Age: 93.0
Sex: M
Vaccine: COVID19
Symptoms: Acquired diaphragmatic eventration, Acute respiratory failure, Alanine aminotransferase normal, Albumin globulin ratio, Anion gap
Clinical narrative: Age:93 y.o. Admit Date:  8/2/2022 Discharge Date:  8/14/2022      Principal Diagnoses:  Principal Problem:   COPD with acute exacerbation Active Problems:   Hypoxia   Chronic respiratory failure with hypoxia   Fall   COVID   Diabetes mellitus     Discharge Diagnosis:  COPD with acute exacerbation possibly related to covid 19 Acute on chronic hypoxic respiratory failure possibly related to covid 19 Covid positive Hyponatremia Chronic urinary retention Bradycardia   Hospital Course:  93-year-old who is admitted secondary to acute on chronic hypoxic respiratory failure patient was admitted placed on oxygen supplement also noted have COPD with acute exacerbation was placed on IV steroids had gradual improvement with this during hospitalization steroid ray will be tapered oral form patient was Covid positive but outside window of remdesivir therapy.  Was placed in isolation but able be removed from isolation during hospitalization. Patient did have occasional episodes of a symptomatically bradycardia Cardizem was discontinued bradycardia improved blood pressure remained stable. Patient was noted have weakness and deconditioning case was discussed with patient and family who wished rehabilitation placement social work followed and it has been available for rehabilitation placement. Patient does have chronic urinary retention typically self catheters at home but has been unable to do this due to weakness Foley catheter was inserted due to urinary retention and patient will follow-up with urology outpatient patient continued to improve stable for discharge   Consults to:  none   Significant Diagnostic Studies:    Magnesium [159945398]   Collected: 08/13/22 0420   Updated: 08/13/22 0551   Lab Status: Final result     MAGNESIUM 2.0 mg/dL Narrative:   NO KNOWN ALLERGIES Comprehensive Metabolic Panel [159945400] (Abnormal)   Collected: 08/13/22 0420   Updated: 08/13/22 0526   Lab Status: Final result     SODIUM 132 Low  mmol/L   POTASSIUM 4.4 mmol/L   CHLORIDE 95 Low  mmol/L   CO2 31 mmol/L   ANION GAP 6   GLUCOSE 95 mg/dL   CREATININE 0.7 mg/dL   BUN 36 High  mg/dL   CALCIUM 8.8 mg/dL   PROTEIN TOTAL 4.4 Low  g/dL   Albumin 2.9 Low  g/dL   T BILIRUBIN 1.7 High  mg/dL   ALP 57 [iU]/L   AST 12 [iU]/L   ALT (SGPT) 12 [iU]/L   OSMOLALITY 273   A/G Ratio 1.9   B/C 51 High    ESTIMATED GFR >90 mL/min    Comment:    *The estimated Glomerular Filtration Rate(EGFR) may not be      accurate for children under the age of 18 yrs.    **To estimate the GFR for African-Americans multiply the      result provided by 1.21.   Stage 1     90 mL/min or greater  Stage 2     60-89 mL/min  Stage 3     30-59 mL/min  Stage 4     15-29 mL/min  Stage 5     14 mL/min or less   Narrative:   NO KNOWN ALLERGIES CBC [159945399] (Abnormal)   Collected: 08/13/22 0420   Updated: 08/13/22 0515   Lab Status: Final result     WBC 9.8 10*3/uL   RBC 3.46 Low  10*6/uL   HGB 11.6 Low  g/dL   HCT 35.1 Low  %   MCV 101.4 High  fL   MCHC 33.1 g/dL   MCH 33.6 pg   RDW 15.5 %   MPV 7.7 fL   Platelet Cnt 214 10*3/uL   Differential Type Auto   Neutrophils 74.4 High  %   Lymphocytes 9.4 Low  %   Monocytes 15.1 High  %   Eosinophils 1.0 %   Basophils 0.1 %   Neutrophils Abs 7.3 10*3/uL   Lymphocytes Abs 0.9 Low  10*3/uL   Monocytes Abs 1.5 High  10*3/uL   Eosinophils Abs 0.1 10*3/uL   Basophils Abs 0.0 10*3/uL Narrative:   NO KNOWN ALLERGIES   XR Portable Chest Results Status: Final result (Exam End: 8/10/2022 13:16)       Order Report   Order Details         Study Result   Narrative & Impression                         Medical Center                                                                      Radiology    PROCEDURE DATE:  08/10/2022  ORDERING PHYS:  DO   EXAM:  Portable chest dated 08/10/2022.   CLINICAL INDICATION: COVID positive hypoxia.   PROCEDURE: Portable AP view of the chest.   COMPARISON: 08/04/2022.   FINDINGS:   Elevation right hemidiaphragm is seen.  There is air space disease in the left lower lung.  Calcification seen in the aorta.  The cardiac silhouette and bones show no acute finding.  There is a left lung granuloma..   IMPRESSION:   Left lower lung air space disease may represent COVID pneumonia.   Elevated right hemidiaphragm..                   THIS IS AN ELECTRONICALLY VERIFIED REPORT              8/10/2022 1:37 PM:  MD     MD       Procedure(s): none   Disposition:  TCC   Discharge Condition:  healed