Age: 76.0
Sex: M
Vaccine: COVID19
Symptoms: Blood alkaline phosphatase normal, Blood bilirubin normal, Blood gases abnormal, Blood sodium decreased, COVID-19
Clinical narrative: Patient is 77 years old with past medical history of COPD, atrial flutter, hypertension, hyperlipidemia, diabetes mellitus, asthma, chronic respiratory failure presented to the hospital with a chief complaint of shortness of breath associated with cough, reduced appetite, fatigue and malaise.  Admits to mild nausea intermittently.  Patient was recently in the ER and attempt to treated outpatient has failed.  He noticed worsening of his symptoms.  And he returned back.  Otherwise patient has no fever, chills, abdominal pain, diarrhea, constipation, difficulty urination, dysuria   In the ED, patient was noted to have elevated troponin.  Cardiology was consulted and an echocardiogram was done.  From cardiology the elevated troponin is likely due to the COVID infection.  Patient had a CTA done which was negative for pulmonary embolism.  CTA was significant for an infiltrate.  Patient was initiated on broad-spectrum hospital-acquired antibiotic.  Venous ABG was done with a PCO2 of 53.  Patient was noted to have hyponatremia and hypokalemia on labs.  HPI per admitting hospitalist.      Clinical Summary   Clinical course Include/ Problem list Acute on chronic hypoxic and hypercapnic respiratory failure Covid-19 -Continue supplemental oxygen -Paxlovid stopped on admission -Continue IV remdesivir (final dose scheduled for 1/18) -Continue IV dexamethasone -Continue albuterol inhaler scheduled and as needed -Continue Spiriva -Continue twice daily Mucinex, twice daily vitamin C, daily vitamin D and zinc -Pulmonology consulted and following   Postobstructive pneumonia -Associated with hilar mass -Continue Zosyn and azithromycin -- >per pulmonology: plan for 2 weeks Augmentin unless cultures indicate otherwise  -Pulmonology consulted and following   Acute exacerbation of COPD, Emphysema -Secondary to above -Continue plan as above   Moderate acute hyponatremia POA -Improving  -Na 135 (on presentation 120) -Continue to monitor   Elevated troponin, likely type II NSTEMI -No chest pain -Cardiology consulted while patient was in the ER  -EKG on admission shows normal sinus rhythm with nonspecific T wave changes -No regional wall motion abnormalities on echocardiogram -Secondary to acute illness as above -Maintained on Eliquis -no abnormalities noted on telemetry  Leukocytosis -likely 2/2 steroids -WBC 13.32  -afebrile -continue to monitor    Transaminitis -improving -Secondary to acute illness vs Paxlovid? -AST 38, ALT 76 -Normal alk phos, bili -Hepatitis panel: Negative  -GGT WNL -Daily CMP   Hilar mass, concern for metastasis vs second lung primary -Larger than prior, measuring 4.8 x 3.0 x 3.2 -Associated with new reticular nodule infiltrates within the left upper lobe, inflammatory versus neoplastic -Follows with Dr., concern for progression of disease -Pending PET scan; May need biopsy -Consulted pulmonology: delay any procedure for minimum 2 weeks d/t current Covid -follow-up with oncology and radiation as OP   Squamous cell carcinoma of the tongue -Follows with Dr., underwent chemo, radiation, and immunotherapy.