Mehtap D. Canastar
New York Medical College Westchester Medical Center
A 64 year old man with BMI of 29, hypertension and acid reflux presented with shortness of breath, fever, cough and altered mental status for one week. He also reported severe epigastric pain radiating to his back the day prior to presentation. He did not smoke or drink alcohol. Outpatient medications were irbesartan-hydrochlorothiazide, amlodipine and famotidine. On presentation, his temperature was 101F and oxygen saturation was 87% on nonrebreather mask. His heart rate and blood pressure were normal. Physical exam was notable for altered sensorium, tachypnea, bilateral crackles at the lung bases, and mildly distended abdomen. The patient was emergently intubated. Abnormal labs on admission include: amylase 698 U/L (Upper limit of normal-ULN=100 U/L), lipase 1277 U/L (ULN=78 U/L), triglycerides 266 mg/dL (ULN=200 mg/dL), and AST 72 U/L (ULN=35 U/L). He was SARs-CoV-2 positive. The lipase normalized two days later. Abdominal imaging could not be performed due to respiratory instability. He remained on mechanical ventilation for 3 weeks and was subsequently discharged to a rehab facility.