Age: 77.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, COVID-19 pneumonia, Carbon dioxide normal, Cardiac murmur, Cardiac telemetry
Clinical narrative: Hospitalized (11.23.21 - 11/23/21-discharge); COVID-19 positive (11.23.21); Fully vaccinated  -x1 J& J  H&P: CHIEF COMPLAINT: Hypotension/AKI   Subjective      HISTORY OF PRESENT ILLNESS: PT is a 77 year old male with a PMH of colitis on budesonide, rosacea on chronic bactrim, non-ischemic cardiomyopathy, hypertension, and anxiety/depression.    He presented to the ED with worsening symptoms of weakness and fatigue for the past 8-9 days. He notes he can't smell or taste. He does not feel short of breath at rest, but has noted shortness of breath and lightheadedness with activity for the past few days. Patient reports he last ate a bowl of soup about 4 days ago. He has had recent exposure to COVID-19 through his girlfriend, who is admitted w/ COVID. Patient was vaccinated in March with J&J.  In the ER, patient was initially tachycardic and hypotensive and responded well to a total of 1.5 L IV fluids. COVID-19 PCR was positive. Patient maintaining appropriate oxygen saturation on room air. Labs show increased creatinine. Lactate normal. Patient given one dose of IV decadron in the ED. Patient admitted to the general medicine floor for further management.   Review of Systems Constitutional:  Positive for fatigue. Negative for chills and fever.  HENT: Negative for congestion, rhinorrhea, sore throat and hoarse voice.  Eyes: Negative for itching and pain.  Respiratory:  Positive for shortness of breath (with activity). Negative for cough.   Cardiovascular:  Negative for chest pain.  Gastrointestinal:  Positive for diarrhea. Negative for nausea, vomiting, abdominal pain, constipation and blood in stool.  Genitourinary:  Positive for difficulty urinating (urinary retention due to enlarged prostate). Negative for dysuria.  Musculoskeletal:  Negative for joint pain and muscle pain.  Neurological:  Positive for light-headedness. Negative for headaches.  Skin:  Negative for rash and wound.          Objective    OBJECTIVE: BP 100/62  | Pulse 80  | Temp 98.6 °F (37 °C) (Oral)  | Resp 17  | SpO2 95%    Physical Exam Constitutional:      General: He is awake. He is not in acute distress.    Appearance: He is not diaphoretic.     Interventions: Face mask in place.  HENT:     Head: Normocephalic.  Eyes:     General: No scleral icterus.    Conjunctiva/sclera: Conjunctivae normal.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.     Pulses: Normal pulses.  Pulmonary:     Effort: Pulmonary effort is normal.     Breath sounds: No wheezing or rhonchi.     Comments: Coarse breath sounds in lung bases bilaterally Abdominal:     Palpations: Abdomen is soft.     Tenderness: There is no abdominal tenderness. There is no guarding.  Musculoskeletal:     Right lower leg: No edema.     Left lower leg: No edema.  Skin:    General: Skin is warm and dry.  Neurological:     Mental Status: He is alert.  Psychiatric:        Behavior: Behavior is cooperative. ASSESSMENT/PLAN: PT is a 77 year old male with a PMH of HTN, collagenous colitis, non-ischemic cardiomyopathy, anxiety presenting with COVID, hypotension and and an AKI.   Hypotensive History of Hypertension Patient was initially hypotensive. Blood pressure improved following 1.5 L NS in the ED. Hypotension likely due to dehydration. He takes carvedilol and lisinopril at home.  - Blood pressure currently stable.  - Continue fluid resuscitation  - Will hold home blood pressure medications for now.    Acute Kidney Injury Cr on admission was 1.37. Baseline Cr is 0.8-0.9. Likely due to dehydration.  - Monitor kidney function  - Continue fluid resuscitation as above   COVID 19 Pneumonia Symptoms started around 11/14 which include fatigue, weakness, loss of smell and taste, shortness of breath and lightheadedness with activity. He was vaccinated in March with J&J. COVID-19 detected 11/23. Cxr with findings of peripheral airspace disease of mid and lower lung zones, right > left. He received 1.5 L NS and 6 mg IV decadron in the ED. He is saturating appropriately on room air. He does not qualify for remdesivir treatment at this time as he is not hypoxemic. - He is not requiring supplemental oxygen at this time - Severe Respiratory isolation - Dexamethasone 6 mg oral daily for 10 days (started 11/23) - Daily labs CBC with differential, CMP, D-dimer, CRP - Monitor Ins/Out  - Monitor vitals - VTE prophylaxis: Lovenox - Discuss MAB treatment with Covid antibody team   Non-ischemic cardiomyopathy Hyperlipidemia Echo in 2019 showed EF of 53%. Follows with cardiology.   - Continue home aspirin, statin, carvedilol   BPH - Hold home finasteride due to hypotension   Anxiety/Depression Citalopram, quetiapine BID   Collagenous Colitis Patient with a history of chronic diarrhea on budesonide chronically. - Hold home budesonide while patient on decadron   Rosacea - hold bactrim due to AKI   Chronic joint pain - Continue home Norco BID prn   GERD - Protonix     Discharge Provider: MD Primary Care Provider at Discharge: MD Admission Date: 11/23/2021 Discharge Date: 11/25/2021   DISCHARGE DIAGNOSES 1. Acute Kidney Injury (resolved) 2. Hypotension (resolved) 3. COVID-19 4. Hypertension 5. Non-ischemic cardiomyopathy 6. QTc prolongation 7. BPH 8. Anxiety/Depression 9. Colitis 10. Rosacea 11. Chronic pain 12. GERD  PROCEDURES Surgery and Procedures    None   Non-surgical Procedures (From admission, onward)   None  CONSULTS None   DETAILS OF HOSPITAL STAY: HOSPITAL COURSE: PT is a 77 y.o. male who presented with worsening weakness and fatigue. Symptoms started on    PT is a 77 y.o. male who presented with worsening weakness and fatigue with recent exposure to COVID. He was hypotensive on arrival with an AKI and was resuscitated with a total of 2 liters of fluids. His creatinine improved as did his blood pressure. He restarted his home blood pressure medications prior to leaving the hospital. He did test positive for COVID. He was treated with monoclonal antibodies. He did not require supplemental oxygen. He noted mild shortness of breath with activity. He ambulated without oxygen desaturation on day of discharge. Discussed warning signs if symptoms were to worsen. He was discharged home in stable condition.   BP 147/96  | Pulse 88  | Temp 36.8 °C (Oral)  | Resp 16  | Ht 1.702 m  | Wt 74.9 kg  | SpO2 93% Comment: while ambulating | BMI 25.86 kg/m²    Physical Exam Constitutional:      General: He is not in acute distress.    Appearance: Normal appearance. He is not ill-appearing or diaphoretic.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.     Heart sounds: Murmur heard.     Pulmonary:     Effort: Pulmonary effort is normal. No respiratory distress.     Breath sounds: No wheezing or rales.     Comments: Coarse breath sounds in the right lung base Abdominal:     General: There is no distension.     Palpations: Abdomen is soft.     Tenderness: There is no abdominal tenderness. There is no guarding.  Musculoskeletal:     Right lower leg: No edema.     Left lower leg: No edema.  Skin:    General: Skin is warm.  Neurological:     Mental Status: He is alert.  Psychiatric:        Thought Content: Thought content normal.      DISCHARGE RECOMMENDATIONS: - Follow up with PCP. - Obtain EKG outpatient. Patient monitored on telemetry for prolonged qtc. Consider altering qtc prolonging meds if possible. - Patient reports he has taken bactrim for years for rosacea and has not had an issues with rosacea since starting it. Consider monitoring symptoms off bactrim.    DISCHARGE DISPOSITION: Home with services - Physical therapy   CONDITION ON DISCHARGE: improving