CHIEF COMPLAINT: liver laceration s/p fall
shock liver r/t hypotension
pituitary macroadenoma rxn/XRT ([**4-/2147**]),

PRESENT ILLNESS: 51M s/p pituitary macroadenoma resection [**4-/2147**] c/b intracranial
hemorrhage (details unknown) s/p post-op radiation therapy
(completed 2 weeks ago) presented to [**Hospital 8**] Hospital from
[**Hospital3 **] [**Hospital1 8**] (where he has been since operation)
after [**2147**] (CT head negative for acute injury)
but on [**2147-10-29**], he was found to be unresponsive,
hypotensive(SBP 60s) and hypoxic (O2 sats 70s) w/ Hct 22 in ED.
CT abd w/ PO contrast only (had acute renal failure)
demonstrated liver laceration/hematoma and 3 right-sided rib
fractures.  He was resuscitated w/ crystalloid (3L) and 4 pRBCs
and no pressors were required - has been hemodynamically stable
since.  At baseline,he ambulates, speaks normally but is
oriented to only person and has memory issues.  However, his
mental status had significantly declined and was only responding
to noxious stimuli.  Repeat head CT [**10-29**] did not demonstrate
any new evidence of acute changes. His transminases were
increasing and were >2800 on transfer,TBili 1.2.  He was
transferred to [**Hospital1 18**] for further management.

MEDICAL HISTORY: pituitary macroadenoma s/p resection via craniotomy and
radiation completed 2 weeks prior to admission c/b ICH w/
residual cortical encephalomacia; hypothyroidism; adrenal
insufficiency; diabetes insipidus; psychosis; s/p falls x2

MEDICATION ON ADMISSION: Levothyroxine 125 po qd,
Cabergoline 0.5po qd,
Hydrocortisone 20 po qd,
Desmopressin 0.1 po qd,
pantoprazole 40 po qd,
Loratadine 10 po qd,
Ferrous sulfate 325 po qd,
Lisinopril 5po qd,
Magnesium oxide 400 po bid,
Methylphenidate (dosage uncertain),
Phenytoin 150 q8h,
Potassium Chloride 40mg po qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: O: T: 97.3   HR: 89  BP: 151/95   R: 21   O2Sats: 96% 4L NC
Gen: WD/WN, comfortable, NAD.
HEENT: R eye edema and ecchymosis
Neck: Supple; RIJ CVL C/D/I
Lungs: diminished bilaterally.
Cardiac: RRR
Abd: decreased BS, Soft, +TTP RUQ (patient grimaces), +mild
distension, no fluid wave, no rebound
Extrem: 1+ edema bilaterally
Neuro:
Mental status: lethargic, wakes to noxious stimuli and voices
intermittently, oriented to person only.
Language: says name, mumbles.

FAMILY HISTORY: unable ot obtain

SOCIAL HISTORY: previously worked in construction, lives in [**Location 5110**],MA; married
w/ two children; +smoking hx >35 pack years; no EtOH;occasional
marijuana use in past
Injury to liver without mention of open wound into cavity laceration, unspecified,Acute and subacute necrosis of liver,Hyperosmolality and/or hypernatremia,Glucocorticoid deficiency,Closed fracture of five ribs,Unspecified pleural effusion,Pulmonary collapse,Diabetes insipidus,Mechanical complication due to other implant and internal device, not elsewhere classified,Acute posthemorrhagic anemia,Other specified hypotension,Other conditions of brain,Unspecified acquired hypothyroidism,Unspecified psychosis,History of fall,Personal history of benign neoplasm of the brain,Personal history of irradiation, presenting hazards to health,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Unspecified fall,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Liver lacerat unspcf cls,Acute necrosis of liver,Hyperosmolality,Glucocorticoid deficient,Fracture five ribs-close,Pleural effusion NOS,Pulmonary collapse,Diabetes insipidus,Malfunc oth device/graft,Ac posthemorrhag anemia,Hypotension NEC,Brain conditions NEC,Hypothyroidism NOS,Psychosis NOS,Personal history of fall,Hx benign neoplasm brain,Hx of irradiation,Hx TIA/stroke w/o resid,Fall NOS,Abn react-procedure NEC,Abn react-surg proc NEC
Admission Date:  [**2147-10-30**]              Discharge Date:   [**2147-11-21**]

Date of Birth:  [**2096-7-6**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5569**]
Chief Complaint:
liver laceration s/p fall
shock liver r/t hypotension
pituitary macroadenoma rxn/XRT ([**4-/2147**]),


Major Surgical or Invasive Procedure:
None

History of Present Illness:
51M s/p pituitary macroadenoma resection [**4-/2147**] c/b intracranial
hemorrhage (details unknown) s/p post-op radiation therapy
(completed 2 weeks ago) presented to [**Hospital 8**] Hospital from
[**Hospital3 **] [**Hospital1 8**] (where he has been since operation)
after [**2147**] (CT head negative for acute injury)
but on [**2147-10-29**], he was found to be unresponsive,
hypotensive(SBP 60s) and hypoxic (O2 sats 70s) w/ Hct 22 in ED.
CT abd w/ PO contrast only (had acute renal failure)
demonstrated liver laceration/hematoma and 3 right-sided rib
fractures.  He was resuscitated w/ crystalloid (3L) and 4 pRBCs
and no pressors were required - has been hemodynamically stable
since.  At baseline,he ambulates, speaks normally but is
oriented to only person and has memory issues.  However, his
mental status had significantly declined and was only responding
to noxious stimuli.  Repeat head CT [**10-29**] did not demonstrate
any new evidence of acute changes. His transminases were
increasing and were >2800 on transfer,TBili 1.2.  He was
transferred to [**Hospital1 18**] for further management.


