Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: Carbon dioxide increased, Clostridium test negative, Computerised tomogram abdomen abnormal, Constipation, Diarrhoea
Clinical narrative: Discharge Summary Date of Service Sep-07-2022 0842  Draft Date of Admission Admit Date: Sep-04-2022  Date of Discharge Date of discharge Sep-07-2022  Allergies Penicillins - Not Specified  iv contrast - Not Specified  Tree Nuts - has epipen  Latex - .  IODINE CONTRAST - .  Chief Complaint Abdominal pain, diarrhea  Procedure(s) Performed None  Lab Results Sep-07-2022 0715 Blood Gas PH  7.430PC02  47.9PO2 ART  110.0BICARB  30.9BE  6.0CO2 CT  28.0O2 SAT  >99.0O2 THER  28TYPEABG  Arterial Sep-07-2022 0530 Hematology WBC  3.9RBC  4.15HGB  12.3HCT  35.3MCV  85.1MCH  29.6MCHC  34.8RDW  12.0RDWSD  37.0PLT  214MPV  9.6AUTONEU%  29.8AUTOLYM%  62.2AUTOMON%  6.7AUTOEOS%  0.5AUTOBAS%  0.5AUTONEU#  1.2AUTOLYM#  2.4AUTOMON#  0.3AUTOBAS#  0.0AUTOEOS#  0.0NRBC%  0.0NRBC  0.0HGB/HCT  2.9IG#  0.01IG%  0.3 Sep-07-2022 0530 Chemistry GLUCOSE  97BUN  12CREAT  0.7MDRD GFR  83NA  144K  2.6CL  106CALCIUM  7.9ALK PHOS  94CO2  30.2AST  24ALT  10AST/ALT  2.4TL PROT  5.3ALBUMIN  2.4TBILI  0.2OSMO  286.5ANION GP  10.4BUN/CRE  17.1CRP  0.80MAGNESIU  1.8 Sep-06-2022 0815 Microbiology CAMPY  NegCDIFF  NegNOROVIR  NegROTAVIR  NegSALM  NegSHIG  NegSHIGATX1  NegSHIGATX2  NegVIBRIO  NegYENTERO  Neg Sep-06-2022 0710 Hematology WBC  2.9RBC  4.49HGB  13.2HCT  37.4MCV  83.3MCH  29.4MCHC  35.3RDW  11.9RDWSD  36.3PLT  213MPV  9.5AUTONEU%  63.5AUTOLYM%  31.0AUTOMON%  5.2AUTOEOS%  0.0AUTOBAS%  0.0AUTONEU#  1.8AUTOLYM#  0.9AUTOMON#  0.2AUTOBAS#  0.0AUTOEOS#  0.0NRBC%  0.0NRBC  0.0HGB/HCT  2.8IG#  0.01IG%  0.3 Sep-06-2022 0710 Chemistry GLUCOSE  118BUN  20CREAT  0.8MDRD GFR  72NA  141K  3.2CL  103CALCIUM  8.5CO2  29.3OSMO  285.0ANION GP  11.9BUN/CRE  25.0CRP  2.10MAGNESIU  2.0 Sep-05-2022 0524 Hematology WBC  4.9RBC  4.45HGB  12.9HCT  38.2MCV  85.8MCH  29.0MCHC  33.8RDW  12.1RDWSD  38.0PLT  223MPV  9.8AUTONEU%  39.4AUTOLYM%  46.6AUTOMON%  10.9AUTOEOS%  2.3AUTOBAS%  0.6AUTONEU#  1.9AUTOLYM#  2.3AUTOMON#  0.5AUTOBAS#  0.0AUTOEOS#  0.1NRBC%  0.0NRBC  0.0IG#  0.01IG%  0.2 Sep-05-2022 0524 Chemistry GLUCOSE  108BUN  24CREAT  1.0MDRD GFR  55NA  139K  3.5CL  102CALCIUM  8.0CO2  29.2OSMO  282.1ANION GP  11.3BUN/CRE  24.0LACTATE  0.90MAGNESIU  1.7 Sep-05-2022 0001 Chemistry LACTATE  1.40 Sep-04-2022 2347 Serology COVIDAG  PosCVD1TEST  NCVDEMPHC  NCVDSYMP  NCVDSYMDT  NCVDHOSP  YCVDICU  YCVDRESID  NCVDPREG  N Sep-04-2022 1718 Hematology WBC  7.9RBC  5.59HGB  16.4HCT  47.1MCV  84.3MCH  29.3MCHC  34.8RDW  12.1RDWSD  36.4PLT  286MPV  9.9AUTONEU%  65.7AUTOLYM%  21.2AUTOMON%  12.2AUTOEOS%  0.3AUTOBAS%  0.3AUTONEU#  5.2AUTOLYM#  1.7AUTOMON#  1.0AUTOBAS#  0.0AUTOEOS#  0.0NRBC%  0.0NRBC  0.0IG#  0.02IG%  0.3 Sep-04-2022 1718 Chemistry GLUCOSE  149BUN  28CREAT  1.1MDRD GFR  50NA  136K  3.4CL  100CALCIUM  8.7CO2  24.3OSMO  280.2ANION GP  15.1BUN/CRE  25.5MAGNESIU  2.0 Imaging Results EXAM: CH-ABDOMEN 1 VIEW DR INDICATION: Gastrografin challenge TECHNIQUE: Supine view(s) of the abdomen 12 hours after the administration of oral contrast. COMPARISON: None FINDINGS: Oral contrast within small and large bowel. Mild ileus bowel gas pattern. No radiographic evidence of a small bowel