Age: 51.0
Sex: F
Vaccine: COVID19
Symptoms: Hyperhidrosis, Hypervolaemia, Hypoxia, Impulsive behaviour, Infection
Clinical narrative: Patient is a 53 y.o. female who is a patient of MD with significant medical history of anxiety, asthma, CAD s/p CABG, CHF, ESRD, diabetes, fibromyalgia, hyperlipidemia, hypertension, PVD presented to Medical Center with shortness of breath, malaise, leg swelling.     Acute hypoxic respiratory failure, resolved Respiratory alkalosis Secondary to volume overload and Covid Initial VBG pH 7.7, CO2 23.3; improed on repeat now w/ mild hypercapnia  CXR w/ cardiomegaly, vascular congestion, mild interstitial edema vs bronchiolitis  CT chest w/o contrast: No evidence of atypical viral pneumonitis, Moderate pulmonary edema with trace bilateral pleural effusions Requiring 2L NC on admission Requiring 2L NC on admission , weaned off  Encourage IS, PEP   Covid-19 Virus Infection Date of onset of symptoms: ~5 days  Symptoms present on admission: malaise, sweats, cough, SOB Date of covid positive test: 8/4/23 Vaccination status: vaccinated Imaging: CXR as above; CT chest as above Oxygen requirements on admission: 2L Current oxygen requirements: None Medical therapy: steroids Consultants following: none Anticipated special isolation end date: 8/9/23 Supportive care, optimize volume status  Discharge on Rx to complete 10 day course of Decadron   Volume overload state BLE edema ESRD on HD Labs c/w this on admission. No hyperkalemia US negative for DVT Nephrology consulted; received HD 8/4 given volume overloaded    Acute metabolic encephalopathy, resolved In setting of hypoxia, infection, recent PEA arrest (told RN some mild cog issues since then) Oriented x4 on admission, but per RN very forgetful/impulsive. Exam non focal. No need for head CT at this tiem Maintain sleep wake as able, fall/delirium precautions Resume home Norco and Xanax for now but low threshold to dose reduce/DC for worsening mentation or somnolence  Consult PT/OT   Diabetes mellitus, type 2, with hyperglycemia  BG in 400s on admission. Recent A1c 7.3%  Giving 10u short acting insulin now, monitor BG levels closely as she will also be getting steroids for Covid  For now resume Lantus 30u BID + SSI Discharged on home regimen   CAD s/p CABG Elevated troponin  Recent PEA arrest  Hx PCI to LAD 2005, CABGw/ LIMA to LAD 2017. Follows w/ Dr.  Had PEA arrest in 7/2023 at CCF during EGD Trop 98, 179, 180 on repeat likely demand from hypoxia, chronically elevated in setting of ESRD; not too far from recent BL labs  BNP 31k (previosuly >70k) EKG no acute findings, non specific T wave changes laterally similar to previous Recent NM stress 6/2023: large, mild-severe perfusion defect, non diagnostic stress EKG, inferolateral akinesis - per cardio no ischemia but large scar Resume ASA, statin  Consulted cardio given complex history: No further cardiac work-up is recommended at this time   Acute on Chronic combined systolic and diastolic CHF Ischemic cardiomyopathy  Moderate valve disesase  Echo (6/24) with EF 35%, mod to severe mitral regurg, pulm hypertension TEE (7/28) moderate MR, moderate TR, low normal LVSF Recently started on Entresto and Coreg per cardio Volume removal via HD, resumed home Lasix