Age: 67.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Sleep apnoea syndrome, Spinal nerve stimulator implantation, Staphylococcus test negative, Transaminases increased, Transferrin saturation decreased
Clinical narrative: Date of Admission Admit Date: Dec-03-2021  Date of Discharge Date of discharge Dec-07-2021  Allergies DARVON - patient unknown reaction  Chief Complaint Shortness of breath  Final Diagnoses Hyponatremia  COVID-19  Acute hypoxemic respiratory failure  Procedure(s) Performed None  Lab Results Dec-07-2021 0728 Point Of Care GLUSTX  105 Dec-07-2021 0503 Point Of Care GLUSTX  89 Dec-07-2021 0420 Serology PROCALC  <0.05 Dec-07-2021 0420 Hematology WBC  8.2RBC  4.17HGB  10.8HCT  32.9MCV  78.9MCH  25.9MCHC  32.8RDW  18.2RDWSD  52.1PLT  275MPV  8.7AUTONEU%  67.3AUTOLYM%  19.5AUTOMON%  12.4AUTOEOS%  0.0AUTOBAS%  0.1AUTONEU#  5.5AUTOLYM#  1.6AUTOMON#  1.0AUTOBAS#  0.0AUTOEOS#  0.0SCAN DIF  YNRBC%  0.0NRBC  0.0IG#  0.06IG%  0.7 Dec-07-2021 0420 Chemistry GLUCOSE  91BUN  14CREAT  1.1MDRD GFR  67NA  129K  4.2CL  94CALCIUM  8.5ALK PHOS  51CO2  28.8AST  61ALT  37AST/ALT  1.6TL PROT  7.1ALBUMIN  3.2TBILI  0.5DBILI  0.1OSMO  259.0ANION GP  10.4BUN/CRE  12.7CRP  2.20MAGNESIU  1.9 Dec-06-2021 2002 Point Of Care GLUSTX  173 Dec-06-2021 1716 Point Of Care GLUSTX  154 Dec-06-2021 1144 Point Of Care GLUSTX  112 Dec-06-2021 0700 Chemistry TSH  7.10 Dec-04-2021 1150 Reference Lab $GGT  35 Dec-04-2021 1150 Coagulation D-DIMER  0.29 Dec-04-2021 1150 Chemistry IRON  15TIBC  277% SAT  5 Dec-04-2021 0610 Hematology WBC  4.8RBC  4.20HGB  11.0HCT  32.1MCV  76.4MCH  26.2MCHC  34.3RDW  17.6RDWSD  49.3PLT  159MPV  8.6MANDIFF  YBAND %  7SEG %  76LYMPH %  10MONO %  7NRBC%  0.0NRBC  0.0IG#  0.01IG%  0.2 Dec-04-2021 0610 Chemistry GLUCOSE  144BUN  13CREAT  1.2MDRD GFR  60NA  125K  4.7CL  89CALCIUM  7.9ALK PHOS  51CO2  26.2AST  62ALT  37AST/ALT  1.7TL PROT  6.4ALBUMIN  3.0TBILI  0.3DBILI  0.1OSMO  254.1ANION GP  14.5BUN/CRE  10.8LDH  411TROPI  <0.017CRP  15.10FERRITIN  326HGBA1C  7.0MEAN GLU  172MAGNESIU  2.4PROBNP  872 Dec-04-2021 0103 Chemistry NA-U  5OSMO-U  131 Dec-04-2021 0100 Chemistry GLUCOSE  179BUN  12CREAT  1.2MDRD GFR  60NA  122K  4.5CL  87CALCIUM  8.1CO2  28.0OSMO  250.2ANION GP  11.5BUN/CRE  10.0 Dec-04-2021 0007 Microbiology MRSA  No methicillin resistant staphylococcus aureus isolated after one night incubation. Functional Status* No Functional Impairments  Mental Status* Normal Cognition  Social History tobacco use Former Smoker, 45 yrs, Smoking Cessation Not Applicable Quit in 2005  marital status Married  Health Concerns Hyponatremia  COVID-19  Acute hypoxemic respiratory failure  Former Smoker, 45 yrs  Father Alive 85y Malignant tumor of lung  Tobacco Cessation* Non-Smoker, Non Tobacco product user  Vital Signs Dec-07-2021 0255 T 97.9 HR 70 RR 16 BP   135 / 71 O2Sat 94 Dec-06-2021 2222 O2Sat 93 Dec-06-2021 2200 T 98.1 HR 70 RR 18 BP       169  / 91 PHYSICAL EXAM CONSTITUTIONAL:  Patient appears comfortable and in no acute distress, resting in PCU on 8L mod flow NC.  EYES: Non injected sclera.  ENT: Normal hearing. Moist mucus membranes.  CARDIOVASCULAR:  Heart has regular rate and rhythm without appreciable murmur, pulses are 2/2 in the upper extremities, no edema noted in the LE, no jugular venous distension  RESPIRATORY:  Auscultation reveals breath sounds distant to auscultation throughout, respiratory effort is non-labored, few deep coughs during exam  GASTROINTESTINAL:  Abdomen is soft, nontender, and nondistended. Bowel sounds present and normoactive  SKIN:  No wounds or rashes appreciated on the head, arms, or legs  NEUROLOGICAL:  No gross neurological deficits noted, sensation is grossly intact  PSYCHIATRIC:  Patient is alert and oriented to person, place, time, and event. Patient's mood is euthymic, affect is appropriate. RASS of 0.  Hospital Course Patient is a 68 year old male with multiple comorbidities that was admitted for treatment of acute on chronic hypoxic respiratory failure secondary to COVID-19.  