Age: 80.0
Sex: F
Vaccine: COVID19-2, FLUA4
Symptoms: Magnetic resonance imaging head normal, Metabolic encephalopathy, Pneumonia, Procalcitonin increased, Pyrexia
Clinical narrative: 5/16/2023 - 5/23/2023 (7 days) Hospital BRIEF OVERVIEW: Admission Date: 5/16/2023 Discharge Date: May 23, 2023 Discharge Disposition:  skilled nursing facility DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Shortness of breath [R06.02] Hypoxia [R09.02] Pneumonia due to infectious agent [J18.9] Pneumonia due to infectious organism, unspecified laterality, unspecified part of lung [J18.9] Acute metabolic encephalopathy [G93.41] Pneumonia due to organism [J18.9] Seizure (HCC) [R56.9]   HOSPITAL COURSE:   81-year-old female with past medical history significant for moderate persistent asthma, chronic hypoxemic respiratory failure on 2 L oxygen, bronchiectasis of right middle lobe/lingula, hypertension, hypothyroidism, GERD, obesity hypoventilation syndrome obstructive sleep apnea on CPAP.  Patient initially presented to Hospital on 5/16 with 1 week of progressive dyspnea/cough and fevers.  She was found to be hypoxic in the emergency department requiring 5 L nasal cannula, as well as tachycardia and tachypneic.  Labs were notable for leukocytosis, elevated CRP, elevated procalcitonin.  Chest x-ray was consistent with pneumonia.  She was started on IV Levaquin, IV Solu-Medrol and admitted to Medicine Services further assessment and management.  The following day, patient became unresponsive.  She was transferred to intensive care unit for close monitoring.  Patient was found to have a seizure (witnessed), suppressed with IV Ativan.  A stroke code was called.  Neurology was consulted.  EEG monitoring was started, and patient was initiated on Keppra.  EEG showed continuous lateralized periodic discharges, left temporal to frontal temporal region seizure activity.  Antiepileptics adjusted to include Vimpat as well.  Brain MRI was negative for acute stroke.  Overall patient's seizure likely caused in setting of acute infection from pneumonia.  Patient's blood cultures and sputum cultures remain negative.  Patient's Solu-Medrol was transitioned to oral prednisone and she is currently completing a steroid taper.  Patient's mentation improved and was almost back to baseline.  She was transferred to floors where she remained stable as well.  He completed antibiotic treatment in the hospital.  Neurology recommended outpatient follow-up in epilepsy Clinic.  A repeat chest x-ray during her stay at general floors showed improvement in pulmonary opacities.  She was weaned to 3 L nasal cannula.   Patient's blood pressure and blood sugar were slightly uncontrolled as a result of steroids.  Blood pressure medications adjusted to metoprolol 100 mg daily as well as hydrochlorothiazide 25 mg daily.  Patient's A1c was 7.1 qualifying diagnosis for type 2 diabetes.  She was monitored on corrective insulin in the hospital, discharging on metformin.  She should follow-up with primary care physician for management of these issues.  Of note as she was waiting to be placed at skilled nursing facility, her screening COVID-19 test came back positive.  Patient has received all COVID-19 vaccines and booster shots.  Her symptoms were only mild (shortness of breath which is likely chronic/congestion).  Patient will take a course of Paxlovid. She was discharged to skilled nursing facility in stable and improved condition.