Age: 83.0
Sex: M
Vaccine: COVID19
Symptoms: Hypovolaemia, Hypoxia, Lactic acidosis, Obstruction, Pelvic discomfort
Clinical narrative: Patient is a 84 y.o. male admitted to the hospital on 10/21/2022 for dyspnea and confusion found to have COVID-19. Initially required oxygen by nasal cannula and treated with dexamethasone. Patient was successfully weaned to ambient air no longer needing steroid treatment. Course complicated by Acute Kidney Injury and acute urinary retention requiring foley placement. Patient was also treated with antibiotics for Urinary Tract Infection. Acute Kidney Injury improved after IV fluids. Urology consulted. Did not tolerate voiding trial and had foley replaced 10/28 prior to discharge to AL.   Comments/Problems to be Addressed After Discharge - Outpatient follow-up with urology for urinary retention - Losartan discontinued. Metoprolol continued at reduced dose. Monitor blood pressures.   Discharge Diagnosis and Associated Hospital Course   Sepsis, resolved Suspect urinary source due to urinary retention and abnormal UA. - patient presents with confusion, dyspnea, AKI and Lactic Acidosis  - s/p IVF. 10/21 blood cultures with no growth, urine culture negative - IV cefazolin transitioned to Keflex, completed 10/27   Suspected UTI Acute Urinary Retention - Noted to have abdominal pain and suprapubic distention on admit found to have acute urinary retention requiring foley catheter placement for bladder decompression in the ED. - UA grossly abnormal; previous urine cultures this year with E. Coli, resistant to Cipro. CT with normal size prostate. - Completed course of antibiotics for Urinary Tract Infection 10/27 - Urology consulted for urinary retention. Failed voiding trial 10/27 and required second foley placement 10/28. Continue Flomax. Outpatient urology follow-up Acute Hypoxic Respiratory Failure, resolved COVID-19 Positive - Presented with: cough, confusion and hypoxia - Symptom onset: Thursday 10/20 and tested positive 10/21. - Vaccinated  - CXR on admission showed clear lungs - Oxygen status: 2-3L NC on admit, now on RA. SpO2 goal over 90% - Received Decadron while requiring oxygen. Not needed at discharge due to being on RA.   Acute Kidney Injury, resolved - suspect post-obstructive component as well as pre-renal component related to volume depletion, dehydration - Creatinine peak 1.77 on admit. Improved with IVF and foley placement now back to baseline 0.7.   DM Type II - most recent HgA1C 6.7% on 7/31/22 - prior to admit regimen includes Metformin and Glipizide; held both as inpatient - SSI with steroids inpatient. - Will discontinue glipizide and metformin on discharge due to risk of hypoglycemia in elderly patient   Essential HTN - home regimen includes Lopressor 50 mg BID, Losartan 50 mg daily - Periods of hypotension inpatient. Stop losartan and continue reduced dose lopressor.   History of Stroke - Right MCA stroke in 2007 with persistent LUE paralysis and LLE weakness  - PT/OT evaluations - continue home ASA, Statin   Cognitive Impairment - suspected Early Dementia, recent accelerated cognitive decline since 4/2022 hospitalization and moved into assisted living facility. Has had difficulty adjusting - currently on scheduled Depakote, continue home dosing  - follows with Neurology, Dr.