Age: 40.0
Sex: M
Vaccine: COVID19
Symptoms: pH urine
Clinical narrative: ID: Patient    Date of Admission:  11/2/2023    Date of Discharge:  11/5/2023    Primary Care Physician:  MD   Pending Study Results at Discharge: Cultures   Issues to be Addressed in Follow-up:   1) continued improvement of fever coughing shortness of breath   2) continued optimization of bowel control and other chronic medical issues as outpatient with primary care.     Reason for Hospital Admission (Admitting Diagnosis):  seizure, sepsis, covid    HPI on admission:    Patient is a 43 Y  male with history of quadriplegic CP, minimally verbal, s/p ventriculostomy, dependent on care and wheelchair bound, presenting to ED w/ seizures x2. Pt's mother provides history at bedside, had fever at 0420 lasting for 1-2m, post-ictal and recurrent seizure soon after first episode. In ED found to be COVID+ w/ associated fevers. Mother notes pt did vomit during seizures, concern for possible aspiration. Pt attends adult day care, no known contacts for COVID, developed a mild cough that began 11/1 evening.    Hospital Course:   Patient initially presented to the emergency room with 2 seizures, found to have fevers cough and COVID-positive in the ER.  After discussion with neurology agreed that acute seizures likely due to COVID state, recommended increasing Vimpat to 150 mg twice daily.  Continue all other antiepileptic medications.  Patient was started on remdesivir and dexamethasone for treatment of COVID as well as Unasyn to treat potential aspiration pneumonia.  Patient initially developed severe COVID with acute hypoxemic respiratory failure however with above treatment clinically improved rapidly and was weaned back off of oxygen saturating high 90s off of oxygen.  Given resolution of severe COVID, patient was discharged home with oral antibiotics for 5 additional days and dexamethasone to complete 10 days.  Patient was also given additional bowel control medications, and scopolamine patch to help with secretions.  Patient was seen by dietitian as inpatient who adjusted recommended tube feed orders.  Patient was sent home with new instructions via dietitian.  Patient will follow-up with primary care to ensure continued resolution of COVID symptoms and optimization of other medical issues.   Significant Findings:    Please see above   Hospital Course By Problem: Patient Active Hospital Problem List:  SEVERE SEPSIS W ACUTE ORGAN DYSFUNCTION (11/2/2023)  COVID-19 DISEASE (11/2/2023)   Assessment:  - High 90s on 3 L nasal cannula - BP 162/111  | Pulse 70  | Temp 98.3 °F (36.8 °C)  | Resp 20  | Wt 44.4 kg (97 lb 14.2 oz)  | SpO2 96%  | BMI 20.46 kg/m²   Lab Results Component Value Date   WBC COUNT 5.0 11/05/2023    Lab Results Component Value Date   Hgb 12.2 (L) 11/05/2023    Lab Results Component Value Date   ALT 27 11/05/2023   AST 26 11/05/2023   ALKALINE PHOSPHATASE 65 11/05/2023   Bilirubin, total 0.3 11/05/2023   Lipase 43 01/28/2019    Lab Results Component Value Date   Lactate, ser/plas 1.2 11/02/2023   Lactate, ser/plas 5.0 (AA) 11/02/2023   Lactate, ser/plas 1.4 03/05/2020     Lab Results Component Value Date/Time   CORONAVIRUS COVID DETECTED (A) 11/02/2023 05:25 AM   No results for input(s): "UPH", "USG", "UAGLU", "UKET", "UABILI", "UPROTEIN", "ULEUKESTER", "UNITRITE", "URBC", "UWBC", "UBACT" in the last 72 hours. - CXR: Curvilinear opacities at left lung base, likely atelectasis - CT-head: No acute IC process, unchanged ventriculostomy catheters and miild ventriculomegaly  - CT-AP: No acute intra-abdominal findings, chjronic distal colonic distention, improved from prior exam. - Blood Cultures 11/2/25: No growth 3 days    Plan:  - Change unasyn to Cefpodoxime and doxycycline for 5 additional days - Remdesivir started 11/2/23 - Dexamethasone started 