Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Dehydration, Diarrhoea, Dyspnoea, Electrolyte imbalance, Electrolyte substitution therapy
Clinical narrative: Patient is a 64 y.o. female patient of CNP with history of osteoporosis, osteoarthritis, recurrent falls, debility, COPD, former smoker, recent UTI, chronic diarrhea, fatty liver, pancreatitis presumably alcohol induced, early dementia/impaired memory presented to Hospital with recurrent falls and cough. She was found to have COVID, possible aspiration PNA, multiple electrolyte abnormalities and abnormal CT of her GI tract. GI evaluated who performed CT to evaluate for pancreatitic malignancy and was negative. They recommended EGD as outpatient. Discharged for rehabilitation.   COVID-19 Virus Infection COPD not in exacerbation Date of onset of symptoms: 4/2  COVID-19 Virus Infection COPD not in exacerbation Date of onset of symptoms: 4/26/2023 Symptoms present on admission: Cough, dyspnea, fatigue Date of covid positive test: 4/26/2023 home test, confirmed positive test on admission 4/29 Vaccination status: vaccinated Imaging: CXR - nonacute Oxygen requirements on admission: Room air Current oxygen requirements: Room air Medical therapy: Not indicated, on RA no wheezing, rhonchi only  Anticipated special isolation end date: 5/6/2023   Possible aspiration pneumonia CT chest showed LLL bronchiolitis concerning for aspiration. Also atelectasis and bronchiectasis b/l lower lobes. Esophagus distally was thickened with retained fluid material.  SLP for swallow eval, MBS without aspiration Continue coverage for aspiration pneumonia with IV levaquin (PCN allergy). Currently on day 7/7.   Abnormal CT findings Barrett's Esophagus H/o hiatal hernia repair with Nissen fundoplication Above concern for aspiration event in setting of clinical findings and CT imaging of retained fluid, possibly achalasia GI followed Not ideal surgical candidate with comorbidities and acute illness With Covid, plan to repeat EGD as OP once clears to r/o malignancy CT AP results without concern for pancreatic malignancy Esophagram (5/2) with recurrent hiatal hernia but unremarkable otherwise, MBS without aspiration Continue omeprazole and Carafate   Etoh Dependence in Withdrawal Nicotine dependence in withdrawal Last drink day of admission, drinks b/t 1-4 daily Briefly on CIWA and stopped 5/4 Continue Nicotine patches   Abnormal UA No dysuria, UA not suspicious Ur cx initially negative now growing 10-50K CFU E.coli Hyponatremia due to dehydration Patient admits to poorly drinking water Sodium 132 at lowest and resolved with IVF   Pancytopenia Patient without history of bleeding Platelet 76, baseline platelet > 93 Counts remained stable    Hypertension, essential BP 146/98, repeat BP 114/79 Patient has stopped taking amlodipine due to GI intolerance   Hypokalemia Hypomagnesemia Electrolyte issues in setting of EtOH use and poor PO K 3.0 and Mag 1.4 at lowest Continue to replete   Chronic diarrhea Pancreatitis, history of alcohol induced Per history, continue colestipol, Pancrease, cholestyramine   Recurrent Falls Severe osteoarthritis Patient has history of frequent falls even while using her rollator walker and generalized weakness, scoliosis, and height loss from osteoporosis Recommend SNF on discharge   Suspect severe protein calorie malnutrition Body mass index is 18.21 kg/m².  Dietary followed during stay