Age: 89.0
Sex: F
Vaccine: COVID19
Symptoms: Lung opacity, Mental status changes, Metabolic acidosis, Pleural effusion, Pneumonia
Clinical narrative: Admit date: 2/28/2024  Discharge date: 3/1/2024  Admitting Physician:    Discharge Physician:   Reason for Admission: acute encephalopathy   Discharge Problem List     * (Principal) Severe sepsis    Type 2 diabetes mellitus with hyperglycemia, without long-term current use of insulin   Lactic acidosis   COVID-19   High anion gap metabolic acidosis   Transaminitis   Acute kidney injury superimposed on chronic kidney disease   Chronic kidney disease, stage 3b   Acute respiratory failure   Bilateral pleural effusion   Hyperkalemia  Procedures: None  Consultations: Case Management, Intensivist, and Social Work, Hospice care   Hospital Course:91 YO female with past medical history significant for DM2 recently diagnosed, and smoking history (quit at 80yo), who presented to ED with complaints of altered mental status. At baseline she has advanced demential but daughter states she has been progressively worsening over the past week. Associated symptoms include progressive weakness leading to multiple falls but no loss of consciousness was reported. She also had increased urinary frequency but family denied noticing a productive cough, fever, chills, blood in the stool or urine. Her husband was sick one week earlier. On presentation she was hypoxic in the 80's and required bipap. Chest imaging was significant for bilateral pleural effusion and opacities bilaterally. LA >8 which improved to normal after IVF. All her labs were consistent with a multisystem shock-like state. Abdominal CT scan was unremarkable for abdominal acute pathology but lungs were noted to have a moderate right sided pleural effusion and a mild left sided pleural effusion with infiltrates suggestive, we suspect this is a parapneumonic effusion. She was somnolent but able to respond to her name but unable to follow commands. She had scattered rhonchi and wheezes in her lungs b/l throughout. She was admitted for severe sepsis secondary to pneumonia and was treated with broad spectrum antibiotics, fluid resuscitation, oxygen/bipap, and supportive measures. was consulted and ordered troponin. EKGs were reassuring for no presence of STEMI but given very high troponin cardiology was consulted. She was placed on heparin gtt and an ECHO revealed HFrEF and family did not want to persue further interventions such as a cardiac cath. Her husband is her POA. The entire family is focused on her comfort, and everyone voices that this is what she would want. Initially plans for a therapeutic/diagnostic paracentesis was discussed with family, however, overnight the patient continued to worsen. She developed afib with RVR and her kidney function continue to worsen making us suspect possibly a cardio-renal component. She is unable to clear her lactic acid, as her bicarb remain very low. We discussed goals of care with the family and they opted for comfort measures and wanted to speak with the hospice team. The hospice team met with the patient and orders were changed to reflect their/patient's wishes. She will be discharge. It was a pleasure caring for her.  Discharged to Hospice.