Age: 60.0
Sex: F
Vaccine: COVID19
Symptoms: Metabolic function test, Metabolic function test abnormal, Pneumonia, Pneumonia bacterial, Positive airway pressure therapy
Clinical narrative: Discharge Provider:  MD Primary Care Provider at Discharge: NP Admission Date: 9/4/2022 Discharge Date: 9/7/2022  PRESENTING PROBLEM: AKI (acute kidney injury) Acute respiratory failure with hypoxia Sepsis due to pneumonia Pneumonia due to infectious organism, unspecified laterality, unspecified part of lung COVID-19 Severe sepsis COVID-19 virus infection   HOSPITAL COURSE: Patient is a 60 y.o. female who presented to the emergency department with complaints of shortness of breath and wheezing.  Patient has past medical history of chronic obstructive pulmonary disease, hyperlipidemia, hypertension, hypothyroidism, metastatic renal cell carcinoma, obesity, tobacco abuse, and chronic respiratory failure. Patient had complaints of shortness of breath and wheezing that had been going on for approximately 1 day and presented to the emergency department via EMS for evaluation.  In the emergency department, patient was febrile, tachycardic, tachypneic, and was on BiPAP to me oxygen demands.  This was subsequently weaned to her baseline oxygen requirement of 4 liters/minute via nasal cannula.  Complete blood count was unremarkable.  CMP showed acute kidney injury, hyponatremia.  Lactic acidosis was also observed.  Troponin was indeterminate at 70 and a repeat was 66. COVID-19 was positive.  Chest x-ray showed increased airspace disease in both lungs consistent with pneumonia.  Procalcitonin was 1.28.  IV fluid boluses and antibiotic therapy  was initiated in the emergency department.  Upon arrival to the unit, patient was very lethargic and hypotensive.  ABG revealed metabolic acidosis.  Since patient remains hypotensive, despite hydration, she was moved to the intensive care unit for vasopressor therapy.  Suspect lethargy is secondary to metabolic processes.  Suspicion of bilateral bacterial pneumonia superimposed on COVID-19 resulting in septic shock and COVID-19 pneumonia.   Patient's hyponatremia resolved with further IV fluid resuscitation and she was able to be weaned off Levophed drip. She was treated with IV Azithromycin and Cefepime and transitioned to oral Ceftin and Doxycycline to complete a 7-day course of antibiotics, as recommended by the antibiotic stewardship team. She received dexamethasone and aggressive pulmonary toilet while inpatient. She remained stable on her 3-4L 02 per nasal cannula, shortness of breath and wheezing beyond her baseline resolved.   Her blood pressure remained stable off of her blood pressure medications; so losartan and amlodipine were discontinued at discharge, hydrochlorothiazide will be continued. The patient understands she is to keep a blood pressure log and follow up with her PCP as soon as possible for continued monitoring of blood pressure.   PT and OT evaluated the patient while in the hospital and recommended that same care services she had prior to admission, home health OT and RN to continue management of pressure wounds on buttocks.  The patient was discharged home in stable condition with the above mentioned care plan in place.