Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Blood phosphorus, Blood potassium, Blood sodium decreased, Blood thyroid stimulating hormone normal, Blood urea increased
Clinical narrative: Date of Admission: 12/8/2023   Date of Discharge: 12/12/2023   Issues to be Addressed at Follow-up:   1.  Completion of isolation for COVID 19: Isolation is recommended through December 28.  Currently asymptomatic from COVID.  At baseline level of oxygen support, 1.5 L.   2.  Pulmonary edema management: Patient has chronic pleural effusions.  Daughter is concerned about daily dosing of Lasix as in the past that has resulted in renal failure.  She had stopped Lasix completely prior to the admission.  Patient diuresed aggressively in the hospital and well-tolerated.  As compromise, I prescribed Lasix 40 mg p.o. daily as needed based on 2 pound weight gain in a 24-hour period.   3.  Moderate pericardial effusion.  Seen on TTE that was obtained during this hospitalization because patient has failed to obtain as outpatient earlier in November.  Increasing pericardial effusion seen from mild to moderate.  No evidence of tamponade physiology.  Results forwarded to Dr. cardiology.   Pending Study Results at Discharge:  Unresulted Lab Orders    No orders found from 11/12/2023 to 12/13/2023.       Final Diagnoses:  Active Hospital Problems   Diagnosis   ? (Principal) COVID-19 DISEASE   ? ACUTE ON CHRONIC HYPOXEMIC RESPIRATORY FAILURE   ? HYPONATREMIA        Lab Results Component Value Date   Sodium 128 (L) 05/31/2023       ? CKD (CHRONIC KIDNEY DISEASE)   ? CHF (CONGESTIVE HEART FAILURE), UNSPECIFIED        Lab Results Component Value Date   B type natriuretic protein 2,595 (H) 04/16/2023     For Diagnosis prompt, please delete, modify at PCP's discretion     ? DM 2        Hgb A1c % Date Value Ref Range Status 01/26/2023 5.9 (H) <=5.6 % Final 07/06/2022 6.3 (H) <=5.6 % Final 12/15/2021 5.6 <=5.6 % Final   -glipizide discontinued due to very good sugar control -metformin. 1/30/23 - offered to decrease metformin to 250mg daily or stopping it due to good a1c control     ? HTN (HYPERTENSION)        BP Readings from Last 3 Encounters: 02/26/20 122/64 02/04/20 119/61 01/22/20 138/59   -metoprolol   ? CHRONIC MYELOID LEUKEMIA   ? POSTRADIOIODINE THERAPY HYPOTHYROIDISM        Lab Results Component Value Date   Thyroid stimulating hormone, ultrasensitive   <0.004 06/12/2005   TSH 4.1 07/05/2023     Post radioactive iodine, has been put on Levothroid 0.1mg with normal TFT in July 2015. Pt can follow up with PCP for refills and future TFT.     Resolved Hospital Problems No resolved problems to display.     Discharge Disposition:  Home with Home Health   Medications, instructions, follow up information: See patient Discharge Instructions/AVS.   Hospital Course and Significant Findings:    78 yo M with medical history relevant for chronic hypoxemic respiratory failure on home oxygen, HFrEF, severe pulm HTN, DM2, admitted for acute on chronic hypoxemic respiratory failure due to COVID 19 PNA.  Treated with remdesivir, Decadron, and Lasix.  Excellent response to therapy.  Quickly returned to baseline level of oxygen supplementation, 1.5 L.  Received 5 days of remdesivir, and 4 days of Decadron.  Observed for an additional day off Decadron to ensure respiratory stability.  Since patient remains stable and clinically well and at baseline level of oxygen support, he was discharged to home health.  Patient strongly in agreement with discharge to home.   Primary Procedures:  None   Secondary Procedures: None   Reason for Hospital Admission (Admitting Diagnosis):  COVID-19   Complications: none   Consults:  HOSPITAL MEDICINE - INITIAL INPATIENT CONSULTATION. HOSPITAL MEDICINE - ONGOING INPATIENT CONSULTATION. Smoker: No.   Condition on Discharge: stable   Code Status at Time of Discharge: DNR   Day of discharge exam   Objective: Patient Vitals for the past 24 hrs:    Temp Temp Source Pulse BP Resp SpO2 O2 (LPM) O2 Delivery 12/12/23 0825 97.5 °F (36.4 °C) Temporal Artery Scan ? 127/75 18 100 % 1.5 LPM NC 12/12/23 0300 97.6 °F (36.4 °C) Temporal Artery Scan 68 144/74 19 98 % ? ? 12/11/23 1525 97.6 °F (36.4 °C) Temporal Artery Scan 55 138/60 16 100 % 1.5 LPM NC 12/11/23 1444 ? ? ? ? ? 99 % ? ? 12/11/23 1102 ? ? 58 127/67 ? 100 % 1.5 LPM NC     Intake/Output Summary (Last 24 hours) at 12/12/2023 0959 Last data filed at 12/12/2023 0835  Gross over last 24 hours Intake 1020 ml Output 2425 ml Net -1405 ml       Physical Exam:   General appearance: Siting up in chair. Well appearing.  Level of consciousness: Awake and alert. Cognition intact.  Cardiac Exam: RRR. Occasional ectopy. No murmur.  Respiratory Exam: ON NC 1.5 L. Breathing even and non-labored. Speaking in full sentences. No cough.  Decreased breath sounds at the bases. Abdominal Exam: non distended, soft, non tender Extremity Exam: No edema of the bilateral lower extremities.    Selected Results: Last CBC    Recent Labs   12/10/23 0730 WBC 4.9 HGB 10.3* HCT 32.0* PLT 290   Last Auto Dif   No results for input(s): "NEUT", "LYMPH", "MONO", "EOS" in the last 72 hours. Last Chem 7    Recent Labs   12/12/23 0636 NA 132* K 3.8 CL 92* CO2 32 BUN 22 CR 1.02 RBS 84   Last Ca, Mg, Phos   No results for input(s): "CA", "MG", "PHOS" in the last 72 hours.     Updated daughter on plan for discharge.  She is in agreement.  Patient also agreement with discharge plan.   MD  12/12/2023 4:11 PM       Note Details  Author (M.D.) File Time 12/12/2023  4:11 PM Author Type Physician Status Signed Last Editor (M.D.) Specialty Hospital Medicine Hospital Acct  Admit Date 12/8/2023  ED to Hosp-Admission (Discharged) on 12/8/2023  ED to Hosp-Admission (Discharged) on 12/8/2023   Detailed Report  Note shared with patient Hospital Problem List   DM 2  HTN (HYPERTENSION)  POSTRADIOIODINE THERAPY HYPOTHYROIDISM  CHRONIC MYELOID LEUKEMIA  CHF (CONGESTIVE HEART FAILURE), UNSPECIFIED  CKD (CHRONIC KIDNEY DISEASE)  COVID-19 DISEASE  HYPONATREMIA  ACUTE ON CHRONIC HYPOXEMIC RESPIRATORY FAILURE Care Timeline  12/08   Admitted from ED (Observation) 1417 12/10   Admitted 1113 12/12   Discharged 1319  Discharge   Home with Home Health   Discharge Instructions (AVS) (Printed 12/12/2023)