CC: worsening SOB and wheezing.
HPI: 71M with severe COPD (FEV1 38%) on 2L home O2, HTN, HLD, GERD, current smoker (1/2 ppd, 50 pk-yr) with 4 days of increased dyspnea, wheezing, and cough with increased green sputum after a cold from his grandson. Using albuterol q2h without relief. Poor appetite, drinking mostly water and tea.
ROS: + SOB, wheeze, cough, sputum, fatigue. Denies fever, CP, leg swelling, hemoptysis.
Vitals: T 37.4, HR 102, RR 24, BP 148/86, SpO2 90% on his home 2L (baseline 91-93% on 2L).
Exam: Mild distress, speaking full sentences. Prolonged expiratory phase, diffuse expiratory wheezes, no crackles. No accessory muscle use. Heart regular, distant. No JVD. No edema. Oral mucosa slightly dry.
Labs: WBC 10.8. Na 129, K 4.2, Cl 92, CO2 30, BUN 22, Cr 1.0, glucose 118. VBG 7.38/52 (baseline pCO2 ~50). Flu/COVID neg.
CXR: hyperinflation, no consolidation, no effusion.
MDM: COPD exacerbation. Duonebs x3, methylprednisolone 125 mg IV, azithromycin. Low sodium noted. Admit.
HPI: As per ED. 71M with severe COPD on 2L home O2 admitted with viral-triggered exacerbation.
PMH: COPD (GOLD 3) on 2L continuous home O2 since 2023, HTN, HLD, GERD.
Meds: tiotropium/olodaterol daily, albuterol PRN, amlodipine 5 mg, pravastatin 40 mg, omeprazole 20 mg. Home O2 2L continuous.
Social: Smokes 1/2 ppd cigarettes, 50 pk-yr; precontemplative. Retired machinist.
Exam: RR 22, SpO2 91% on 2L. Diffuse wheezes, prolonged expiration. Euvolemic to slightly dry.
Assessment/Plan:
1. Acute exacerbation of COPD - O2 requirement unchanged from his home baseline 2L, pCO2 at baseline; no acute respiratory failure. Prednisone 40 mg daily x5d, azithromycin x5d, scheduled duonebs q4h, continue LAMA/LABA.
2. Hyponatremia - Na 129, likely hypovolemic from poor solute intake with free water ("tea and toast"). Urine Na 14, serum osm 270. NS 75 mL/h, encourage solute intake, BMP q12h, avoid overly rapid correction.
3. Dependence on home O2 - continue 2L continuous.
4. HTN - continue amlodipine.
5. HLD - continue pravastatin.
6. GERD - continue PPI.
7. Tobacco dependence, cigarettes - counseled >3 min; nicotine patch 14 mg offered and accepted.
DVT ppx: enoxaparin. Code: Full.
S: Breathing a bit better, still wheezy. Eating more.
O: HR 94, RR 20, SpO2 92% on 2L. Scattered wheezes, improved air movement.
Labs: Na 129 -> 132, K 4.0, glucose 142.
A/P:
1. COPD exacerbation - improving. Continue prednisone, azithro, duonebs; space to q6h.
2. Hyponatremia, hypovolemic - improving with NS; correction 3 mEq in 18h, appropriate. Stop IVF this evening if Na >= 133.
3. Tobacco dependence - nicotine patch.
4. HTN, HLD, GERD - home meds.
S: Near baseline, walked to nursing station on 2L.
O: SpO2 93% on 2L at rest, 90% with ambulation (baseline). Few end-expiratory wheezes.
Labs: Na 136.
A/P:
1. COPD exacerbation - resolving; plan discharge tomorrow to complete prednisone/azithro at home.
2. Hyponatremia - resolved with IVF and diet.
3. Tobacco dependence, HTN, HLD, GERD - as before.
Admit: 09/21/2026 Discharge: 09/25/2026
Discharge diagnoses:
1. Acute exacerbation of COPD, viral-triggered
2. Hyponatremia, hypovolemic, resolved
3. Dependence on supplemental oxygen (2L home O2, at baseline)
4. Hypertension
5. Hyperlipidemia
6. GERD
7. Tobacco dependence, cigarettes
Hospital course: Admitted with 4 days of increased dyspnea, wheezing and productive cough. CXR without pneumonia. O2 requirement remained at home baseline; no acute respiratory failure. Treated with steroids, azithromycin and bronchodilators with steady improvement. Na 129 on admission from poor solute intake, corrected with NS to 136.
Discharge meds: prednisone 40 mg x1 more day, azithromycin x1 more day, tiotropium/olodaterol, albuterol PRN, amlodipine, pravastatin, omeprazole, nicotine patch 14 mg daily. Home O2 2L continuous.
Follow-up: pulmonology 2 weeks; PCP 1 week with BMP; smoking cessation clinic referral placed.