Age: 91.0
Sex: M
Vaccine: COVID19
Symptoms: Red blood cell count decreased, Red cell distribution width increased, Respiratory alkalosis, Respiratory tract congestion, SARS-CoV-2 test positive
Clinical narrative: /Narrative: Pt presented to ED on 9/27/2022 c/o cough with yellow mucous and chest congestion x 1 week; + sick contact exposure. In the ED, the pt was tachypnic. COVID-19 swab was positive. CXR showed elevated right diaphragm and possible right lower lobe atelectasis. Pt admitted 9/27/22-9/30/22 with priniple diagnosis: PRINCIPAL DIAGNOSIS: 1. New Onset of Shortness of Breath with Productive Cough, Tachypnea & Tachycardia 2/2 COVID-19 Viral Syndrome 2. Acute Respiratory Failure with Hypoxia & Hypocapnia 2/2 Covid-19 Viral Pneumonia 3. Acute Tachycardia & Tachypnea in Setting of Acute on Chronic Atrial Fibrillation w/ Flutter, Occasional Rapid Response on Apixaban 4. Acute on Chronic Normocytic Anemia 5. Acute on Chronic Kidney Disease Stage 4 6. Hyperkalemia 7. Hyperchloremia ADDITIONAL DIAGNSES: 8. BPH 9. Hypertension 10. Hx Prostate Cancer 11. Depression 12. Type II diabetes, Diet Controlled 13. GERD 14. Obesity Class 2: BMI 34.0 Hosp. Course includes: Patient's chief symptoms on admission were; hypoxia requiring supplemental oxygen therapy, hypocapnea, tachycardia and tachypnea. Patient noted on file- Moderna vaccination x 3 doses. Supportive care and monitoring implemented; screening/trend labs, EKGs and imaging studies. EKGs obtained during this hospitalization, noted with Atrial flutter with variable A-V block with PVCs. Pt is on chronic anticoagulation with apixiban for management of chronic Atrial Flutter. CXR obtained-impression negative for cardiopulmonary and elevated right diaphragm and possible right lower lobe atelectasis. No evidence of superimposed bacterial pneumonia. Airborne Precautions initiated. COVID-19 viral pneumonia treatment was initiated with ; dexamethasone 6mg qd, PRN acetaminophen/tesselon/albuterol inhaler, continous pox, telemetry monitoring, PRN supplementation of electrolytes, consults, etc. Patient noted with respiratory alkalosis; CO2 levels ranged between 15-20 mmol/L - treated with sodium bicarbonate supplementation of 1300mg oral twice a day for management. Patient did not require remdesivir. Patient considered for discharge on 9/29/22, and initially no labs were obtained. In preparing medication reconcillation, unable to determine if sodium bicarbonate should be ordered on discharge. There fore, ordered a CHEM7 at 13:00 on 9/29/2022. CHEM7 resulted, most notable for hyperkalemia (K+ level of 5.80) and Scr 2.2/BUN 40. NO hemolysis noted on lab report. Discharge cancelled for management of hyperkalemia. One dose of Patiromer Calcium Sorbitex 8.4gm/1PKT was ordered and administered. Telemetry monitoring restarted, EKG obtained at this time(results - Aflutter with variable A-V block, ST & Twave abnormality), initiated IVF hydration w/ NS @ 75cc/hr and cardiac enzymes ordered. On following day (9/30/22), Pt denied any acute concerns or pain, K+ level; 5.0, Scr 2.2 and cardiac enzyme set of 3 negative for troponin elevation. Patient was cleared for discharge to home with family at this time- on 9/30/22.