Age: 88.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Blood sodium decreased, Chest X-ray normal, Chronic kidney disease, Computerised tomogram head normal, Confusional state
Clinical narrative: Hospitalized;  COVID-19 positive (9.1.21);  fully vaccinated Admission Date: 9/1/2021 Discharge Date:  09/02/2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute hyponatremia  Stupor Altered mental status    HOSPITAL COURSE Patient had presented I was admitted for confusion/altered mental status which spontaneously resolved.  She has remained awake alert oriented x3 under also been insistent on being discharged today.  CT scan of the head and CTA of the head and neck done on admission with unremarkable with no acute abnormalities and no high-grade vessel occlusion.  There was no symptoms of stroke, she had denied any speech or swallowing impairment no acute change in vision no focal weakness.  ER physician had discussed with neurologist prior to admission and did not also think it was related to stroke.  Patient's sodium was found to be low at 125 on admission.  We subsequently discontinued hydrochlorothiazide, I substituted with 5 mg of amlodipine for blood pressure control.  She received IV normal saline and the sodium level has improved to 131. It is also felt that dehydration could have contributed to hyponatremia as evident of defiance duct patient also had acute kidney injury on chronic kidney disease on admission.  Creatinine was 1.10 with estimated GFR of 47 and this has improved with IV fluids to creatinine of 0.94 and GFR of 56. Patient has been very insistent on being discharged today as we advised to follow closely with the family physician on discharge.  On admission patient was also found to be COVID-19 positive however she has remained asymptomatic for this.  She denies any shortness of breath and she has remained on room air saturating at 97%.  She denies any chest pain no significant cough.  She is advised to continue social distancing at home  H&P:  ASSESSMENT / PLAN: 1. Hyponatremia, continue IV normal saline.  Monitor sodium levels closely, will hold hydrochlorothiazide   2. Altered mental status/encephalopathy, unknown etiology in likely with hyponatremia contributing, CT scan of the head was unremarkable.  This has resolved patient is awake alert oriented x3, will follow   3. Hypertension continue home meds but hold hydrochlorothiazide and monitor blood pressure   4. DVT prophylaxis   5. COVID-19 positive patient is asymptomatic no chest pain no shortness of breaths presently on room air   I have spent a total of 75 minutes of patient care coordination     HISTORY OF PRESENT ILLNESS: Patient is a 89 y.o. female who presents today with confusion, patient reports that she woke up this morning feeling disoriented and confused with slow thought process.  She denies any difficulty in speech, denies any impairment of swallowing, no headache no acute change of vision no focal weakness.  She reports that she feels much better no she is able to answer questions she is awake alert oriented x3.  She denies nausea vomiting no abdominal pain no change in bowel movement.  She denies chest pain no cough no shortness of breath no diaphoresis no fever.  Denies dysuria hematuria no leg pains no leg swelling  In the emergency room CT scan of the head was done which was unremarkable, CTA of the head and neck was also unremarkable, chest x-ray no acute abnormality.  Blood work shows sodium level of 125 and a GFR of 50 below troponin is 23 but trended down once to 2