11/3/23, 7 additional doses as outpatient 6 mg via PEG - Continue O2 Support as needed, currently on room air, none needed for home   GENERALIZED CONVULSIVE EPILEPSY (10/14/2014)  EPILEPSY, UNSPECIFIED (11/17/2014)   Assessment:  - Noted, complicated by above, had acute seizure prior to admission - Per discussion with Neurology: recommend increase Vimpat to 150 mg BID    Plan:  - Continue Baclofen 20 mg TID, Carbamezepine 500 mg TID, Lacosamide 150 mg BID, Keppra 750 mg IV TID - Scopolamine for 6 additional days as outpatient   QUADRIPLEGIC CEREBRAL PALSY (10/14/2014)  PRESENCE OF GASTROSTOMY (10/14/2014)  NUTRITION TREATMENT FOR ENTERAL NUTRITION (10/14/2014)  DIPLEGIC CEREBRAL PALSY (11/17/2014)   Assessment: noted, stable - Appreciate Dietitian TF recommendations    Plan:  - Continue MiraLAX, Senokot, bisacodyl for bowel control - Continue baclofen, omeprazole       Complications:  None   Diagnoses:  Active Hospital Problems   Diagnosis   ? (Principal) SEVERE SEPSIS W ACUTE ORGAN DYSFUNCTION   ? COVID-19 DISEASE   ? EPILEPSY, UNSPECIFIED   ? GENERALIZED CONVULSIVE EPILEPSY   ? DIPLEGIC CEREBRAL PALSY   ? QUADRIPLEGIC CEREBRAL PALSY   ? NUTRITION TREATMENT FOR ENTERAL NUTRITION   ? PRESENCE OF GASTROSTOMY     Resolved Hospital Problems No resolved problems to display.     Primary Procedures:  None      Secondary Procedures: None   Consults:  None   Condition on Discharge:  Stable    Code Status at Time of Discharge: Full Code     Discharge Disposition:  Home   Discharge Medications: Medications, instructions, follow up information: See patient instructions (or SNF Admission orders if applicable).           DO   11/5/2023 12:00 PM              Note Details  Author (D.O.) File Time 11/5/2023 12:03 PM Author Type PHYSICIAN (D.O.) Status Signed Last Editor (D.O.) Specialty Hospital Medicine Hospital Acct # Admit Date 11/2/2023  ED to Hosp-Admission (Discharged) on 11/2/2023  ED to Hosp-Admission (Discharged) on 11/2/2023   Detailed Report  Note shared with patient Additional Orders and Documentation   Results Imaging   Meds    Orders    Flowsheets   Encounter Info:  History, Allergies, Education, Care Plan, Detailed Report   Hospital Problem List   QUADRIPLEGIC CEREBRAL PALSY  GENERALIZED CONVULSIVE EPILEPSY  PRESENCE OF GASTROSTOMY  EPILEPSY, UNSPECIFIED  DIPLEGIC CEREBRAL PALSY  SEVERE SEPSIS W ACUTE ORGAN DYSFUNCTION  NUTRITION TREATMENT FOR ENTERAL NUTRITION  COVID-19 DISEASE Care Timeline  11/02   Admitted from ED (Observation) 1659 11/05   Discharged 1430  Discharge   Home or Self Care.   Discharge Instructions (AVS) (Printed 11/5/2023) Medication List at Discharge   albuterol sulfate   2.5 mg /3 mL (0.083 %) Neb soln, Inhale contents of 1 vial via nebulizer every 4 hours as needed for wheezing  90 mcg/actuation Hfaa, 2 Puffs Inhalation EVERY 4 HOURS AS NEEDED, . 100 days supply for asthma is 1 canister  bisacodyl 10 mg Rectal DAILY AS NEEDED  carbamazepine 500 mg G-tube 3 TIMES A DAY, Administer 1 dose (5 tablets) crushed via G-tube at 6 AM and 8PM, and 5 tablets at school at 1 PM crushed via G-tube  cefpodoxime proxetil 100 mg/5 mL Take 10 mL via PEG tube every 12 hours for 5 days. Note: Change in drug strength and direction due to availability  dexamethasone 6 mg PEG DAILY  doxycycline monohydrate 100 mg PEG 2 TIMES A DAY  lacosamide 150 mg PEG 2 TIMES A DAY  lansoprazole 15 mg Oral DAILY  levetiracetam 750 mg G-tube 3 TIMES A DAY, Administer 1 dose (3 tablets) crushed via G-tube at 6 AM and 8PM, and 3 tablets at school at 1 PM crushed via G-tube  polyethylene glycol 3350 17 gram/dose Mix 17 grams in 4 to 8 ounces of water and administer via PEG tube daily  scopolamine 1 mg over 3 days Apply 1 Patch to skin behind ear every 72 hours as needed for Secretions. May cause drowsiness  sennosides 17.2 mg PEG DAILY