Age: 79.0
Sex: F
Vaccine: COVID19-2
Symptoms: Asthenia, Blood creatine phosphokinase increased, Blood culture negative, Blood sodium decreased, Bundle branch block
Clinical narrative: Discharge Provider: MD Primary Care Provider at Discharge: MD  Admission Date: 2/6/2023 Discharge Date: 2/8/2023  PRESENTING PROBLEM: Rhabdomyolysis [M62.82] Hyponatremia [E87.1] Traumatic rhabdomyolysis, initial encounter [T79.6XXA] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 79 year old patient with a PMH of atrial fib anticoagulated with Eliquis, hyperlipidemia, hypertension, anxiety/depression, and narcolepsy.  She presented to the ER on 02/06/2023 after rolling out of bed.  Patient was unable to get up off the ground several hours due to weakness.  Her spouse was not able to assist her getting up.  In addition, patient also had been experiencing cough, congestion, and generalized weakness for 2 days.   In the ER, patient was afebrile and vital signs were otherwise stable.  Labs were significant for WBC 7.67, hemoglobin 13.8, sodium 129, pro cal 0.18.  Creatinine kinase 716 (high normal 175).  Blood cultures x2 were obtained.  UA noted small leukocytes and urine WBC of 9. Patient tested positive for COVID-19.  Chest x-ray revealed streaky pulmonary opacities in the left lung base; no consolidation or pleural effusions present.  Head CT negative for acute intracranial abnormality.  Twelve lead EKG revealed normal sinus rhythm with bundle branch block.  Patient received Rocephin and azithromycin for potential bacterial pneumonia.  She also received 500 mL IV fluid bolus and was started on Decadron 6 mg orally.  Hospitalist asked to admit patient for management of COVID-19 and rhabdomyolysis.   During hospitalization, patient received ongoing IV fluid rehydration.  Hydrochlorothiazide was placed on hold due to hyponatremia.  Patient remained on room air throughout hospitalization.  Decadron was continued, albuterol inhaler p.r.n. for shortness of breath/wheezing, Tessalon Perles for supportive treatment of COVID-19.  On 02/07/2023, antibiotics were discontinued as bacterial pneumonia was no longer viable diagnosis.  PT and OT evaluated patient due to weakness and fall at home.  Patient did not require subacute rehab or home PT/OT per PT OT eval.  Patient CK mildly increased on 02/07/2023.  She received an additional bolus of 0.9 percent normal saline and IV fluids were continued.  On 02/08/2023, CK trending down.  Patient remains on room air, afebrile, and WBC 6.42.  Sodium has normalized to 135. Blood cultures remain no growth to date.  Patient's weakness has improved during hospitalization.  She has been able to ambulate in her room with minimal assist.  Patient reported constipation during hospitalization.  Will provide patient with MiraLax and milk of magnesia to ensure patient has bowel movement prior to discharge.  Otherwise patient is medically and hemodynamically appropriate for discharge.  Plan is to discharge patient with 7 days of Decadron 6 milligrams orally, Tessalon Perles for cough, and albuterol inhaler for p.r.n. shortness of breath.  Patient denies fevers/chills, shortness of breath, difficulty breathing, chest pain, palpitations, nausea/vomiting/abdominal pain or diarrhea.  Patient does report continued non-productive cough that is alleviated with Tessalon Perles.  Does have a sore throat that resolves with throat lozenge.  Patient may resume home medications at discharge.  Patient is to follow-up with primary care provider within 1 week of discharge.  Plan of care discussed with the patient at the bedside who is agreeable to the plan.  Questions answered to her satisfaction.