Influenza A with pneumonia

EXAM: XR chest, 2 views. FINDINGS: Patchy bibasilar airspace and interstitial opacities, left greater than right. No effusion or pneumothorax. Cardiomediastinal silhouette within normal limits for technique. IMPRESSION: Bibasilar opacities, which may reflect multifocal pneumonia, viral or bacterial.

CC: fever, cough, body aches. HPI: 63 y/o F with HTN, HLD, hypothyroidism, obesity presents with 3 days fever to 39.4 at home, dry cough now productive, myalgias, headache, SOB with walking to bathroom. Husband had "the flu" last week. Did not receive flu vaccine this season. Vitals: T 39.0, HR 108, RR 22, BP 128/74, SpO2 92% RA -> 95% on 2 L NC. Exam: Ill-appearing, A&Ox3. Coarse crackles bilateral bases. Tachycardic, regular. Abd soft. Labs: Influenza A/B PCR: Influenza A DETECTED, B not detected. SARS-CoV-2 PCR negative. RSV negative. WBC 6.8 (lymphocytes 9%). Na 129, K 3.8, Cr 0.8, BUN 18, glucose 121. Procalcitonin 0.09. Lactate 1.4. CXR: bilateral lower lobe patchy opacities. ED course: oseltamivir 75 mg PO, ceftriaxone 1 g + azithromycin 500 mg IV (empiric CAP coverage), acetaminophen, 1 L NS. Impression: Influenza A; bilateral pneumonia - viral vs superimposed bacterial. Hyponatremia. Admit.

HISTORY AND PHYSICAL HPI: 63F, unvaccinated this season, sick contact at home, 3 days of fever, myalgias, cough, exertional dyspnea. Flu A PCR positive. CXR bibasilar opacities. Na 129. PMH: HTN, HLD, hypothyroidism, obesity (BMI 33.4). Meds: amlodipine 10 mg, rosuvastatin 10 mg, levothyroxine 100 mcg. Exam: T 38.6, HR 102, RR 20, SpO2 95% 2 L. Bibasilar crackles. No edema. Euvolemic to slightly dry. ASSESSMENT/PLAN: 1. Influenza A with bilateral pneumonia - oseltamivir 75 mg BID x 5 days. Continue ceftriaxone/azithro pending procalcitonin trend; low suspicion for bacterial superinfection (PCT 0.09). O2 to keep SpO2 > 92%. Droplet precautions. 2. Hyponatremia - Na 129, likely hypovolemic from poor PO intake/insensible losses. NS 75 mL/h, BMP q12h, avoid overcorrection. 3. HTN - continue amlodipine. 4. HLD - continue rosuvastatin. 5. Hypothyroidism - continue levothyroxine; TSH 2.1 in 07/2026. 6. Obesity, BMI 33.4 - counsel outpatient. DVT ppx enoxaparin. Full code.

Droplet precautions maintained. Pt resting, coughing intermittently, productive of small amt white sputum. SpO2 93-95% on 1 L NC, trialed RA at 01:30 with SpO2 92-93%, left off O2 per order. T 37.6 at midnight, acetaminophen given for myalgias with relief. Taking PO fluids well, ~900 mL this shift. IVF NS @ 75 mL/h infusing. Voiding qs. Ambulated to BR independently, steady. Husband called, updated per pt request.

Sodium trend: 09/20 20:15 129; 09/21 06:00 131; 09/21 18:00 133; 09/22 05:45 135. Serum osmolality (09/20): 268 mOsm/kg. Urine Na (09/20): < 20 mmol/L. Urine osm 540. Procalcitonin: 0.09 (09/20) -> 0.07 (09/22). Blood cultures x2 (09/20): no growth at 48 h. Sputum culture: normal respiratory flora. WBC 6.8 -> 5.9. Cr 0.8 -> 0.7.

S: Fevers breaking, myalgias better. Cough persists. Ambulating with RN. O: Tmax 37.8, HR 88, RR 18, SpO2 94% RA (weaned off O2 overnight). Na 129 -> 133 -> 135. Repeat PCT 0.07. Blood cx NGTD. A/P: 1. Influenza A pneumonia (viral) - PCT low x2, cultures negative; stop ceftriaxone/azithromycin. This is pneumonia due to influenza; no evidence of bacterial pneumonia. Continue oseltamivir, day 3 of 5. 2. Hyponatremia - improved to 135 with IVF; saline lock today. 3. HTN, HLD, hypothyroidism - home meds. 4. Obesity BMI 33.4.

DISCHARGE SUMMARY Admit 09/20/2026 - Discharge 09/23/2026. Home. Principal diagnosis: Influenza A with pneumonia. Secondary diagnoses: Hyponatremia (hypovolemic), resolved. Hypertension. Hyperlipidemia. Hypothyroidism. Obesity, BMI 33.4. Hospital course: Presented with fever, cough, hypoxemia; influenza A PCR positive with bibasilar opacities. Treated with oseltamivir and initially empiric antibiotics, discontinued HD2 given low procalcitonin x2 and negative cultures; pneumonia felt to be due to influenza. Weaned to room air HD2. Hyponatremia corrected with isotonic fluids (129 -> 135). Discharge meds: oseltamivir 75 mg BID to complete 5 days; home amlodipine, rosuvastatin, levothyroxine. Follow-up: PCP 1 week with BMP; flu vaccine when recovered; household members advised re: prophylaxis.