Age: 59.0
Sex: F
Vaccine: COVID19
Symptoms: Carbon dioxide abnormal, Chest X-ray abnormal, Condition aggravated, Convalescent plasma transfusion, Dehydration
Clinical narrative: ED to Hosp-Admission Discharged  3/17/2021 - 3/22/2021 (5 days) Hospital  MD Last attending ? Treatment team COVID-19 Principal problem Discharge Summary (Physician) ? ? Internal Medicine         HOSPITAL INPATIENT DISCHARGE SUMMARY HOSPITALIST GROUP .   Patient                                                            Date: 3/22/2021 Admission Date: 3/17/2021 MRN: 000008419        Length of stay: 5 Days PCP: CRNP Discharging provider    Admission diagnosis:     Primary Admission Diagnosis    Hospital Problems          POA   * (Principal) COVID-19 Yes       Factor 5 Leiden mutation, heterozygous (CMS/HCC) Yes       Hypertension Yes       Hyperlipidemia Yes       Dehydration Yes      Hospital Course     Hospital Course: Patient is a 59 y.o. female treated in the hospital for COVID-19 pneumonia and dehydration.  The patient received her second Covid 19 vaccination on March 11 but was experiencing some myalgias.  She had multiple sick contacts at home with COVID-19 infection.  Unfortunately she had diarrhea and poor p.o. intake and developed dehydration.  She came to the emergency department for further evaluation after she had her vital signs at home and saw her heart rate was elevated and her blood pressure was low.  She was found to have a sinus tachycardia with hypotension upon arrival despite the fact that she has been holding her blood pressure medications for several days.  She was hypokalemic.  Covid swab came back positive.  She was given IV fluids and potassium was replaced her blood pressure remained on the lower side.  She was admitted to the hospital and started on steroids.  She met criteria for remdesivir and convalescent plasma with saturation at 90% on room air on the second day of her admission.  She completed a 5-day course of remdesivir.  She was given a unit of convalescent plasma.  Her potassium normalized.  Her heart rate normalized.  She had a better oral intake.  Metoprolol tartrate was started on a lower dose for blood pressure and heart rate control.  Her blood pressure remained in the normal range off her lisinopril and Norvasc.  She does have history of Leiden 5 and with a history of DVT and takes Xarelto.  She had a D-dimer which was checked which was normal.  She continued on her Xarelto as an inpatient.  She has clinically improved and is now ready for discharge.  She is agreeable to remote patient monitoring and that has been arranged.  She should follow-up with her family doctor in 1 week.  Her lisinopril and Norvasc were discontinued at discharge.  I have recommended close follow-up with her family doctor to reintroduce these medications as needed pending on blood pressure trend.   _ Labs/Imaging   LABORATORY:   CBC:  Results from last 7 days Lab Units 03/22/21 0629 03/21/21 1224 03/20/21 1528 03/19/21 0550 WBC AUTO K/mcL 5.8 6.2 4.4 3.8* HEMOGLOBIN g/dL 13.8 13.4 12.7 12.2 HEMATOCRIT % 41.1 39.9 38.9 37.3 PLATELETS K/mcL 237 204 187 147 NEUTROS PCT AUTO % 63  --  81 75 LYMPHO PCT MAN %  --  17  --   --  LYMPHS PCT AUTO % 29  --  14 18 MONO PCT MAN %  --  2  --   --  MONOS PCT AUTO % 6  --  3 6 EOSINO PCT MAN %  --  0  --   --  EOS PCT AUTO % 0  --  0 0     CHEMISTRY:  Results from last 7 days Lab Units 03/22/21 0629 03/21/21 0642 03/20/21 1529 03/19/21 0550 SODIUM mmol/L 141 140 138 143 POTASSIUM mmol/L 3.8 3.9 3.6 3.6 CHLORIDE mmol/L 105 106 106 110* CO2 mmol/L 28 26 21 24 BUN mg/dL 18 18 16 8 CREATININE mg/dL 0.77 0.79 0.81 0.71 CALCIUM mg/dL 8.7 8.9 8.6 8.3* TOTAL PROTEIN gm/dL 7.1 7.2  --  7.1 BILIRUBIN TOTAL mg/dL 0.3 0.4  --  0.4 ALK PHOS IU/L 103 101  --  106* ALT IU/L 12 15 | 15 14 15 AST IU/L 15 17  --  22    Results from last 7 days Lab Units 03/20/21 1529 03/19/21 0550 03/18/21 0601 MAGNESIUM mg/dL 1.9 2.2 2.0     COAGULATION:      OTHER TESTS: No results found for: TROPONINI     IMAGING: X-ray Chest 1 View - Portable   Result Date: 3/17/2021 XR CHEST 1 VW PORT IMPRESSION: Limited patchy bibasilar airspace disease, right worse than left. This nonspecific imaging pattern can be seen with COVID-19. Other considerations include but are not limited to other infectious or noninfectious etiologies.  END OF IMPRESSION: INDICATION: Shortness of breath. TECHNIQUE: Single AP view of the chest. COMPARISON: December 4, 2008. FINDINGS: Support devices: None. Lungs: Limited patchy bibasilar airspace disease. Mediastinum: Cardiac silhouette unchanged. Other: No significant interval changes when compared to the prior study. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Durable Medical Equipment