61 18 90 % RA 10/21/23 2011 99.2 °F (37.3 °C) Axillary 89 127/86 16 95 % RA 10/21/23 1600 99.1 °F (37.3 °C) Axillary 81 124/82 16 ? RA 10/21/23 1205 98.9 °F (37.2 °C) Axillary 73 138/90 18 98 % RA   Physical Exam:  General appearance - NAD, sitting up in bed; tracking; non-verbal at baseline  HEENT: EOMI, Sclera anicteric.  Neck: no nuchal rigiditiy. No JVD Chest - clear to auscultation, no wheezing, rhonchi, or rales Heart - regular rate and rhythm, no murmurs, gallops or rubs Abdomen - soft, nontender, nondistended, + bowel sounds Extremities - no cyanosis or edema,  Neuro - no focal deficits, moving all extremities spontaneously    Final Diagnoses:  Active Hospital Problems   Diagnosis   ? SEIZURE, UNSPECIFIED   ? EPILEPSY, INTRACTABLE   ? DIPLEGIC CEREBRAL PALSY   ? LENNOX GASTAUT SYNDROME   ? SEIZURES, GENERALIZED 2ND   ? PROGRESSIVE MYOCLONIC EPILEPSY   ? ATONIC EPILEPSY   ? URETERAL CALCULUS   ? RENAL CALCULUS       Added automatically from request for surgery     ? HX OF RENAL CALCULUS   ? INTELLECTUAL DEVELOPMENT DISORDER, UNSPECIFIED     Resolved Hospital Problems   Diagnosis Date Resolved ? FEVER 10/22/2023 ? NONTRAUMATIC ACUTE KIDNEY INJURY 10/22/2023     Discharge Disposition:  Home   Medications, instructions, follow up information: See patient Discharge Instructions/AVS.   Patient is a 35 Y  male with a history of  Intellectual disability, cerebral palsy, Lennox-Gastaut syndrome, intractable seizures, kidney stone with PCN placement and removal, recently admitted 10/4-10/7 for intractable epilepsy discharged with increased Cenobamate 50mg two times a day and continue Vimpat 400mg daily per Neurology however per caregiver unable to get Cenobamate as outpatient from pharmacy and patient only received 25mg 10/12-10/16. Patient admitted with recurrent seizures, fever and COVID-19.     EPILEPSY, INTRACTABLE (2/6/2012)  SEIZURE, UNSPECIFIED (10/20/2017)  ATONIC EPILEPSY (5/8/2002)  PROGRESSIVE MYOCLONIC EPILEPSY (4/21/2003)  SEIZURES, GENERALIZED 2ND (10/20/2003)  LENNOX GASTAUT SYNDROME (9/11/2006)  DIPLEGIC CEREBRAL PALSY (3/26/2007)  EPILEPSY, INTRACTABLE (2/6/2012)  SEIZURE, UNSPECIFIED (10/20/2017) Multiple hospitalizations with similar seizures, at baseline 1-2 per month. Suspect exacerbation may be 2/2 fever from COVID-19 as mentioned below as well as missed doses of antiseizure medication per primary caregiver were unable to get it from pharmacy. Followed by Neurology Dr. as outpatient. Case discussed with Dr. (Neurology), recommended discharge with Cenobate 50mg daily for 14 days and then increase to 100mg daily thereafter. Per pharmacy medications are ready for pick up and patients care facility notified not to miss doses due to risks of seizures.    NONTRAUMATIC ACUTE KIDNEY INJURY (8/8/2023) Resolved, likely 2/2 pre-renal etiology.    HX OF RENAL CALCULUS (7/12/2012)  RENAL CALCULUS (6/14/2023)  URETERAL CALCULUS (8/8/2023) Status post left double J ureteral stent, no hydronephrosis. UA negative. Scheduled for ureteroscopy with Dr. on 11/07/2023.    SEPSIS 2/2 COVID-10 DISEASE (10/20/2023)  FEVER (8/8/2023)  LACTIC ACIDOSIS (10/20/2023) Febrile and positive COVID test, patient resides at care facility. Was not hypoxic, on room air and chest x-ray without focal infiltrates. Defered steroids but recieved remdesivir.    CONSTIPATION (10/20/2023) Noted on CT scan. Had bowel movements during hospitalization.     INTELLECTUAL DEVELOPMENT DISORDER, UNSPECIFIED (12/27/1996) Noted    Primary Procedures:  None   Secondary Procedures: None   Reason for Hospital Admission (Admitting Diagnosis):  Seizures & COVID-19   Complications: none   Consults:  HOSPITAL MEDICINE - INITIAL INPATIENT CONSULTATION. HOSPITAL MEDICINE - ONGOING INPATIENT CONSULTATION. NEUROLOGY - INITIAL INPATIENT CONSULTATION. NEUROLOGY - ONGOING INPATIENT CONSULTATION. Smoker: No.   Condition on Discharge: stable   Code Status at Time of Discharge: Full Code       Note Details  Author (M.D.) File Time 10/22/2023 10:54 AM Author Type Physician Status Signed Last Editor (M.D.) Specialty Hospital Medicine Hospital Acct #  Admit Date 10/20/2023  ED to Hosp-Admission (Discharged) on 10/20/2023  ED to Hosp-Admission (Discharged) on 10/20/2023   Routing History   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   SEIZURES, GENERALIZED 2ND  HX OF RENAL CALCULUS  RENAL CALCULUS  URETERAL CALCULUS  NONTRAUMATIC ACUTE KIDNEY INJURY Resolved  FEVER Resolved  ATONIC EPILEPSY  PROGRESSIVE MYOCLONIC EPILEPSY  INTELLECTUAL DEVELOPMENT DISORDER, UNSPECIFIED  LENNOX GASTAUT SYNDROME  DIPLEGIC CEREBRAL PALSY  EPILEPSY, INTRACTABLE  SEIZURE, UNSPECIFIED Care Timeline  10/20   Admitted from ED (Observation) 1729 10/22   Discharged 1652  Discharge   Assisted Living Facility or Board & Care or Residential Care   Discharge Instructions (AVS) (Printed 10/22/2023) Medication List at Discharge   cenobamate   50 mg (14)- 100 mg (14) Dose pk tab, Take 50 mg by mouth once daily for 14 days, then increase to 100 mg once daily  Patient taking differently:  Was taking 25 mg qday   Prescribed 50mg qday x14 days, then increase to 100mg qday  100 mg Oral DAILY  diazepam   5 mg Oral  AS NEEDED  5-7.5-10 mg Kit, 5 mg Rectal  AS NEEDED  docusate sodium 100 mg TAKE 1 CAP BY MOUTH EVERY DAY FOR CONSTIPATION - HOLD FOR LOOSE STOOLS  erythromycin base 5 mg/gram (0.5 %) 0.5 Inches Both eyes  AS NEEDED, Apply on both eyes for prn redness  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  lacosamide 200 mg Oral 2 TIMES A DAY  multivit-min/ferrous fumarate 15 mg iron 1 tablet Oral DAILY  olanzapine 2.5 mg Oral EVERY BEDTIME  psyllium seed 6 g Oral DAILY, mix 1 teaspoon with 8 ounces of water and give daily as needed  for consipation ( hold for loose stools)  trazodone HCl 50 mg Oral 2 TIMES A DAY