obstruction. Enteric tube tip terminates in the proximal stomach. Cholecystectomy. IMPRESSION: Mild ileus bowel gas pattern. MD  Functional Status* No Functional Impairments  Mental Status* Normal Cognition  Social History tobacco use Never Smoked, Smoking Cessation Not Applicable  marital status Married  Health Concerns COVID-19  Small bowel obstruction  Father Deceased Heart disease @ 71  Mother Deceased Diabetes mellitus @ 71  Tobacco Cessation* Non-Smoker, Non Tobacco product user  Vital Signs Sep-07-2022 0733 O2Sat 95 Sep-07-2022 0642 T 97.6 HR 83 RR 14 BP   120 / 68 O2Sat 97 Sep-07-2022 0400 HR 80 RR     13 BP   103 / 59 Sep-06-2022 2000 T 97.7 PHYSICAL EXAM General: Patient appears fatigued, acutely and chronically ill but in no apparent distress.  Cardiovascular: Heart has regular rate and rhythm. No murmurs, rubs or gallops. Radial pulses 2+ bilaterally. No lower extremity edema.  Respiratory: Lungs diminished to auscultation bilaterally. Respiratory effort is non-labored. SpO2 100% on 2L NC.  Gastrointestinal: Abdomen is soft and nondistended. Tenderness to palpation in the left quadrants with guarding. No rebound. Bowel sounds normoactive.  Psychiatric: Patient is calm and cooperative. Affect is flat. Judgment and insight intact.  Hospital Course is a 67-year-old female who presented to Hospital on 9/4/22 with left-sided abdominal pain and diarrhea for 4 days. She incidentally tested positive for COVID. CT abdomen without contrast showed small bowel obstruction vs. ileus/enteritis and the patient was transferred to NRMC. The patient was admitted for SBO vs. ileus. General surgeon Dr. was consulted. The patient was made NPO and NG tube placed. IV fluids and PRN morphine were started. She desaturated while sleeping the 2nd hospital night and required 2L NC. Gastrografin challenge showed contrast through the small intestine and into the colon, ruling out SBO. C. diff toxin and enteric panel ordered for loose stools were negative. Abdominal pain improved with de-escalation of pain medication to acetaminophen. Last liquid stool was on 9/6/22. Diet was advanced and tolerated without nausea. On nocturnal oximetry started that night the patient saturated less than 89% for 38 minutes, and down to 18% (32% per telemetry) for 2 minutes.  Condition at Discharge Stable  Discharge Disposition Discharge to home  Plan ASSESSMENTS: -Mild ileus/enteritis, possibly secondary to COVID-19, improving -Hypokalemia, like due to diarrhea -Hypomagnesemia, likely due to diarrhea, resolved -Likely obstructive sleep apnea -COVID-19 infection, symptomatic 9/2/22, vaccinated -Chronic constipation, on Linzess (currently held) -Irritable bowel syndrome, per history, likely mixed type -History of diverticulitis -Asthma, unknown severity -History of breast cancer status post bilateral resection -Atopy with prior anaphylaxis, has EpiPen -Pseudoseizures, on zonisamide -Fibromyalgia  Plan: -The patient is hemodynamically stable and has been cleared for discharge home with 2L oxygen. -Continue all IBS and other home medications as previously taken. -Follow-up appointment with her PCP Dr. will be scheduled within 7 days. -Recommend home sleep study for presumed sleep apnea. -Consider follow-up with gastroenterology.  Primary Care Provider  MD