Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: ACTH stimulation test abnormal, Adrenal insufficiency, Asthenia, COVID-19, Chemotherapy
Clinical narrative: Admit date: 2/13/2024  Discharge date: 02/19/24  Admitting Physician: DO   Attending Physician at the Time of Discharge: MD  Primary Care Physician: NP, None  Reason for Admission:  Weakness and fall  Hospital Course: 75-year-old male with history of pancreatic adenocarcinoma, type 2 diabetes, hypertension, hyperlipidemia, chronic obstructive pulmonary disease and chronic AFib on Xarelto. He presented for several ground level falls and lower extremity weakness. Patient states his upper and lower extremities have been swelling since beginning chemo 3 months ago but have been significantly worse since Thursday 2/8. He reports he has fallen up to 7 times in the past week due to lower extremity weakness where he states his legs "feel like noodles" and give out on him. His last fall caused him to injure his left ribs. He states he has minor pain with twisting motions but no pain with deep inhalation. He follows with surgical oncology at facility that will plan on surgical resection in this Spring. He has been on chemotherapy (Camptosar/oxaliplatin/leucovorin/5-FU/pegflgrastim) since November with Dr. They have held oxaliplatin on 1/31 and for future infusions due to worsening neuropathy. His CA 19.9 has appropriately decreased and is thus going into remission. He was instructed to start PRN Lasix for extremity swelling by Dr. on 1/29 but patient was taking the wrong medication and has not had any Lasix yet.  He was admitted to the hospital and these issues were addressed while in the hospital.  1.Hypotension- his blood pressure has been trending down over the last few months.  He was admitted to intensive care unit.  This is most likely related to adrenal insufficiency based on his stimulation testing.  He was started on hydrocortisone 100 mg followed by taper.  He was started on midodrine and was increased to 10 mg 3 times a day.  Currently his renin , aldosterone level currently pending.  He will definitely need to follow up with endocrinology as an outpatient.  He was tapered to Cortef 10 mg in the morning and 5 at night.  2.Anasarca/fluid overload- probably related to hypoalbuminemia.  He was treated with IV Lasix.  Hold further diuresis as he appears euvolemic  3.Carcinoma of the head of pancreas- undergoing chemotherapy plan for curative surgical resection.   4.COVID19- Incidentally found on admission.  He was given couple of doses of remdesivir.  5.Rib fracture- with recent falls. D/w trauma. IS, increase activity, no indication for intervention.   6.Atrial fibrillation- rate controlled, on xarelto (no procedures planned). On digoxin  7.DMII- Significantly improved HgA1C (11.6 on 10/24/23 and now 6.7). Some hypoglycemia with long acting insulin. Continue accu checks and SS. Possible relation to adrenal insufficiency.  Restart Lantus  Blood pressure 95/65, pulse 62, temperature 36.4 °C (97.5 °F), temperature source Oral, resp. rate 16, height 1.753 m (5' 9"), weight 87.3 kg (192 lb 7.4 oz), SpO2 100%. Needs to follow-up with endocrinology for management adrenal insufficiency.  Follow-up on direct renin and aldosterone level.  Diabetes management Discharged to Home