Age: 17.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Hypervolaemia, Hypotension, Hypovolaemic shock, Intensive care, Pyrexia
Clinical narrative: Hospitalized (5.26.22);  COVID-19 positive (5.26.22);  fully vaccinated PLUS booster BRIEF OVERVIEW: Primary Care Physician at Discharge: MD  Admission Date: 5/26/2022 Discharge Date: 5/31/2022   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Diabetes insipidus (HCC) [E23.2] Adrenal insufficiency (HCC) [E27.40] Acute febrile illness in child [R50.9] Sepsis, due to unspecified organism, unspecified whether acute organ dysfunction present (HCC) [A41.9] Sepsis (HCC) [A41.9] Hypovolemic shock (HCC) [R57.1] HOSPITAL COURSE: Overall Assessment:   The patient is a 17 y.o. female with PMHx significant for spastic quadriplegic CP, hydrocephalus with VP shunt, epilepsy, schizencephaly, septo-optic dysplasia, 3rd nerve palsy, diabetes insipidus, adrenal insufficiency, secondary amenorrhea, g tube dependence,slow-transit constipation, short stature, global developmental delay, disordered sleep, and aggressive behavior who presented with fever and increased urine output, admitted to the PICU for steroid and fluid refractory shock.  Respiratory/ENT:  Patient remained on room air throughout her hospitalization Cardiovascular:  Her multiple episodes of hypotension throughout her admission.  She initially received to 60 mL per kg bolus of IV fluid.  She was started on epinephrine and vasopressin both of which were eventually weaned off.  She was dosed with stress dose steroids with 50 mg of hydrocortisone followed by 12.5 mg every 6 hours.  Eventually she was weaned off the epinephrine.  He was attempted to wean her onto her home dose of steroids but she did require further boluses of normal saline.  This was likely secondary to her diabetes insipidus and excessive urine output.  She will have a steroid taper at discharge.  Her DDAVP was uptitrated throughout her hospitalization. Renal/Genitourinary: Patient was initially excessively fluid positive due to her shock.  Following multiple doses of DDAVP and dose titration she was nearly euvolemic upon discharge.  She did have a Foley catheter for urine output measured. FEN/GI: Patient's sodium levels fluctuate throughout her course.  Upon discharge her sodium had been between 140 and 150 for multiple days.  Her tube feeds were restarted after initially being held. Infectious Disease: Patient noted to be COVID + last week of April, asymptomatic at that time. Again tested positive on admission. Unclear if active COVID infection vs viral shedding. Noted to have rectal temp to 105.8 prior to admission. Film array positive for adenovirus and COVID 19. UA not suggestive of UTI. No focal consolidation on CXR. Possible related to MISC with prior COVID infection noted. Vanc and CTX started in the ED. Received 48 hours of empiric rocephin, cultures no growth to date, MISC workup noncontributory.  Mom is also COVID positive with new symptoms. Endocrine:  patient has a history of diabetes insipidus as well as adrenal insufficiency.  See the above for stress dose steroid dosing.  She require titration of her DDAVP prior to discharge.  Discharge instructions have her taking 50 mcg of DDAVP at night and 100 mcg in the morning.  Prior to admission she was taking at 50 mg nightly.  We will have a 5 day steroid taper with hydrocortisone.  These instructions were provided to the patient. Neurologic/Pain/Sedation/Psych:  Throughout her hospitalization room we continued her home antiepileptic medications as well as her baclofen.