Age: 64.0
Sex: F
Vaccine: COVID19
Symptoms: Acute kidney injury, Acute respiratory failure, Blood creatinine increased, Blood magnesium, Bradycardia
Clinical narrative: Patient is a 65 y.o. female patient of local MD with past medical history of hypertension, hyperlipidemia, insulin-dependent diabetes mellitus, chronic restrictive and obstructive lung disease, COPD, obstructive sleep apnea, obesity hypoventilation syndrome, chronic hypoxemic respiratory failure on 4 L of oxygen through nasal cannula, chronic diastolic heart failure, breast cancer, CVA, CKD stage III, anxiety/depression, paroxysmal Afib, morbid obesity body mass index 46.3, presented with shortness of breath   Covid-19 Virus pneumonia COPD with acute exacerbation Hemoptysis Recent history of bilateral pneumonia Obstructive sleep apnea Obesity hypoventilation syndrome Acute hypoxemic respiratory failure currently on nonrebreather Chronic hypoxemic respiratory failure on 4 L of oxygen through nasal cannula Date of onset of symptoms: 12/10/2022 Symptoms present on admission: Shortness of breath and coughing blood Date of covid positive test: 12/13/2022 Vaccination status: vaccinated Imaging: Chest x-ray bilateral pneumonitis Oxygen requirements on admission: Nonrebreather 100% Current oxygen requirements: 5 L of oxygen through nasal cannula Wean oxygen as tolerated.  Patient at baseline uses 4 L of oxygen Medical therapy:  - remdesivir, steroids, and zithromax Rocephin  -Symbicort/Spiriva/rescue inhaler albuterol Consultants following: Infectious disease consult and pulmonary consult Anticipated special isolation end date: 12/27/2022 Encourage patient to do prone positioning and incentive spirometer   Patient was doing well this morning, was on 4 L nasal cannula which is patient's baseline.  Sleeping discharged with advised to follow-up with PCP on discharge.  Patient was seen by pulmonologist while in the hospital who recommended patient to continue using Symbicort and Spiriva, continue AVAPS with all sleep and shortness of breath.   Bradycardia and 2-second sinus pause: Patient had overnight event of bradycardia and 2-second sinus pause.  Patient is being discharged with follow-up with cardiology.  Metoprolol dose has been reduced to half.  Mild acute kidney injury on CKD stage III-improved Baseline creatinine 1.1 Creatinine on admission 1.3 Closely monitor urine output and kidney function test Daily BMP and magnesium   Chronic diastolic congestive heart failure Elevated troponin most likely demand ischemia secondary to above Echocardiogram 8/15/2022 showed dilated and moderate concentric LVH hyperdynamic  First troponin 70s, repeat troponin was 69 EKG no ST-T wave changes Guideline/goal-directed medical therapy   Insulin-dependent diabetes mellitus with hyperglycemia Initially Lantus reduced from total of 120 units daily to 70 units daily. We will place her back on 60 units twice daily (giving initiation of IV steroids) Preprandial insulin 30 units 3 times daily, titrate accordingly to home dose 60 units 3 times daily. Hemoglobin A1c 7.9 Endocrinology consulted due to significant hyperglycemia   History of hypertension Amlodipine 5 mg daily Imdur 60 mg daily Metoprolol succinate 25 mg twice daily Losartan 75 mg daily IV hydralazine and labetalol as needed   Paroxysmal Afib Metoprolol succinate 25 mg twice daily Coumadin ~6 mg daily pharmacy to dose   History of breast cancer Anastrozole 1 mg daily   Severe morbid obesity Body mass index 46.3 Encourage weight loss and lifestyle modification  Chronic fatigue syndrome Physical deconditioning PT OT and social service consulted for discharge plan