Age: 83.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Dehydration, Echocardiogram abnormal, Ejection fraction normal, Fall, Fatigue
Clinical narrative: Hospitalized 11.20.21;  COVID-19 positive (11.19.21);  Fully vaccinated Admission Date: 11/20/2021 Discharge Date: 11/21/2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Generalized weakness COVID-19 HOSPITAL COURSE: PT is a 84 year old male with PMH of spinal stenosis, chronic pain and weakness, PVD, HTN, DMt2 long term insulin use, afib on eliquis who presented with acute generalized weakness and fall at home. He was sent to ED for evaluation.  Patient tested positive for COVID-19 and reported mild symptoms.  No hypoxia.  Patient was agreeable to regeneron infusion and received this on 11/21.  He is vaccinated. Patient had mild renal insufficiency and received 1 L of IV fluid with improvement.  He was eating and drinking well. Patient's outpatient physician and pain physician were concerned patient may require MRI due to fall and increased lower extremity weakness.  However, weakness most likely secondary to COVID and dehydration. Patient's weakness significantly improved during his stay back to his baseline.  Patient had no concerning findings or focal findings on neurological exam warranting urgent MRI.  Patient also severely claustrophobic and would require general anesthesia and would not recommend this unless urgent given COVID-19.  This was explained to family and patient who were agreeable with holding off on MRI and can be pursued outpatient on a routine basis.  He was seen by occupational therapy who recommended to discharge home with assist.  Home healthcare was set up by care management. Patient was noted to have low normal blood sugars during admission.  After extensive conversation regarding his home diabetes regimen it was found that patient is taking toujeo10-20 units in the morning and 10-20 units at night but not tell how he is deciding this. Able to state he would not give this for a low blood sugar.  On the med list in his wallet he has written toujeo 120 units nights. On outpatient office notes toujeo 50 units nightly noted.  Discussed significant concerns regarding how patient is outpatient is administering Toujeo with patient, wife, and daughter over the phone.  Discussed he is likely having low blood sugars at home with his hemoglobin A1c of 6.5.  They note he has lost weight over the last 2 years which may be contributing to this.  Will discontinue Toujeo on discharge.  Patient should continue to check his blood sugars twice a day and bring log to his family physician to further discuss his diabetes regimen.  He can continue Jardiance and Trulicity. Patient also admits to being very forgetful but states but ?I never for get my medications?.  Discussed that with patient's short-term memory deficits this is a concern and he would benefit from neuropsych testing.  Recommend outpatient neuropsych testing and information provided in depart.  Discharge instructions reviewed at length with patient, wife, and daughter over the phone.  Patient will discontinue Toujeo.  Home health care set up as well. Patient discharged home in stable condition. Discussed one of the daughters attending all doctors visits.