Notes

MDs-EB-2 transformed to AML, A-Fib, Acute respiratory failure sec to heart failure with infection (initially type 1 now type 2)
hypernatremia with metabolic alkalosis (sec to CO2 retention/ Lasix administration)

S/P Covid pneumonia and PCP pneumonia 2020, COPD




83 year old male K/C COPD has history of recurrent transfusion, Bone trephine done in Oct 2021 show MDS-EB-2 with normal cytogenetics. S/P 3 cycles of Azacitidine and venetoclax (last azacitidine was on 10/1/22) now presented with complaints of acute shortness of breath and fever. Initial lab workup showed pancytopenia and Chest Xray showed Pulmonary infiltrates with raised Procal.His covid swab was negative. He was started on antibiotics and supportive transfusion were given and pulmo was taken on board, advised to start on steroids. He remained in special care when he had episode of A-Fib; Cardio was taken on board and was given amiodarone Iv then along with GTN infusion then switched to Oral meds. His shortness of breath exacerbated and was placed on bipap. Echo showed Ef of 22% and was started on ACE inhibitors along with diuretics for acute pulmonary edema. His fungal markers BDG-Gala were negative and his procal showed downward trend. Family was counselled regarding poor prognosis and changed the code status to DNR-Comfort care and was shifted out of special care but stilled remained on Bipap, not tolerating off trail. Palliative team was taken on board and advised for nalbuphine injection but after administering patient developed CO2 retention and became drowsy. N/G could not be performed due to low platelet and was started on Dextrose inj 20ml/h keeping in view his cardiac status and nutritional status. His Chest xray showed deterioration and his oxygen requirement also was increased.