Age: 59.0
Sex: M
Vaccine: COVID19
Symptoms: Fibrin D dimer increased, Haematocrit normal, Haemoglobin normal, Human metapneumovirus test, Hypomagnesaemia
Clinical narrative: ED to Hosp-Admission Discharged   8/16/2021 - 8/21/2021 (5 days) Hospital. Last attending treatment team, acute respiratory failure with hypoxia (CMS/HCC) Principal problem. Presenting Problem/History of Present Illness/Reason for Admission. Acute respiratory failure with hypoxia (CMS/HCC); Multifocal pneumonia; COVID-19.  Patient is a 59-year-old male with past medical history of hypertension, hyperlipidemia, diabetes, gout hypothyroidism, hemochromatosis presented to the emergency room with a chief complaint shortness of breath that started 1 week ago and was getting worse with time associated with cough, fever, chills, decreased appetite, generalized weakness and fatigue.    Patient received his 2 Moderna  Vaccine shot, the ED labs showed white blood cell count 8.5, H and H 15.4/42.9, chemistry showing sodium of 134 potassium 3.3 was replaced chloride 94, BUN/creatinine 22/1.70, magnesium one-point was replaced, troponin 0.07 CRP 247.9, ferritin 695, chest x-ray showed bilateral infiltrate, D-dimer was elevated 1.41 CTPA was negative for PE showed bilateral infiltrate, patient was requiring 10 L of specialty cannula with saturation 92%, patient was endorsed to me for further evaluation and management/hospitalization.    Hospital Course Acute hypoxic respiratory failure with sepsis due to COVID-19 pneumonia. Due to the above presentation patient was admitted to the hospital, started on remdesivir and Decadron patient oxygen requirement continues to worsen initially patient was placed on high flow nasal cannula up to 70% with a flow 45, pulmonology was consulted and recommendation was to give Actemra, Actemra was given and patient was continued on Decadron patient symptoms started to improve gradually and we were able to wean down the oxygen patient was switched to regular nasal cannula and on the day of discharge patient had a rest exercise oximetry which showed the patient will only require 2 L of oxygen with exertion and at night, during my evaluation patient was setting 97% on 2 L, patient to be discharged on tapered dose of Decadron also patient received Zithromax due to mildly elevated procalcitonin during hospitalization. Patient saturation improved significantly, patient currently saturating 95% 4 L nasal cannula. Patient received Actemra 8/17, ISB, Albuterol 4 times daily.  -CRP trending down 247.9-247.9-145.5--83.5-45.7-7.6 -CTPA is negative for PE   - Non-STEMI type II -Likely demand mismatch ischemia related Covid 19 pneumonia and sepsis -Not having any chest pain    -  Hypomagnesemia -Magnesium replacement was given during hospitalization     -  Diabetes -Patient to resume his oral meds, fingerstick stabilized during hospitalization patient received insulin during hospitalization, I am expecting that his glucose measurement will improve with tapering down the steroids, and to follow-up with the PCP and continue to monitor his fingerstick at home    **Patient was evaluated by me today. Patient is alert awake oriented x4, no signs of respiratory distress, discussed with the patient regarding current discharge plan he is agreeable       Treatments: IV steroids, IV remdesivir, Actemra