Age: 80.0
Sex: M
Vaccine: COVID19
Symptoms: Myoglobinuria, Neurological examination normal, Neutrophil count, Platelet count decreased, Protein total decreased
Clinical narrative: COVID+ 10/22/22 Vaccination status - Pfizer x4 BRIEF OVERVIEW: Admission Date: 10/22/2022 Discharge Date: 10/23/2022   DETAILS OF HOSPITAL STAY:  Clinical Narrative:  Admitted after a fall and dehydration/mild rhabdomyolysis. Myoglobinuria. Did well with hydration. Renal functions stable. Incidental note of mild cough. Covid positive. See below discussion. Preferred home based care. See discussion. Home today.   Please see the following problem-list oriented Hospital Course below:  * Rhabdomyolysis Assessment & Plan  Likely secondary to his fall and being down to the evening and early morning hours.  He is also on a statin which will be held.  Will hydrate.  Recheck CK in a.m.  CK a bit higher, as expected, but renal function normal and low enough that the Rhabdo will not be likely to impact renal function. Renal function stable. Push fluids at home. Stop Statin. The patient and his wife feel that the Statin has actually been contributing to his muscular discomfort (prior to the fall) and they will take a holiday from taking it.  Type 2 diabetes mellitus with hyperglycemia Assessment & Plan  Denies recent hypoglycemia.  Was placed on a basal bolus regimen with glipizide on hold until further trends are available.  A1C 7.2  Remained on bolus insulin back-up given the D5 solution. One time use. Improved off of the solution.  Hypothyroidism Assessment & Plan  Reports multiple recent adjustments in his thyroid.  TSH was slightly low today though his free thyroxine level is 1.1.  Recheck in 6 weeks.  Dysphagia Assessment & Plan  See above.  Resolved, per patient report. No s/s during his time on the unit.  Oropharyngeal cancer Assessment & Plan  States he finished radiation therapy and chemotherapy summer of 2021. He does have a dry mouth and throat is result.  He does have a history of dysphagia as well but states this had improved to the point were no other dietary consistency adjustments were required.  He denies dysphagia to solids and liquids at present.  It is somewhat unclear why he has been falling forward.  His neurological exam seems relatively benign but will obtain CT head in a.m.  10/23 - CT head stable. F/u with PCP/Oncology. No evidence of recurrence.  COVID-19 Assessment & Plan  Mild cough of several days duration.  Wife was enquiring about Paxlovid. This is a possibility.  Will also check a film array.  Chest x-ray clear.  Recheck chest x-ray in a.m..  MDI as he has used this in the past.  We did discuss the outpatient process for obtaining Paxlovid and will attempt to assist with this should it be needed and should the patient be discharged tomorrow.   10/23 - Discussed Paxlovid with Pharmacist. Discussed indications and dosing. Cr Cl > 65, recent symptoms onset, meets criteria.   CXR with possible mild bibasilar infiltrates. O2 needs normal. Will discuss options with patient. He is at risk of other atypical infections. Film array pending. Add Azithromycin or Doxy.  Discussed with patient and wife in detail. Functional status back to normal. States he "can do this at home". Remarkably few symptoms and CXR findings subtle. He prefers to not stay for Remdesivir and we discussed that if the Covid screen had not been positive we may not have done a CXR with his mild symptoms. He does want to consider Paxlovid and I discussed this with the pharmacist at the patient's retail pharmacy to ensure the ability to procure. I've discussed circumstances in which he should call me or return to the hospital/ED. His Oxygen needs are stable. He has no dyspnea or fever.  Dehydration Assessment & Plan  Hydrate.  Recheck renal functions in a.m.  Improved.  Essential hypertension Assessment & Plan  Will check orthostatic blood pressure and pulse.  Follow-up.  Home meds reviewed.  - remained stable  Penicillin allergy Assessment & Plan  The patient does have a cough.  Unclear if this was related to the positive COVID test or other etiology.  A full film array will be obtained.  Chest x-ray clear.  No evidence of clear pneumonia or pulmonary infiltrates present.  Penicillin allergy noted in the event that antibiotics required.  Will provide Doxycycline on discharge. Hx of H/N Cancer and prior health-care exposures.                - reviewed guidelines on drug interactions and doxycycline was not on any of the list of anti-infectives of concern.                - he has no clinically significant hepatic dysfunction or insufficiency to require dose adjustment or concern. He will have repeat LFTs off of Crestor.  INPATIENT PROCEDURES:  CT Head without acute change.