internal/icu Case

71-year-old female is admitted to the step down ICU after initial  presentation to the previous hospital on March 20th complaining of shortness of  breath cough, fever, body aches and decreased appetite.  The patient had  underlying history of diabetes hypertension and hyperlipidemia.  Patient was  found with diffuse pneumonia.  Patient eventually did test positive for  COVID-19.  Patient was placed on a ventilator orally intubated but then improved  and was extubated successfully. However shortly after had further respiratory  failure requiring re-intubation after which she did not wean and required  tracheostomy placement.  The patient also suffered multiple other issues during  hospitalization including acute renal failure with acute tubular necrosis  requiring hemodialysis as well as a DVT in her right lower extremity.  Patient  was placed on heparin, but shortly after developed heparin-induced  thrombocytopenia requiring argatroban therapy.  Patient was afterwards placed on  warfarin.  Patient also developed multidrug resistant organism multifocal  sepsis.  The patient's course overall was generally uneventful  after above admission with the exception of increasing LFTs with absence of  gallbladder on HIDA scan and significant worsening of transaminitis.  She was  sent for an intervention and now is resting comfortably.  Her trach is red  capped.     

Thought to ponder:

(What intervention do you think she had?) 

FSBS 109 mg/dL

Comprehensive Metabolic Panel 

ALT 111 U/L Previously (Before intervention) was as high as 478

AST 83 U/L previously (Before intervention) was as high as 391

Albumin 2.9 g/dl

Alkaline Phosphatase 1144 U/L Previously (Before intervention) was as high as 1673

Bilirubin Total 1.1 mg/dl Previously (Before intervention) was as high as 4.8

Blood Urea Nitrogen 21 mg/dl

Calcium 8.7 mg/dl

Chloride 104 mmol/L

Creatinine 3.10 mg/dl

Enzymatic CO2 28 mmol/L

GFR, African American 19.0 mL/min/1.73 sqm

Glucose 98 mg/dl

Potassium 3.9 mmol/L

Protein, Total 6.8 g/dl

Sodium 139 mmol/L

Blood Count;Complete w/ Auto Diff 

Absolute basophils 0.0 ths/cumm

Absolute eosinophils 0.1 ths/cumm

Absolute lymphocytes 2.1 ths/cumm

Absolute monocytes 0.9 ths/cumm

Absolute neutrophils 5.3 ths/cumm

Basophils 1 %

Eosinophils 1 %

Hematocrit 24.4 %

Hemoglobin 8.3 g/dl

Lymphocytes 25.4 %

MCH 30.2 pg

MCHC 34.0 %

MCV 88.8 cu micron

MPV 9.5 pg

Monocytes 10.3 %

PLT, AUTO 319 ths/cumm

RBC, AUTO 2.7 mil/cumm

RDW 17.2 %

Segmented neutrophils 62.6 %

WBC, AUTO 8.4 ths/cumm

D-Dimer  1662

Create your own list, try to include everything that is pertinent to this case in the ICU 

(Look at History, physical, labs and medications to find all the problems)