Age: 40.0
Sex: F
Vaccine: COVID19
Symptoms: Hyponatraemia, Ileus, Inappropriate antidiuretic hormone secretion, Lipase increased, Liver function test normal
Clinical narrative: Patient is a 41 y.o. female patient of Physician No with history of schizoaffective disorder, bipolar disorder and obsessive-compulsive disorder presented to a local Medical Center with diarrhea, found to have acute enterocolitis, hyponatremia and psychosis. Course complicated by Covid 19, AKI and complex discharge planning. Awaiting SNF placement     Acute enterocolitis Ileus...resolved With loose stools which have persisted during stay  CT abd/pelv on admission with multiple fluid-filled small bowel and colonic loops, nonspecific finding which can be seen with acute enterocolitis  CT PE 12/4 concerning for mechanical obstruction Surgery consulted, more consistent with ileus than obstruction  Etiology of symptoms believed to be enteritis from covid, appears less likely pancreatitis or acute cholecystitis  Stopped clozapine while ileus/obstruction is a concern, has been resumed and generally tolerating  Cont regular diet, cont supportive care   C-Diff negative, Having daily BMs   Metabolic acidosis...resolved Persistent non gap acidosis  Started PO bicarb -- continue  Possible RTA from Lithium but has not been present in the past  Nephrology assessed, ok to cont lithium at lower dose   BMP stable 12/16   Hyponatremia....resolved SIADH Pt drinking large amounts of water prior to admission and constantly requesting during admission  ADH dependent, probable SIADH, polydipsia may contribute   Is on SSRI  Cont 2L fluid restriction, given severe thirst would not decrease   Cont sodium bicarb on discharge  Nephrology assessed, Na upto 141, can liberalize Fluid restriction per nephrology 12/14  Schizoaffective disorder Bipolar disorder Patient presented from a HCF; admitted there for acute psychosis Per BH  -no longer meeting inpatient criteria. Stable to DC per BH perspective, Discontinued No AMA  Safest disposition is to have her sister pick her up to take her home. Monitoring patient's pill sorter at least weekly would be recommended as well as assisting with making sure she is seeing her outpatient clinic regularly Will need continued clozapine dose titration as opt likely  Currently on 150 mg QHS F/u with  with Dr  at office    Covid-19 Virus Infection Date of onset of symptoms: 11/28/2022 Symptoms present on admission: diarrhea Date of covid positive test: 11/29/2022 Vaccination status: unvaccinated Oxygen requirements on admission: RA Current oxygen requirements: RA Special isolation end date: 12/9/2022   Elevated lithium level  Lithium elevated at 1.6 on admission, improved to 1.0 Resumed lithium at 450 BID Li level 1.3 (12/3) -- > repeat on 12/5 1.1  Reduce lithium to 300 nightly  Gallbladder distention Seen incidentally on CT abd/pelvis on 11/27 Has generalized abd pain, not specifically worse in RUQ  LFTs wnl, US with hydropic gallbladder, sludge   Discussed with surgery, do not think acute cholecystitis, can follow up for possible chronic issue    Elevated lipase Lipase 564 on admission, due to enterocolitis Patient denies abdominal pain, only has diarrhea which is improving CT abd/pelv with unremarkable pancreas Uncertain if pancreatitis contributed, tolerating diet w/o post prandial pain    Prolonged QT   Qt mildly prolonged BH aware, not able to eliminate all Qt prolonging agents from her psych regimen