Age: 72.0
Sex: M
Vaccine: COVID19-2, FLUA4
Symptoms: Blood phosphorus, Bundle branch block right, COVID-19, Cardiac telemetry abnormal, Chest X-ray normal
Clinical narrative: COVID+1/4/2023.  Vaccination status - Pfizer x4 + Pfizer BIVALENT x1 BRIEF OVERVIEW: Discharge Provider: MD Primary Care Provider: DO Admission Date: 1/4/2023 Discharge Date: Jan 15, 2023   Active Hospital Problems   Diagnosis Date Noted POA ? Acute encephalopathy 01/04/2023 Unknown  Active Issues Requiring Follow-up:  Hypomagnesemia/hypophosphatemia/hypokalemia:  Continue daily replacement.  Check labs per facility provider within 1 week Pac/PVC/isolated V-tach run:  Continue Toprol-XL. Prolonged QTC:  Have discontinued Aricept Lexapro Effexor recheck EKG within 1 week  DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Weakness [R53.1] Acute encephalopathy [G93.40] Confusion and disorientation [R41.0] Moderate dementia without behavioral disturbance, psychotic disturbance, mood disturbance, or anxiety, unspecified dementia type [F03.B0] HOSPITAL COURSE: Patient is a 72 y.o. male with past medial history of dementia, COPD, CAD s/p PCI, HTN, and AAA who presented to ED  with chief complaint of fall and generalized weakness. He has dementia and at baseline was oriented to himself and family and they felt that  he was more confused than normal. In the ED, patient was afebrile and hemodynamically stable. COVID-19 +. Labs were notable for Mg 1.4, troponins 86-> 78, hgb 12.1. EKG showed NSR with PAC's and incomplete RBBB. CTH was negative for bleed but showed findings suspicious for early NPH. CXR was negative for acute pathology. Blood cultures were obtained.   Patient had MRI of the brain done which did not reveal any acute pathology.  He was found to have multiple electrolyte abnormalities and these were replaced.  One blood culture initially grew strep and he was placed on cefazolin.  Repeat blood cultures were obtained.  Initial positive blood culture was updated and showed strep mitis/strep oralis as well as Staphylococcus epidermis in the same culture bottle and this was felt to be a contaminant.  Antibiotics were discontinued.  He did have imaging done at the time of admission as he had a fall but there was no evidence of fracture or dislocation.   Troponins on admission were flat.  EKG showed prolonged QTC.  Effexor discontinued.  Electrolytes replaced.  Echocardiogram done 1/6/2023 and shows EF 55%/LV normal in size and function/regional wall motion abnormalities could not be excluded due to limited visualization/moderate aortic valve thickening/mild AR.  Previous echo 8/2022 EF 55% mod concentric LV hypertrophy grade II diastolic dysfunction moderate AR.  Repeat EKG continued to show prolonged Qtc.  Aricept and lexapro held.  On telemetry short runs of V tach.  Patient started on toprol XL and electrolytes continued replacement.  During admission all home BP meds held as not indicated based on blood pressure.  Decrease burden of PACs/PVC noted after up titration of beta-blocker.  Recommend repeat BMP, magnesium, phos within 1 week with facility provider to monitor electrolytes and EKG within one week to monitor Qtc.  At DC effexor, aricept, and lexapro have all been discontinued.  Home blood pressure medications including Norvasc, clonidine, Imdur, lisinopril, hydrochlorothiazide held during admission as blood pressure well controlled without.  Monitor BP and restart as indicated or consider further up titration of BB.  He was seen by PT/OT and recommendation was for SAR at discharge. Nutrition was consulted due to poor oral intake and calorie count was done.  Will need continued monitoring for this issue at rehab