Age: 50.0
Sex: M
Vaccine: COVID19
Symptoms: Blood alkaline phosphatase increased, Blood culture negative, Blood lactic acid, Bronchial disorder, C-reactive protein increased
Clinical narrative: The patient is a 52 y.o. male patient with history of IDDM2, alcohol abuse, GERD, hyperlipidemia who presented to the Hospital with abdominal pain, nausea and vomiting.   Acute pancreatitis, alcohol induced Nausea and vomiting  Alcoholic hepatitis Presented with epigastric / RUQ abdominal pain, nausea vomiting,  ongoing alcohol use ALT 153, AST 280, alk phos 155 on admission with mildly elevated lipase to 108 Abdominal US? coarse increased echogenicity of the liver possibly lobulated contour posteriorly, perihepatic free fluid posteriorly CT abdomen?mild peripancreatic fat stranding around the pancreatic head/uncinate process; hepatic steatosis No indication for steroids for alcoholic hepatitis LFTs improving, repeat in one week   Acute respiratory failure with hypoxia Abnormal CXR Fevers New fevers with O2 sats intermittently around 90% with intermittent cough CXR with low lung volumes with central bronchovascular crowding and mild nonspecific streaky bilateral basilar opacity possibly atelectasis/scarring; infiltrate technically not excluded COVID-19 positive on 3/14, tested given new fever Mildly elevated procal with leukocytosis and significantly elevated CRP Blood cultures without growth Urinary antigens negative CTPA without PE, showed streaky left lower lobe airspace opacity Treating with course of antibiotics for potential bacterial pneumonia and treated with steroids while admitted for COVID   COVID-19 virus infection Date of onset of symptoms: unclear Symptoms present on admission: nausea/vomiting, intermittent cough Date of covid positive test: 3/14 Vaccination status: vaccinated without booster Imaging: CXR as above with streaky bibasilar opacities Oxygen requirements on admission: none Current oxygen requirements: none, though O2 sats at 90% intermittently early in oxygen, did not require oxygen Medical therapy: steroids for short course Significantly elevated CRP Acute toxic/metabolic encephalopathy In setting alcohol withdrawal delirium Delirium for a few days initially, then improved back to baseline Completed taper for alcohol withdrawal   Alcohol use disorder, severe dependence Acute intoxication with withdrawal and delirium Currently enrolled in program Increased daily use after death of wife several months ago secondary to cancer Endorses history of withdrawal/tremors, denies seizures/DTs Agitated initially on admission therefore started on precedex with front load CIWA, triggering frequently Changed to fixed dose lorazepam taper with PRNs with precedex with improvement and completed taper with significant improvement Alcohol cessation recommended   Lactic acidosis LA 2.9 on admission in setting of dehydration and intoxication Elevated up to 3.6 with dehydration and poor hepatic clearance with liver disease Blood cultures negative Resolved   IDDM2 with hyperglycemia Hgb A1c of 7.6% Home regimen metformin, Lantus 18 units nightly However has not used insulin in months Hyperglycemic here with steroids Resume home regimen on discharge   Tobacco use Marijuana use 20 cigarettes/day Occasional marijuana, denies other drug use Cessation recommended   HLD Home atorvastatin held during admission, can resume on discharge