Age: 77.0
Sex: M
Vaccine: COVID19
Symptoms: Hypocalcaemia, Hypomagnesaemia, Hyponatraemia, Hypophagia, Hypotension
Clinical narrative: BRIEF OVERVIEW: Admission Date: 9/2/2023 Discharge Date: 9/5/23 Discharge Disposition:  home health care svc   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute prostatitis [N41.0] Hyponatremia [E87.1] Elevated troponin [R77.8] AKI (acute kidney injury) [N17.9] Septic shock [A41.9, R65.21] COVID [U07.1]   HOSPITAL COURSE: Patient is a 80 y.o. male with past medical history significant for  coronary artery disease, ulcerative colitis, hypertension, hyperlipidemia, multiple myeloma currently undergoing chemotherapy, abdominal aortic aneurysm, inflammatory arthritis, obesity, cerebral infarction, thoracic aortic aneurysm, anemia, benign prostatic hypertrophy, history of DVT, presenting to the emergency department with chief complaint of generalized weakness. Patient states that he started coughing two weeks ago and for the last 3 days have had no appetite with decreased oral intake. Patient reports mild headache, profound weakness over last day being unable to get out of bed and sleeping excessively. Patient reports chronic nocturia. Reports chronic neuropathy to bilateral feet from chemotherapy. Reports sweats and chills, upset stomach. Reports diarrhea last week, but none now. Denies nausea or vomiting, denies shortness of breath or chest pain, denies abdominal pain, no leg swelling or leg pain. Denies any new rashes or sores. Patient is immunocompromised on Plaquenil.   Vital signs upon presentation to the emergency department with evidence of fever of 103.3, tachycardia, and tachypnea.  Patient also developed hypotension in the emergency department despite fluid resuscitation.   Laboratory values reviewed with evidence of leukocytosis of 16.7, normocytic anemia with hemoglobin of 9.1 and hematocrit of 27.4, thrombocytopenia with platelet count of 138, hyponatremia of 128, acute kidney injury with BUN of 45 and creatinine of 1.84, hyperglycemia of 186, hypocalcemia of 8.3, hypomagnesemia of 1.5, NT proBNP elevated at 12,225, troponin elevated at 67 and 61 respectively, lactic acid elevated at 3.4 and 2.4 respectively after fluid resuscitation, COVID-19 positive, urinalysis with trace ketones, positive for nitrites, moderate leukocytes, large amount of blood, WBCs.  CT of the abdomen and pelvis with evidence of prostatitis.  Two-view chest x-ray with no acute cardiopulmonary process. EKG with no acute ischemic process.   Treatment in the emergency department:  Tylenol a 1000 mg PO, cefepime IV 1 g, ibuprofen 400 mg orally, Mag-Ox 400 mg orally, 0.9% normal saline 2500 mL IV bolus, norepinephrine IV.   Patient was admitted to the intensive care unit for further evaluation and treatment.     He remained asymptomatic from covid and was discharged on prolonged course of abx for prostatitis. He had successful voiding trial and foley was removed. He was discharged in stable conditions with plans to follow up with pcp.   Patient later admitted on 9/19/23-9/23/23 to Hospital for PRESENTING PROBLEM: Dyspnea on exertion [R06.09] Severe sepsis [A41.9, R65.20] AKI (acute kidney injury) [N17.9] Multiple myeloma not having achieved remission [C90.00]  Patient passed away on 9/25/23