Age: 66.0
Sex: M
Vaccine: COVID19
Symptoms: Cerebral small vessel ischaemic disease, Cervical spinal stenosis, Chest X-ray abnormal, Chronic kidney disease, Computerised tomogram head abnormal
Clinical narrative: HOSPITAL COURSE:  66-year-old male with PMH of reversible posterior leukoencephalopathy syndrome, seizure disorder, hypertension, and diabetes mellitus who presented to the hospital after being found on the ground with acute confusion that resolved while in ED. Admitted to medicine for additional monitoring of acute toxic-metabolic encephalopathy and found to be COVID-19 positive with associated acute hypoxic respiratory failure.    Acute toxic metabolic encephalopathy  Reversible posterior leukoencephalopathy syndrome Seizure disorder, chronic Cervical Spine Stenosis, moderate to severe Elevated creatinine kinase Patient was found on the ground, unclear how long. He was confused and thought that it was 1950 at the time of initial assessment. Mentation had improved upon arrival to ED. Noted to have BP elevated to 180 systolic on presentation to ED. Unclear if encephalopathy is related to seizure with postictal state, hypertensive encephalopathy, or possible depakote toxicity, or other etiology. CT head was without acute abnormality, but notes chronic encephalomalacia of the right temporal occipatal and inferior parietal lobe, as well as mild chronic small vessel ischemic changes. CT C-spine was without fracture or malalignment however noted to have baseline developmentally narrow cervical spinal canal with superimposed degenerative changes resulting in moderate to severe spinal canal narrowing at C3-C4 and C4-C5. Ammonia normal at 12. Depakote level within range at 96.8. - Continue monitoring - Keppra level: wnl - Continue PTA Keppra BID - Blood culture: no growth at 48 hours - Continue PTA depakote daily - CK mildly elevated to 300s in the setting of being found down; continue gentle IVF given AKI as well   - Continue PTA gabapentin - Acetaminophen PRN, Cepacol lozenge PRN, Tessalon TID PRN   Constipation-resolved - Bowel regimen: bisacodyl PRN, miralax PRN, senna BID   Acute hypoxic respiratory failure COVID-19 pneumonia Patient presenting with mildly elevated temp to 100F. Also reported URI symptoms for 4 to 5 days. Cough has been nonproductive. Chest x-ray with subtle interstitial infiltrates in both lungs which was reported as possible early or developing COVID pneumonia. Also with retrocardiac airspace opacity of LLL which may represent atelectasis or left basilar pneumonia. Procalcintonin negative. Has been vaccinated and boosted. D-dimer minimally elevated to 0.53. Noted to have LLE warm and slightly larger than RLE on initial evaluation. Bilat LE US to eval given elevated VTE risk in COVID-19 and mildly elevated d-dimer. US negative for DVT  - With Decadron while on oxygen, weaned off oxygen before discharge - CRP peak to 6.7downtrending to 2 at discharge     Hypertensive urgency - resolved Hypertension, chronic BP initially 180s systolic but improved.  - Continue PTA amlodipine 10mg daily - Continue PTA lisinopril 20mg daily   Diabetes mellitus type 2 Steroid-induced hyperglycemia A1c 7.6% as of 1/26/22.  - continue home empagliflozin while in house   Normocytic anemia, chronic Iron deficiency anemia Hb 12 on presentation, trending down.  - Daily CBC to trend - Continue PTA ferrous sulfate BID -Hemoglobin on discharge 10.5   Hyperlipidemia - Continue PTA atorvastatin   Mild thrombocytopenia Platelets 130 on presentation. Improving.   - Continue to monitor - Trend daily CBC   Hypomagnesemia Hypokalemia - Trend daily and replete daily   Elevated creatinine, suspected mild CKD Hypernatremia, mild Creatinine 1.35 on presentation. Most recent prior was 1.18, however has ranged 1.1-1.4 on prior checks over past few years. Cr improved to 1.2 with IVF hydration. Does not meet criteria for AKI given baseline as noted above. Na minimally elevated to 146 in setting of reduced PO intake. Received IVFs.  - Trend BMP daily; improved to 1. 25 as of 1/30