Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: Abdominal pain, Acute respiratory failure, Azotaemia, Barium swallow abnormal, Bladder hypertrophy
Clinical narrative: Hospitalized;  COVID-19 positive (8.26.21 / 9.7.21);  fully vaccinated  Admission Date: 9/7/2021 Discharge Date: 09/13/2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute cystitis with hematuria Acute encephalopathy Altered mental status, unspecified altered mental status type   HOSPITAL COURSE: Patient is a 68-year-old female with past medical history significant for end-stage renal disease on dialysis, diabetes, hypertension and chronic debility, resides in a nursing home over the last 4 months, presents to the hospital from dialysis as she became confused and started yelling that her legs hurt, complain of abdominal pain and had only finished about 75% of her dialysis run.  Patient was also tested positive for COVID-19 on 08/26 and was started on Decadron on 08/30.  She was noted to be mildly tachypneic, hypertensive 199/73 and needed 4 L nasal cannula.  Urinalysis also was indicative of infection.  Chest x-ray showed moderate pulmonary vascular congestion.  Patient was admitted for further workup.   Patient was noted to have E coli urinary tract infection and upon further evaluation with a CT showed possible ascending urinary tract infection.  Urology consultation was obtained however felt that changes noted on CT were noted previously and this is likely related to low flow state given her dialysis state.  No further urological interventions were felt to be needed.  7 day antibiotic course was completed.   COVID-19:  Patient was diagnosed to have COVID-19 on 08/26 and was started on dexamethasone 8/30 which she completed 10 day course.  Respiratory status improved to her baseline.   Acute hypoxic respiratory failure:  Likely related to a combination of COVID-19 and volume status given her dialysis.  This returned back to her baseline with supportive treatment, negative fluid balance to dialysis and ongoing treatment of COVID-19   End-stage renal disease:  Nephrology assisted in management of dialysis.  Patient was noted to be on Lokelma 4 days per week but was also noted to have low normal to low potassium levels and hence ir Lokelma dose was reduced to just 2 days per week.   Hypertension:  Even though she was noted to be hypertensive at admit, patient actually needed of her home dosing both Lopressor and losartan and maintained normal blood pressures.   Encephalopathy:  Likely related to toxic/metabolic encephalopathy related urinary tract infection, uremia and COVID-19.  Over the hospital stay her mental status slowly improved.   Goals of care discussion:  Spoke to multiple times with son but attempts to call husband were unsuccessful.  Did speak further about code status but per my conversation with patient, wishes are consistent with full resuscitation   Consultations: Nephrology Neurology Gastroenterology   Procedures: CT of the head negative Lower extremity bilateral ultrasound negative for DVT Barium swallow esophagogram suspicious for esophageal stricture, presbyesophagus CT of the abdomen and pelvis with IV contrast--bilateral urothelial/bladder wall thickening and hyper enhancement concerning for ascending urinary tract infection.  Similar to changes noted on previous CT in April.  Patchy ground-glass attenuation interlobular septal thickening has peripheral solid nodularity related to pulmonary edema versus COVID-19 infection Bilateral upper extremity ultrasound negative for DVT