Age: 80.0
Sex: M
Vaccine: COVID19-2
Symptoms: Infusion, Lactic acidosis, Legionella test, Liver function test increased, Mobility decreased
Clinical narrative: Patient is a 80 y.o. male with PMH Parkinson's disease, afib, CAD, and asthma/COPD who presented from home on 12/11/2022 with generalized weakness. Found to have COVID-19 pneumonia with possible superimposed bacterial pneumonia.  Course complicated by orthostatic hypotension in the setting of parkinson's disease.  He was discharged to SNF for ongoing skilled nursing and structure PT/OT.   Discharge Diagnosis and Associated Hospital Course   Orthostatic hypotension -Secondary to his severe autonomic instability in the setting of Parkinson's disease. Symptoms have been ongoing for several months prior to arrival -s/p 1.5L LR infusion 12/20 with mild improvement but persistent objective ortho stasis though symptoms are relatively mild -Imdur and flomax discontinued. Not a candidate for mineralocorticoid replacement or midodrine due to supine HTN.  -Continue compression hose and abdominal binder during waking hours. Continue PT/OT with attention to prolonged transitions. Patient will continue to be objectively orthostatic and will need to focus on symptom management and avoid offending agents.    Community acquired Streptococcal pneumonia - Superimposed bacterial infection in the setting of COVID-19 PNA - Strep urine ag positive on admission. Blood and urine cultures NGTD Urine legionella negative. - Completed 7d course of antibiotics with Omnicef 12/18    COVID-19 pneumonia - CT chest on admission with multifocal inflammatory pneumonitis or pneumonia within left lower lobe, most severe at lung base - ID consulted on admission and reccomended remdesivir x 3 days which was completed 12/14.  - Out of isolation 12/22/22   COPD exacerbation Asthma - Home regimen includes Trelegy Ellipta, Singulair, and albuterol as needed.  Also on Xolair injections every 14 days for asthma.  - Acute exacerbation secondary to above. Completed 5d course of oral prednisone 40 mg - Continue home Xolair, trelegy and albuterol as needed on discharge  Urinary retention BPH Suspect retention 2/2 to decreased mobility - initial UA negative for infection; on Rocephin as above. Denies dysuria - PVR >500 ; attempt to straight Cath unsuccessful earlier in admission  - Repeat Ua and Urine cx negative  - Urology consulted for catheter placement; Coude placed and recommending to DC with Foley  - Continue home Finasteride. Flomax held in the setting of significant orthostatic hypotension.  Follow-up with urology as OP for voiding trial early next week.  Their office to arrange follow-up after discharge   Hematuria - Microscopic hematuria noted 12/22, neurology reevaluated.  Foley catheter working appropriately likely mild prostatic bleeding in the setting of Eliquis -Recommend follow-up as above with urology as above   Elevated troponin Coronary artery disease - History of BMS to mid LAD in 1998.  Last LHC in 2015 with mild diffuse CAD. -Troponin 34-- >31 - Denies chest pain - Continue home aspirin, statin. Imdur held in setting of orthostasis   Hypokalemia Continue to follow and replace as appropriate.   Lactic acidosis, resolved  -Lactic acid 2.5 on presentation.  No signs of hemodynamic instability currently.  This is resolved   Alcohol abuse - pt reports daily alcohol use; 2-3 beers (higher alcohol concentration per wife) plus wine nightly - mild tremors on exam; denies hallucinations - Received thiamine, folate and multivitamin.  Did not trigger CIWA, discontinued. - Encouraged cessation  Parkinson's disease - Diagnosed in November 2021.  Follows with Dr. - Ambulates with walker or cane at baseline. - Continue home Sinemet    Persistent atrial fibrillation - Follows with Dr.  History of previous cardioversion and attempt a trial of Tikosyn.  Currently on amiodarone 200 mg daily. - Continue home amiodarone and Eliquis   Hyperlipidemia - home regimen statin and Zetia; hold while on remdesivir with mildly elevated LFTs - LFTs stable  - resume at DC   Aortic atherosclerosis - Continue home aspirin and statin