401K loan default

2024 I had a default on a 401k loan for medical expenses due to a high medical bills over >$30,000. I file single and am wondering if I should pay that $1900 back before the year end or can I claim that I used it for medical bills? The penalty is $640. I had less than $10,000 earned income this year. I am also going to itemize due to the high medical bills. Thank you

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