Age: 47.0
Sex: F
Vaccine: COVID19
Symptoms: Urine analysis abnormal, Urine ketone body present
Clinical narrative: This is a 48yo female with PMH of DM 1 on insulin pump, hypertension, peripheral neuropathy who presents to the ED with about 7d of subjective fever, chills, body aches, shortness of breath and an overall feeling of unwell. She says she also was not eating well and has been staying in bed. She says her son was also sick so they both went for COVID and flu test on Thurs but has not yet been made aware of the results. Since Thurs she has also noticed increased shortness of breath which has gradually worsened as well as some chest discomfort. This is what prompted her to call EMS and come to the ED.    She has a history of DM 1 and is on an insulin pump but, because she has not been eating, she had not been checking her BG. She says the last time she checked was a couple of days ago. At that time it was in the 180s. She has not taken her bolus insulin also because of this.    In the ED, VSS. Labs notable for glucose of >600, K 5.2, CO2 16, BHB of 7.2. UA showed ketones and >1000 glucose. VBG with pH of 7.22. Troponin nex. CXR unremarkable. Unable to find results of COVID test from OSH so she has been re-swabbed. She was given a fluid bolus and started on isulin drip. She will be admitted to medicine for management of DKA.  1/17/2022 PROGRESS NOTE ASSESSMENT: 48 y.o. female with history of DM Type1 on insulin pump, HTN, and GERD admitted 01/09/22 for DKA in the setting of COVID infection. Has been on and off insulin ggt due to being a very brittle diabetic and varying oral intake . Did not tolerate going back onto her PTA insulin pump. Transition  lantus/aspart dosing.   PLAN: DKA x 2, resolved DM Type 1  on PTA insulin pump Iatrogenic hypoglycemia, resolved COVID infection. Criteria for DKA-- PH of 7.22, ketosuria, bhb elevated at 7.20, AG of 19, CO2 of 16 on amission. Was able to be weaned insulin ggt in the ED. Attempted to switch back to PTA insulin pump for 2 days (1.45 units/hr), but had recurrent lows. Hospital policy does not allow adjustment of this pump, so switched to SQ lantus/aspart dosing however went back into DKA. Placed back on insulin ggt and had required ~ 1 unit/hr consistently) but then suddenly a morning low (58) with rapid rebound 428 within 4 hours of holding insulin ggt    continue carb consistent diet with 1 unit per carb  d/c insulin ggt 1/16 , start lantus 17 units daily  MDSSI  reduce BMP to q12H continue Mg and K replacement protocol  consider reaching out to outpatient endocrinologist     COVID-19 infection Vaccinated,overdue for booster. This was delayed due to recent episode of shingles which is resolving. symptom including fatigue, subjective fever, decreased appetitie, shortness of breath   No hypoxia and CXR clear. No decadron  continue full barrier precautions F/u PCP for booster   Sinusitis  Not improved on conservative therapies with sudafed.  continue augmentin BID x 7 days  continue sudafed BID   Hyponatremia 2/2 hyperglycemia    Corrected sodium WNL.    Hypertension   PTA lisinopril and HCTZ   Gastroparesis PTA Reglan   Anxiety/ Depression  PTA Zoloft and Xanax   GERD  PTA Protonix    HLD  PTA pravastatin