Age: 61.0
Sex: M
Vaccine: COVID19-2
Symptoms: Blood bicarbonate increased, Blood glucose increased, Blood pH normal, Blood potassium normal, Blood sodium decreased
Clinical narrative: Patient is a 62 y.o. male patient of MD with history of new uncontrolled DM, pancreatic cancer, COPD, HTN who presented to Hospital with syncope, dizziness x3 months feeling unwell after pancreatic cancer treatment.    HHS Uncontrolled DM  Labs on admission with sodium 132, potassium 4.3, bicarb 24, anion gap 18 with glucose 540.  VBG with pH 7.41 with PCO2 44.3 and HCO3 28.  BHB 1.5 Recently on glipizide and switched to Basaglar 10 units daily with titration.  A1c 12.4 Initially on Insulin gtt. Now transitioned to Lantus 25 units nightly and 10 units am+ 1:4 insulin to Carb ratio + SSI Continue diabetic diet Consulted endocrinology, diabetic educator and dietitian   Patient seen and evaluated bedside today.  Appears to be in no acute distress.  Diabetic educator at bedside.  Patient was instructed to use insulin as prescribed.  Increase dose while on Decadron, titrate down when off the Decadron.  Specific instructions as follows   For discharge while prescribed dexamethasone: Lantus 35 units daily Humalog 45 units with meals plus Meal times correction scale   150 - 200 - 2 unit   201 - 250 - 4 units 251 - 300 - 6 units 301 - 350 - 8 units  351 - 400 - 10 units Notify us if glucose values are less than 70 mg/dL or over 250 mg/dL frequently (2 or 3 times over 2 or 3 days)    Upon discontinuing dexamethasone: Lantus 25 units daily Humalog 15 units with meals Meal times correction scale 150 - 200 - 2 unit   201 - 250 - 4 units 251 - 300 - 6 units 301 - 350 - 8 units  351 - 400 - 10 units Notify us if glucose values are less than 70 mg/dL or over 250 mg/dL frequently (2 or 3 times over 2 or 3 days)  Patient instructed to follow-up with PCP and endocrine.  Had to be prescribed aspart instead of lispro due to insurance coverage.   Covid-19 Virus Infection Date of onset of symptoms: SOB Symptoms present on admission: unclear, reports everyone at work has been sick  Date of covid positive test: 11/16/23 Vaccination status: vaccinatedx4 last 11/2022 Imaging: CXR mild bibasilar airspace disease, atelectasis and/or early basilar infiltrate. Procal within normal limits.  CRP elevated at 40.7 Oxygen requirements on admission: room air, required upto 3 L oxygen on 11/17 Current oxygen requirements: Room air Medical therapy: Decadron and Remdesevir. First dose 11/18 Consultants following: ID Anticipated special isolation end date: 11/26 Continue Decadron on discharge   Syncope Dizziness Likely due to HHS.  CTA head and neck?nonacute, remote right angular gyrus infarct.  Patent normal caliber intracranial and extracranial circulation Cardiac monitoring Echocardiogram with a EF of 60%, normal left ventricular segmental wall motion, normal right ventricular systolic function. Holding losartan Discussed with PCP to restart losartan   Pancreatic adenocarcinoma Pathology from 2/13/2023 consistent with adenocarcinoma pancreatic body Follows with Dr. last seen in office 10/27/2023.  S/p neoadjuvant chemo treatment.  3 cycles gemzar and abraxane with last treatment 6/7/23 cycle 3 day 15.  S/p surgical resection 7/5/2023.  Recommendation at that time was for 3 more cycles of Gemzar/Abraxane.  Patient declined adjuvant chemotherapy treatment.  At that time patient's choice was for no more chemotherapy treatment.  Has had chemotherapy treatment with p.o. Xeloda in past.  States he has not been taking Zenpep or Questran as after Zenpep he had persistent nausea and vomiting AECOPD Previously on trelegy, issues with insurance coverage Dulera/Spiriva with prn albuterol  Mucinex PEP/IS Continue Decadron and azithromycin on discharg