Age: 50.0
Sex: F
Vaccine: COVID19
Symptoms: Ammonia increased, Anaemia, Ascites, Asthenia, Blood thyroid stimulating hormone increased
Clinical narrative: Discharge Provider: MD Primary Care Provider: MD Admission Date: 9/8/2022 Discharge Date: Sep 15, 2022  PRESENTING PROBLEM: Adult failure to thrive  Failure to thrive in adult   HOSPITAL COURSE:  51-year-old female with PMH significant for hereditary hemochromatosis/Dr.  recurrent urinary tract infection/sepsis, seizures/status epilepticus/Keppra, alcohol abuse/quit 02/2022, cirrhosis/portal hypertension, chronic thrombocytopenia, chronic anemia, iron deficiency as well presents to ER 9/8 due to generalized weakness, abdominal pain multiple falls. Patient was at a alcohol rehab since July and was discharged from there on 09/08 and was asked to come directly to ER and she did.  However when she got admitted there, she had to be transferred to acute hospital the second day due to sepsis related to urinary tract infection.  She was there in the hospital for 1 month.  After discharge back to alcohol rehab, she had to go to ER 2-3 times for swelling, abdominal swelling, paracentesis x2.  She has been falling recently.  Increased weakness and also has noted increased abdominal distension lower extremity edema.   Presented with multiple falls and generalized weakness, likely related deconditioning.  Even though family requested that patient be arranged with rehab, she did not qualify.  Patient independently ambulating in the hallways.   Patient with known cirrhosis, presented with decompensated cirrhosis (ascites, lower extremity edema, elevated ammonia and INR).  Etiology is felt to be related to alcohol use, could be also from her history of hemachromatosis.  She will need follow-up at GI office, office will arrange.  She was noted to have ascites, empirically started on Rocephin for SBP prophylaxis but fluid studies were negative after paracentesis on 09/11.  A 2.6 L. ultrasound was negative for thrombosis.  Patient was started on Lasix/Aldactone and was instructed about 2 g salt restriction.  He will need a screening EGD as outpatient.  An EGD was scheduled for 9/12 however this was canceled after patient tested positive for COVID-19.  Ammonia was 72 and was started on lactulose.   Patient was noted to have fever along with nasal congestion sore throat, tested positive for COVID-19 but chest x-ray without infiltrates and patient is on room air.  Patient received 3 days of remdesivir.   TSH was noted to be 100 and free T4 low normal at 0.6.  Home dosage to 175 mcg was increased to 200 mcg daily.  Repeat free T4 ordered for 9/14 normal, as suggested by endocrinology.  They recommend to continue current levothyroxine dose of 200 mcg daily and repeat TSH in 6 weeks.  Patient's primary care can follow this.   Patient noted to have anemia without any obvious bleeding.  Occult blood however was positive and was 1 of the reasons why she was going to get EGD, this will have to be pursued as outpatient.  No evidence of hemolysis.  Haptoglobin was low but that is related to her liver dysfunction.   Chronic alcoholism, recently discharged from alcohol rehab, reiterated about need for absolute alcohol cessation.  Social work also evaluated patient.   PTOT re-evaluation performed on 09/14 for patient's daughter continued to voice concerns of safety.  Patient did well with this re-evaluation that they recommended no post hospital skilled care needs.  With patient stable she was discharged home on 9/15/2022.