Age: 90.0
Sex: F
Vaccine: COVID19
Symptoms: Tricuspid valve incompetence, Troponin increased, Ventricular extrasystoles, Wheezing, White blood cell count increased
Clinical narrative: Patient is a 91 y.o. female with history of HFpEF, asthma, hypertension, CKD 4 complicated by bone mineral disorder, non-insulin-dependent type 2 diabetes, hyperlipidemia, anemia presented to the Medical Center with shortness of breath and cough.   Acute asthma exacerbation  Acute Respiratory Failure with hypoxia Patient reported 2 days history of shortness of breath associated with cough and wheezes CXR with pulmonary hyperinflation. No focal consolidation  is clear of any consolidation WBC 17K on arrival; dwon to 14K (12/15). AF, HDS VBG nonacute.  Resp PCR panel + for COVID  Cont scheduled and PRN breathing txs. Added Mucinex and Claritin  Cont steroidburst, pulmonary toilet   Ran out of her home inhaler and will need Rx for new one Lungs clear, RA, discontinued decadron 12/19 as may be contributing to BP   Covid-19 Virus Infection, PNA Date of onset of symptoms: 12/13/22 Symptoms present on admission: Dyspnea, cough Date of covid positive test: 12/15/22 Vaccination status: vaccinated Imaging: CXR Oxygen requirements on admission: 2L Current oxygen requirements: Room air Medical therapy: steroids (discontinued) Consultants following: None Anticipated special isolation end date: 12/25/22   Abd pain Midline mostly Likely GERD Started PPI Resolved Elevated troponin Trop 76, 63. Baseline ~50s EKG noted SR with PVCs, no acute ST/T wave abnormality   + dyspnea in setting of above, but denies CP Pro BNP 3,738; 1978 8-months ago Troponin 76-- >54     Elevated BNP Troponin and proBNP elevated as noted above Current echo with EF 67%, moderate AoV sclerosis, mild TR  EKG and CXR as noted above Patient on furosemide 20 mg BID at home reportedly per her nephrologist. Denies known h/o HF Lasix 40 mg IV BID x2 on arrival then PO lasix resumed  Held lasix (12/17) for AKI - appeared euvolemic 12/19   Leukocytosis Down to 14K from 17K on arrival 17.33 Afebrile, no signs of infection but for #1 above.  Also on steroids WBC 12 12/19 and overall clinically improved   Ground level Fall R Hip pain One episode with no traumatic injury Xray R hip with pelvis: Reports no obvious acute abnormality but limited by severe bone demineralization.  Xray Lumbar spine: no acute fracture; DDD L2-3 and facet athropathy  Tylenol as need for pain  PT/OT consulted. Recs are for 2-3 days/WK No pain reported 12/19  Essential Hypertension  BP elevated on arrival Home losartan, amlodipine Home metoprolol succinate held on arrival for borderline bradycardia. Improved HR, Held Losartan (12/17) due to AKi Fluctuating BP also affecting Cr - 12/19, stopped decadron as above Better trend 120-169 12/21 - Per nephrology, discharge without losartan and without lasix     AKI on CKD IV Hyperkalemia Bone mineral disorder Creat 2.01 on arrival.  Baseline 1.93 Renally dose medications Cr increased to 2.35 (12/17) Stop losartan, Lasix. Avoid NSAID'S, other nephrotoxins Nephrology consulted FLuctuating BP affecting Cr Cr improved to 1.8 12/20 but K 5.5 Cr stable 1.9 12/21 with K 5 Discussed with doctor- ok with discharge and will get RFP 12/16  with HH Will follow up with doctor Pt to call doctor's office if she develops edema     Hyponatremia Likely due to CKD Na 135 (12/15) > 128 (12/17) > 129 (12/18) Serum Osm 299 Urine studies ordered 12/17, but still not sent Nephrology follows.  Given high Serum Osm checking triglycerides Fluid restriction per nephrology 2 L  Tertiary hyperparathyroidism Hypercalcemia Ca at 11.4 Has had mildly elevated phosphorus in the past;  Continue home Sensipar; increased 12/19 SPEP obrained and Immunofixation both negative;  Increased Kappa and Lambda light chains but normal ration Nephrology consulted Ca still 11 12/20   Type 2 Diabetes with hyperglycemia  A1c 7.1 Home  glipizide held  SS On Lantus 15 units every morning Decreased for 12/20, decreased po intake, off decadrib Controlled 12/21 - po intake slowly improving, will resume on discharge as back to baseline Cr and po intake improving   Normocytic Anemia  HGB stable ~ 10 for the past 6 months; 10.2 on arrival Iron studies in 10/22 consistent with Anemia of chronic disease; likely CKD Stable 12/18   HLD Cont home Atorvastatin