Age: 49.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Alanine aminotransferase normal, Anaemia, Anticoagulant therapy, Aspartate aminotransferase normal
Clinical narrative: 49 Y male with history of HTN, HLD, DM2, ESRD (recent transition from PD to HD, T/Th/Sat), paroxysmal Afib (on warfarin), gout, ACD, recent admission 12/16 - 12/20 for hypervolemia (new start HD at that time) who presented 1/11/22 from home (ALF) with weakness SOB, chills, no fevers. He was found to have acute hypoxemic respiratory failure, Covid positive 1/11/22, abnormal troponin. Normal lactate.  CT chest with large left pleural effusion with atelectasis. Not short of breath at rest.  Started on antibiotics for possible parapneumonic effusion and Decadron for covid pna. No Remdesivir given ESRD. Thoracentesis 1/14/22, removal of 1.3 L of fluid.  Cultures so far negative.  Clinically improved, weaned to room air. Ambulatory on RA with O2 sats greater than 92%. Eating well.  CRP 1.6  from 8.9 on admission. D-dimer 2.71 from 3.30.    1) COVID Pneumonia, Acute hypoxemic Respiratory failure (resolved), PNA, L effusion- Symptom onset on 1/10. COVID positive on 1/11. Last fever unknown.  Vanco 1/11-15.  Zosyn in house 1/11-1/16. BCX neg.              - Vantin to complete 7 days total 1/17/22.               - consider CXR in 2 weeks to f/u L effusion             - Decadron 6mg PO qday for up to 10 days (1/11-1/19 ) given high risks for complications.              - Remdesivir not given as pt is ESRD              - Protonix for GI prophylaxis             - s/p Thoracentesis 1/14/22. GS no organisms. F/u pleural fluid cytology, and culture so far negative.              - continue isolation per Regional/Local ID guidance. Until 01/31/22.     2)  Non ischemic myocardial injury from Covid infection, pna. Trop  0.12 x 2.    3) HTN, HLD - PTA Metoprolol. Amlodipine increased to 5mg bid.  Added Hydralazine 25mg TID for HTN. Continue to adjust medication as outpt as appropriate.     4) AFib:  - on Warfarin. F/u with AC clinic, next INR on Tuesday on HD 1/18/22                 - PTA BB     5) DM: Last hgba1c 7.2. Pt states no longer takes NPH or regular insulin as his AM sugars are usually < 100. BG on admission was 71             - Here on low dose NPH and regular insulin (as he is on steroids) to tirate as outpt once off steroids.              - Low ISS   6) ESRD on HD             - Continue T,Th,Sat HD sessions at Covid center. After finish isolation he can go back to HD  MWF.              - Continue nephrovite              - Pt also taking Phoslo and Renvela .   -  ANEMIA: Suspect AOCD. Baseline hgb 8-9. No e/o bleeding             - iron tabs    - Gout:     - Continue PTA allopurinol   - Undiagnosed OSA: pt desaturates occasionally when sleeping requiring on and off oxygen. He has been told he needs sleep study and CPAP.              - e consult to home sleep study for CPAP sent.    -  Followed by derm for rash. Acne vs. Kyrle's disease.             - PTA Doxycycline 100mg Q12h resume.              - PTA Atarax 10mg daily PRN itching   Diet: DIET, RENAL DVT prophylaxis: As above Code Status: Full Code Reason for Hospital Admission (Admitting Diagnosis):  Covid infection