Age: 87.0
Sex: F
Vaccine: COVID19
Symptoms: Blood potassium normal, Blood urea increased, Brain natriuretic peptide increased, Cough, Decreased appetite
Clinical narrative: 09MAR2021-Patient is a 87 y.o. old female with a history of receiving her second COVID vaccine this past Friday.  For the previous 2 to 3 days she has had increasing fatigue and generalized weakness.  Anorexia and nausea have been noted as well.  Apparently has not been eating or drinking well at all.  No vomiting or diarrhea.  No new medication recently.  No fever or chills. Patient was seen and evaluated in the ER tonight by the ER physician.  Significant acute renal failure was noted.  Urinalysis was unrevealing.  Mild hyperkalemia and moderate metabolic acidosis were noted as well.  Initial treatment in the emergency room included a 1 L bolus of normal saline and antiemetic therapy.  The hospitalist service was then consulted for admission."   Discharge Summary Written 20MAR2021-Patient was admitted and started on IV fluids.  Nephrology was consulted.  She was started on a bicarb drip for metabolic acidosis.  Renal US was negative for hydronephrosis but with incidental biliary ductal dilatation which was stable compared to a previous imaging study in 2011.  Unfortunately her renal function continued to worsen and require dialysis.  She had a temporary dialysis catheter placed on 3/12.  She had RRT started on 3/12 and again on 3/13.  Her urine output, electrolytes, and azotemia started to improve slowly.  Renal function continued to improve and she no longer required any RRT.  Her temporary dialysis catheter was removed on 3/19.  Her Foley catheter was also removed on 3/19 and she was urinating well prior to discharge.  She will go home with oral Lasix.  Patient felt much improved and is agreeable for discharge on this date- 20MAR2021  Second Admission- 02APR2021-05APR2021- INDICATION FOR ADMISSION:   This is an 87-year-old female with history of COPD, hypertension, and chronic lung disease, who presented to the Emergency Department on April 2, 2021 with a chief complaint of shortness of breath..  Three days prior to this admission the patient had increasing shortness of breath.  The patient also had a nonproductive cough but denied any fever or chills.  The patient was started on IV Lasix and IV steroids in the ED.  She also had elevated BNP. She was admitted to the hospital for further medical management.   Discharge Summary Written 05APR2021- She was started on IV steroids, IV Lasix, nebulization, and she was monitored closely.  The patient also had HGB dropping to 8.8 from 11.3 back in March 2021.  The patient was started on proton pump inhibitor. Gastroenterology and cardiology eventually were consulted to see the patient.  She did have an EGD done at this time which showed gastritis.  She will continue Protonix for now.  She was started on IV Lasix and she improved with the treatment.  Now she remains on room air.  She denied any respiratory issue.  Her renal function still remains at baseline.  Today creatinine is 1.5.  The patient can be discharged home today and continue oral Lasix at home daily for now.  She was instructed to follow up with her primary care physician and also her cardiologist as outpatient in 1 to 2 weeks.