Age: 68.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Blood chloride normal, Blood creatine increased, Blood glucose normal, Blood ketone body absent, Blood magnesium normal
Clinical narrative: H&P note- Chief Complaint:  AMS *CAVEAT: Full HPI limited due to AMS HPI: Patient is a 69 y.o. male with a history of seizures, stroke, dementia and parkinsons who presented to the ED for further evaluation of AMS above his normal baseline. Per pts partner he has been having increase in confusion and has been combative at home throwing things for the last few days. Pts friend states reported that he was having right arm and leg weakness and numbness. The patient does endorses mild right sided weakness but denies numbness or tingling. He is unable to tell me how long this has been going on. he denies headache, vision changes, facial droop, CP, recent fever, SOB or other complaints. At this moment He is alert and mostly oriented to everything apart from time, speech is slightly garbled but understandable. The pt has struggled with progressively worsening confusion/memory and behavior changes. He was just admitted here in august for evaluation of confusion, hallucinations, paranoia, aggression: he was seen by neuro and psych and this was ultimately attributed to developing lewy body dementia and Parkinson's related dementia, his parkinson meds were further optimized and its unclear how he has done on them. Has hx of stroke without residual deficits. A CT of his brain today showed no acute changes. UA unremarkable. Lab work is gorssly normal. Vitals are stable. He will be admitted to the hospital for further observation   Assessment/Plan:  Patient is a 69 y.o. male who presents with the following: 1. AMS 2. Hx of Parkinson's dementia, Lewy body dementia 3. Stroke like symptoms: Unilateral weakness, some slurred speech (unclear baseline) 4. Behavioral disturbances related to dementia  --CT brain negative for stroke but will confirm with MRI. He would not be candidate for tpa given unknown last well time.   --mentation actually reassuring during my exam but reportedly having mood disturbances at home along with some confusion. Unable to talk to pts partner over the phone as he is deaf. --neurology consulted for any further recommendations, suspect pts issues will be attributed to advancing Parkinson's dementia  --crisis worker evaluated pt in the ED and given his apparent impulse control issues, Mood liability, Implied suicidal ideation without active plan, and Poor coping mechanisms regarding disease progression, they recommended psych consult would be beneficial, will order.  --of note pt had his meds adjusted when he was here a few months ago, there are some discrepancies between what he was sent home with and what his med list is today. It looks like a rivastigmine patch was started then but per partner not on med list now. Also look slike pt is Still taking amantadine 100 mg BID, when it was decreased by neuro at that time with the intent of it to be discontinued after a week.  --Does have correct sinemet dose and requip, continue. --will decrese amantadine dose to 100 mg daily pending neuro and psych recs  --will consult PT/OT and case management for eval of post d/c needs  5. History of CVA --check updated lipid panel  --continue aspirin, lipitor and Plavix.  6. HTN, controlled --Continue coreg, Norvasc, hydralazine.   7.. Type I DM  --controlled today --check updated A1C --continue Lantus with SSI and trajenta  8.  Psoriasis --on Otezla  MD ED note- Chief Complaint:  Confusion  HISTORY OF PRESENT ILLNESS Patient is a 69 y.o. male who presents to the Emergency Department reportedly due to generalized weakness, increased confusion and combative behavior.  The patient himself is unsure why he is here.  Reports history of Parkinson's disease and diabetes.  He reports he is compliant with his medications is unsure if they have changed recently.  He is unable to provide additional history. Caveat: Full history of present illness is unobtainable from patient secondary to mental status  Dr. note- Chief Complaint:  Right-sided weakness History of Present Illness:  History was obtained from a review of the electronic record and discussion with the patient and family.  Patient is a 69 y.o. male with history of Parkinson's related dementia, having gradual decline over the last few months presented to the hospital on 11/30/2021 after having worsening right-sided weakness, unclear when the symptoms started but possibly for few days.  The patient was admitted and had a CT brain which did not show any acute abnormalities.  Patient's husband was at bedside.  As per the husband, patient has been having worsening mood and agitation episodes at home.  Patient is established with the neurology clinic and is on medications at home.  When evaluated at bedside, patient continues to have significant right arm and right leg weakness.  He also complains in numbness in his right lower extremity compared to the left leg.  Dr. note- Patient's MRI brain negative for an acute stroke, patient's symptoms are most likely due to progression of his Parkinson's related dementia, will recommend PT OT evaluation and patient might benefit from subacute rehab placement. Regarding his Parkinson's medications, will discontinue his ropinirole, will change the Sinemet CR to immediate release 2 tablets 4 times a day to see if it helps his mobility Continue his rivastigmine patch and amantadine 100 mg daily.  Please call Neurology for any questions.