Discharge Provider: MD Primary Care Provider: DO Admission Date: 9/12/2022 Discharge Date: 9/13/2022  PRESENTING PROBLEM: Encephalopathy [G93.40] Acute respiratory failure with hypoxia [J96.01] Acute hypoxemic respiratory failure [J96.01] Acute non intractable tension-type headache [G44.209] COVID-19 virus infection [U07.1]   HOSPITAL COURSE:   Patient was personally interviewed and examined, and management discussed with MS4. Documentation of findingsgs, impression, and plan, are accurate as docummented   Patient is a 71 year old female with a history of COPD, bipolar disorder, chronic back pain who presented to the ED via EMS with altered mental status. Her partner provided most of the history to the ED provider as patient was confused, but by the time the hospitalist team came to evaluate her her mental status had cleared and she was alert and oriented x4. Stated that she was unable to orient to place or situation and also weak and unable to walk. One prior episode of confusion/altered mental status like this in July for which she was hospitalized and no etiology was determined. Of note partner states that she manages all of the patient's medications except for her Tramadol prescription which she believes she has taken about double the dose she is supposed to for the past one week. She was also found to be covid positive and hypoxic on arrival requiring 4-6 L nasal cannula. CXR showed bibasilar atelectasis with a possibility of pneumonia. She was admitted to the ICU for treatment of hypoxic respiratory failure and further workup of her altered mental status.    She was treated for her respiratory failure and covid with supplemental oxygen and one day of remdesivir and solumedrol. She was also placed on BiPAP briefly in the ED which was found to not be needed due to her reassuring ABG and improving mental status. She had resolution of hypoxia by the following day, no longer needing supplemental oxygen. She also received one day of Rocephin for potential pneumonia but procalcitonin was normal and due to her rapid improvement doubt that there is a superimposed pneumonia. She was anticoagulated with Lovenox for VTE prophylaxis, and D-dimer improved after 1 day so there is no concern for DVT/PE at this time.    For her altered mental status she received a full stroke workup including CT noncontrast head, CTA, CTP, and MRI brain which were all normal. Labs were unremarkable as well with TSH being slightly low ruling out myxedema coma and B12 level wnl. Her mental status continued to be at her baseline with no further episodes of confusion. Discussed with her the possibility of subacute seizures with the confusion representing a post-ictal state with the option of starting her on seizure medication and recommending outpatient follow up with Neurology. Also encouraged a sleep study which patient is already scheduled for and has been trying to get this done. Patient was started on 500 mg Keppra BID and encouraged to follow up with neurology. Also discussed law that she should not drive for 6 months given possibility that this was a seizure. She was also found to have significant WBCs and bacteria on UA and was discharged on keflex to treat UTI as it is unclear whether this was contributing to her weakness and confusion. Patient was discharged in stable condition.