Age: 79.0
Sex: M
Vaccine: COVID19
Symptoms: Blood glucose increased, Blood immunoglobulin M decreased, Blood potassium increased, Blood sodium increased, Blood thyroid stimulating hormone normal
Clinical narrative: Patient is a 79 y.o. male patient of MD with history of CLL, Colon cancer, C-dif, GERD, HLD  presented to Hospital with shortness of breath .   Acute hypoxic respiratory failure  Suspecting secondary to COVID-19 viral pneumonia  CXR shows faint patchy opacities in left mid to lower lung zone which may correspond to some subtle atelectasis or pneumonitis.  Started on Rocephin and Azithromycin for possible pneumonia however symptoms more consistent with viral etiology than bacterial especially given negative pro-cal. Urinary Ags and sputum culture negative D-dimer elevated. CTPA negative for PE but did show pulmonary HTN, patchy ground-glass infiltrates bilaterally with tiny bilateral pleural effusions.  Wean O2 requirements able Home O2 eval done today- qualified for 2L Management of COVID-19 listed below   Covid-19 viral pneumonia Date of onset of symptoms: 12/12/22 Symptoms present on admission: productive cough, chills, altered mental status Date of covid positive test: 12/12/22 - at home, repeat test positive Vaccination status: vaccinated Imaging: 7 faint patchy opacities in the left mid to lower lobes with some subtle atelectasis or pneumonitis Oxygen requirements on admission: 3L NC -> 4L Current oxygen requirements: 2L NC Medical therapy: Steroids x10 days. Out of time frame for Remdesivir Consultants following: None at this time Anticipated special isolation end date: TBD  Albuterol, steroids x5 days, and Tessalon Perles at discharge   Acute encephalopathy Suspecting secondary to hypoxia, underlying infection, and possible CVA TSH, B12, Folate all wnl Attempt to regulate sleep/wake cycle Resolved   Abnormal CT CT head shows low density areas in basal ganglia compatible with lacunar infarcts and/or dilated perivascular space. Low attenuation in left external capsule/subcortical insular white matter compatible with age indeterminate ischemic changes MRI brain showed chronic microvascular angiopathic changes Neuro consulted. Recommended starting ASA Neuro checks Q4H PT/OT/ST- HHC at discharge  History of CLL Patient is on Calquence BID which is non-formulary Continue Valcyclovir therapy Oncology consulted. Continue to hold Calquence/Acalabrutinib while admitted. Immunoglobulin levels shows decreased IgM of 33. Discussed with Dr. on day of discharge- does not need IVIG. Follow up with outpatient Oncologist when to resume Calquence/Acalabrutinib.   Hyperkalemia K 5.9 Hyperglycemia protocol with Ca-gluconate, Albuterol, and Lokelma Monitor   Hypernatremia Na 147 Resolved   DM, new onset Glucose also elevated due to steroids HbA1c 6.8 Recommend lifestyle changes Defer to PCP for further management   Hx of HLD Cholesterol panel: Cholesterol 194, TG 260, HDL 26, LDL 116 Recommend lifestyle changes Follow up with PCP for consideration for statin   Microcytic anemia Hb 12 with MV 96.5 No signs of bleeding Iron studies + ferritin pending- defer to PCP for follow up   Severe malnutrition POA Nutrition consulted   GERD  Continue Maalox PRN