He has improved since admission and is now at his home oxygen requirements of 4-5L continuous. Today is also day #5 of dexamethasone. He is vaccinated and appears to be convalescing well. We will discharge to home today and return to his baseline home oxygen. His admission was complicated by chronic hyponatremia that did respond well to fluid restriction which will need to be continued and recommend follow up with PCP for medications changes if needed.  Condition at Discharge Stable  Discharge Medications acetaminophen-hydrocodone 325mg 10 MG ORALLY 3 TIMES A DAY Albuterol Sulfate HFA Inhalation Aerosol Solution 108 (90 Base) MCG/ACT 2 PUF INHALATION EVERY 6 HOURS AS NEEDED for SHORTNESS OF BREATH - WHEEZING Aspirin 81 Oral Tablet Chewable 81 MG 81 MG ORALLY EVERY 24 HOURS Co-Q10 100 mg capsule 100 MG ORALLY EVERY 24 HOURS Cymbalta Oral Capsule Delayed Release Particles 60 MG 60 MG ORALLY EVERY 24 HOURS Depakote Oral Tablet Delayed Release 500 MG 500 MG ORALLY EVERY 24 HOURS HumuLIN 70/30 KwikPen Subcutaneous Suspension Pen-injector (70-30) 100 UNIT/ML 17 UNT SUBCUTANEOUSLY DAILY AT BEDTIME HumuLIN 70/30 KwikPen Subcutaneous Suspension Pen-injector (70-30) 100 UNIT/ML 25 UNT SUBCUTANEOUSLY DAILY AT 0700 levETIRAcetam 500 MG ORALLY TWICE DAILY Levothyroxine Sodium Oral Tablet 75 MCG 75 MCG ORALLY EVERY 24 HOURS Losartan Potassium Oral Tablet 50 MG 50 MG ORALLY EVERY 24 HOURS Neurontin Oral Capsule 400 MG 400 MG ORALLY EVERY 6 HOURS PriLOSEC OTC Oral Tablet Delayed Release 20 MG 40 MG ORALLY EVERY 24 HOURS Tamsulosin HCl Oral Capsule 0.4 MG 0.4 MG ORALLY EVERY 24 HOURS Trelegy Ellipta Inhalation Aerosol Powder Breath Activated 100-62.5-25 MCG/INH 1 PUF INHALATION EVERY 24 HOURS tumeric supplement 1 TAB ORALLY EVERY 2 HOURS Vitamin B-50 Vitamin B complex 1 TAB ORALLY EVERY 24 HOURS Vitamin C Oral Tablet 1000 MG 1000 MG ORALLY EVERY 24 HOURS Discharge Disposition Discharge to home  Plan Assessments: -Acute on chronic hypoxemic respiratory failure secondary to COVID-19 pneumonia,  -COVID-19 viral pneumonia -Hypo-osmolar hyponatremia, chronic, likely secondary to psychogenic polydipsia and SSRI use -Microcytic anemia, mild, unknown chronicity, likely of chronic disease -Transaminitis, likely secondary to COVID -Hypoalbuminemia, likely secondary acute illness -COPD, without acute exacerbation -Obstructive sleep apnea, not CPAP compliant -Essential hypertension, on losartan -Insulin-dependent diabetes mellitus, A1c 7.0 -Hyperlipidemia -Morbid obesity, BMI 39.9 -Coronary artery disease, per history -History of PCI with stent placement -Gastroesophageal reflux disease -Hypothyroidism -Seizure disorder -Chronic neck and back pain -History of spinal fusion, C5-C6 -Neurostimulator in situ, lower back  Plan: Discharge to home today. He has 5L O2 concentrator at home. Tolerating this level of oxygen supplementation with exertion.   TSH is improved from November. Down to 7.1. Follow up with PCP as indicated. Recommend follow up BMP in 1 week and encourage 1.5L fluid restriction. May need medication adjustments to improve hyponatremia   Finish 5 day course of dexamethasone today before discharge.  Discharge Instructions Diet 1.5L fluid restriction, diabetic diet  Activity As tolerated  Follow up Appointments PCP in 1 week.   Electronically signed by DO RESIDENT on Dec-07-2021 1229 I have seen and physically examined the patient on 12/7/2021 and agree with the documentation of Dr. I have also discussed my findings and plan of care with Dr. Any changes and additional information are listed below.  Patient requests discharge today. As noted by the resident O2 requirements have improved consistently over the past 48 hours and he is requiring 5L at most on exertion, less at rest. Discussed fluid restriction with him to maintain his sodium level in the high 120s, low 130s which is his chronic apparent baseline. Patient has a pulse oximeter at home, discussed spot checking and checking when feeling short of breath and seeking care if sustaining below 88%. Patient voiced understanding of discharge plan and follow up.   32 minutes spent coordinating discharge. Electronically signed by DO on Dec-07-2021 1458