Age: 55.0
Sex: F
Vaccine: COVID19
Symptoms: Liver function test increased, Nausea, Renal failure, Renal function test normal, SARS-CoV-2 test positive
Clinical narrative: J&J Dose 8/5/21 (204A21A) COVID Positive 1/7/22  1/7/21: 55-year-old patient with multiple medical problems.  She has severe cardiomyopathy with ejection fraction of  20 - 25%, coronary artery disease with most recent stents in July 2021, ulcerative colitis which required Remicade infusions in the past, status post subtotal colectomy, hyperthyroidism, COPD chronic anticoagulation therapy and other medical problems.  She was previously seen in emergency department at end of October 2021. Had acute kidney injury with serum creatinine of 6 and was transferred to higher level of care.   She has high-output colostomy and takes Imodium as needed. She presented with nausea, multiple bouts of emesis of 1 day duration.  Poor p.o. intake.  She was reminded of previous episode in October 2021. Continues to have high output from ostomy.  Lab work again showed serum creatinine of 6.18.  Elevated BUN.  She is receiving IV fluids.  As noted above she has significant ischemic cardiomyopathy with EF of 20-25%.   She has seen endocrinologist for hyperthyroidism.  She was advised to increase dose of beta-blockade.  She has an appointment coming up with local endocrinologist on 1/13/2021 for further management of hyperthyroidism.  She is no longer on Entresto.  She tested positive for SARS-CoV-2.  Denied shortness of breath.  Remains on room air.  Had low blood pressures in emergency department which resolved with IV fluids.  1/13/22: 55-year-old female with a past medical history of coronary artery disease, ischemic cardiomyopathy with congestive heart failure, ulcerative colitis s/p subtotal colectomy, hyperthyroidism, COPD and degenerative joint disease presented to the emergency room with  nausea, emesis and high colostomy output and decreased intake. Patient was noted to have creatinine of 6.18 and elevated BUN.  Renal service was consulted and patient was admitted for acute kidney injury.  Patient was also found to have positive COVID-19.  Dr. has seen the patient and patient was started on IV hydration with bicarb.  Patient was later changed to lactated Ringer and was started on oral bicarb.  Patient started having cough and shortness of breath that she had to be put on oxygen.  She was also started on remdesivir and dexamethasone.  Patient apparently had 1 dose of Johnson and Johnson COVID-19 vaccine.  Patient's condition improved.  Patient was started on psyllium which helped with the decreasing the bowel motility and  decrease in colostomy output.  Patient had an increase in metoprolol dose due to tachycardia secondary to hyperthyroidism. Patient's TSH is low and free T4 is high and patient is planned to see an endocrinologist soon.  Patient has completed 4 days of remdesivir.  Her renal failure has resolved.  Patient was started on potassium supplements due to hypokalemia.  At today's labs showed hyperkalemia with potassium of 5.9 but renal function was normal.  Repeat potassium is 5.4.  Patient will not need any supplements of potassium. Her LFTs are mildly elevated but needs to be followed as an outpatient.  She will be discharged on oral redness own and Levaquin.  Patient did not qualify for home O2. Follow up with PCP.