Age: 82.0
Sex: M
Vaccine: COVID19
Symptoms: Thyroxine free increased, Toxic encephalopathy, Troponin increased, Ultrasound Doppler normal, Urinary tract imaging abnormal
Clinical narrative: This is an 83-year-old patient who presented with acute respiratory failure with hypoxia with concern for aspiration event patient is well was found to have COVID-19 pneumonia.  Patient initially treated with antibiotic therapy had significant improvement was weaned down to room air.  Patient is well found to have candidal esophagitis initiated on fluconazole with improvement in symptoms.  Statin placed on hold while on focus on.  Discussed plan of care at length with son at the bedside on the day of discharge including what to monitor for and when to seek medical attention.   Acute hypoxic respiratory failure Aspiration pneumonia COVID 19 - concern for aspiration event  - Initial CXR indicating tiny bilateral effusions but with no consolidation. - initially requiring 3L NC on admission, on 3/16 noted to de-sat to low 80s, and required 100% NRB and ICU transfer for heated high flow oxygen. -Treated with IV Unasyn for possible aspiration, stopped on 3/18 -Currently on room air.  With significant improvement in symptoms.   Hypotension -Had issues with hypotension overnight on 3/21.  Unclear etiology.  Treated with IV fluid boluses.  Also received an extra dose of IV Solu-Cortef -Patient reports no symptoms -Levophed needed to be started completely and weaned off 3/22 -Received higher dose of steroids.  That will be tapered down to his home dose today   COVID-19, with Sepsis   - Presented with: Nausea, vomiting, diarrhea, and cough - Symptom onset: 3/14 - Positive COVID-19: 3/15 at Facility - on admit noted to be febrile 102.9; blood cx negative  -Initially started on Decadron, now stopped as do not think COVID-19 contributing much to his respiratory issues.  Patient currently on room air -Can come out of isolation on 3/25   Ileus -KUB consistent with colonic ileus.  NG placed. -Has return of bowel function, tolerating diet   Oropharyngeal/laryngeal candidiasis -White spots were noted on the laryngeal vestibule on fees 3/17 -Started on 14 days of Diflucan by the ICU team on 3/20 -Hold statin while on Diflucan.   -Reports hoarseness of voice but no difficulty swallowing.  Oral exam without any evidence of oral candidiasis Acute metabolic toxic encephalopathy - multifactorial COVID-19, hypoxia, dehydration and AKI. - CT head negative for any acute process. - Delirium precautions in place.  -Doing much better today.  Awake and alert back to his baseline   Nonoliguric AKI - Likely in the setting of intractable nausea and vomiting related to COVID. - Baseline creatinine about 1 year ago was 1.2, 2.20 on admission. -Resolved.  Improved   Elevated troponin -Likely demand ischemia from hypoxemia/respiratory failure -  His EKG on admission showed a ventricularly paced rhythm with no signs of ischemia. - Trop 46/59  - TTE with EF 70%.     Elevated D-Dimer - suspect in setting of infection  - D-Dimer 1.32 - Doppler LE negative for DVT   Adrenal insufficiency -This is a known diagnosis. Followed by Dr. No records in data. - Continue hydrocortisone IV. Home dosing 10 mg am and 5 mg pm. -Plan to transition to oral home dosing   CAD status post CABG with chronic angina Had bypass surgery on 4/19/2019 by Dr. On aspirin and Lipitor - Continue home meds. He is on Ranexa and followed by Dr. -Holding statin while on Diflucan   Complete heart block status post pacer Placed by Dr. in 2010, he continues to follow with him.  Generator change was done in January 2021.   Hypothyroidism On previous admissions this year, has had low TSH and high free T4, levothyroxine dose adjusted multiple times - Follows with Dr.   -TSH continues to be low but on arrival in setting of acute illness.  Will have patient repeat thyroid function test as outpatient with PCP