Age: 78.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Bacterial test, Bladder diverticulum, Blood alkaline phosphatase increased
Clinical narrative: Hospitalized 8.29.21;  found to be COVID-19 positive;  fully vaccinated. Patient is still hospitalized at this time.   HISTORY OF PRESENT ILLNESS:  Patient is a 78 y.o. female with past medical history significant for T2DM, COPD, asthma, anxiety, bilateral AKA, C difficile, CHF, duodenal abscess, recurrent UTI 2/2 colovesicular abscess and frequent admissions over the last six months who presents today with altered mental status and hypoglycemia. The patient resides at a care facility. She was admitted 8/26-8/28 due to hypoglycemia at which time her Lantus was discontinued and she was discharged on only corrective insulin. Call placed to patient's daughter and granddaughter/reported guardian who state the patient was reportedly doing well since returning to assisted living. Her daughter called to check in last night and was told the patient's blood sugars had been stable all day. However, reportedly later in the night the patient was found down and confused with a blood sugar in the 20s.  She was given an amp of dextrose and brought to the emergency department.  I attempted to call the care facility however the lady was unable to verify that patient was a resident at the facility, and I was unable to obtain further information. In the ED, the patient was initially hypothermic (T95.2), mildly hypertensive with otherwise stable vital signs.  The patient had recurrent hypoglycemia while in the emergency department and received 2 amps of D50 and was then started on a D10 infusion.  To start have leukocytosis with WBC 12.51.  Hemoglobin 10.2.  Potassium 2.8.  TSH was low but free T4 was normal.  COVID-19 PCR was positive. K 2.8, BUN 13, Cr 0.32, Ca 11.3, Tbili 0.2, Alk phos 175, ALT 211, AST 142. CXR negative for acute findings. UA showed moderate leukocytes and received 1g IV Rocephin. The patient will be admitted for further management.  ASSESSMENT / PLAN: Hypoglycemia Type 2 diabetes mellitus, insulin dependent - Recently admitted to ED observation 8/26-8/28 due to hypoglycemia. Lantus was discontinued during admission and patient was discharged on only corrective insulin - Returns today with hypoglycemia; unclear if patient received insulin prior to the event. Attempted to call facility but unable to receive additional information - Interestingly two other patients from same facility admitted today for hypoglycemia - Status post octreotide in ED - Blood sugar improving s/p 2 amp D50 and D10 infusion - Decrease D10 infusion from 150ml/hr -> 100ml/hr due to hx of CHF - Monitor BS q1hr x2, q2hr x4 then q4hr thereafter - Check c-peptide, insulin, proinsulin level, BHB and comprehensive urine drug screen - Consult endocrinology   Covid 19 positive - Reportedly there is an outbreak at patient's facility - Covid test 8/27 was negative but is positive today - No respiratory symptoms. O2 is stable on 2L (which is patient baseline) - CXR negative for acute cardiopulmonary process - Not current candidate for decadron or remdesivir but will monitor daily Transaminitis - Possibly related to COVID infection - Hepatitis panel ordered - Repeat CMP in AM, consider RUQ US if worsening