Past Medical History:
pituitary macroadenoma s/p resection via craniotomy and
radiation completed 2 weeks prior to admission c/b ICH w/
residual cortical encephalomacia; hypothyroidism; adrenal
insufficiency; diabetes insipidus; psychosis; s/p falls x2


Social History:
previously worked in construction, lives in [**Location 5110**],MA; married
w/ two children; +smoking hx >35 pack years; no EtOH;occasional
marijuana use in past


Family History:
unable ot obtain

Physical Exam:
O: T: 97.3   HR: 89  BP: 151/95   R: 21   O2Sats: 96% 4L NC
Gen: WD/WN, comfortable, NAD.
HEENT: R eye edema and ecchymosis
Neck: Supple; RIJ CVL C/D/I
Lungs: diminished bilaterally.
Cardiac: RRR
Abd: decreased BS, Soft, +TTP RUQ (patient grimaces), +mild
distension, no fluid wave, no rebound
Extrem: 1+ edema bilaterally
Neuro:
Mental status: lethargic, wakes to noxious stimuli and voices
intermittently, oriented to person only.
Language: says name, mumbles.

Cranial Nerves:
I: Not tested
II: Pupils equally round and reactive to light, 3 to 2mm
bilaterally.
III, IV, VI: Extraocular movements appear intact but minimal
movements bilaterally
V, VII: did not follow command
VIII: Hearing intact to voice.
IX, X: did not follow command
[**Doctor First Name 81**]: did not follow command
XII: did not follow command

Motor: Normal bulk and tone bilaterally. No abnormal movements,
tremors. Weak movement to toes and hand grip bilaterally.

CT/MRI:

Labs:
134  103  28    AGap=9
-------------<115
4.1  26  1.1

Ca: 8.9 Mg: 2.3 P: 2.6

ALT: 3195 AP: 377 Tbili: 1.0 Alb:
AST: 2812 LDH: 2820 Dbili:  TProt:
[**Doctor First Name **]: 46 Lip: 47

9.9 \ 11.0 / 106
    / 30.7 \

PT: 16.0  PTT: 25.8  INR: 1.4


Pertinent Results:
[**2147-11-1**]:MRA BRAIN W/O CONTRAST
1. No evidence of acute ischemia, or acute hemorrhage.
2.Bilateral ACA infarct of uncertain chronicity, likely chronic
with signal abnormality suggesting cortical laminar necrosis and
developing encephalomalacia.
3. Post-surgical changes at the sella turcica, with evidence of
packing material (uncertain on procedure performed), and sella
turcica floor remodeling, presumably related to resected mass.
Significant residual tumor encasing the right cavernous sinus.


[**2147-11-5**]: CT CHEST/[**Last Name (un) **]/PELVIS
1. Evolving large subcapsular hematomas with the more anterior
hematoma
displaying internal liquification and a thick surrounding rim.
The additional irregular surrounding low-density lesions within
the right lobe are most suggestive of underlying evolving
lacerations and intraparenchymal hematomas although some may be
bilomas. If there remains a high clinical concern for
superinfection, these would be amenable to diagnostic needle
aspiration under ultrasound or CT.
2. Irregular thickening and enlargement of the left adrenal
gland is nonspecific with differential including focal adrenal
lesion such as adenoma or adrenal hematoma. Can consider
evaluation with MRI on non emergent basis.
3. Nondisplaced rib fractures involving the right fifth through
ninth ribs.
Interval increase in size to simple right pleural effusion.
4. Extensive atherosclerotic disease involving the aorta with
occlusion of the left common iliac and proximal portions of the
left internal and external iliac vessels. Infrarenal aortic
ectasia measuring just under 3 cm.


[**2147-10-30**] 02:48PM BLOOD Glucose-115* UreaN-28* Creat-1.1 Na-134
K-4.1 Cl-103 HCO3-26 AnGap-9
[**2147-10-31**] 10:03AM BLOOD Glucose-99 UreaN-20 Creat-1.0 Na-153*
K-4.0 Cl-118* HCO3-28 AnGap-11
[**2147-11-2**] 03:07AM BLOOD Glucose-91 UreaN-15 Creat-0.7 Na-142
K-3.1* Cl-107 HCO3-31 AnGap-7*
[**2147-11-3**] 03:00AM BLOOD Glucose-86 UreaN-11 Creat-0.6 Na-143
K-4.3 Cl-108 HCO3-32 AnGap-7*
[**2147-11-4**] 08:05AM BLOOD Glucose-112* UreaN-11 Creat-0.7 Na-140
K-3.9 Cl-102 HCO3-32 AnGap-10
[**2147-11-5**] 12:25PM BLOOD Glucose-127* UreaN-19 Creat-1.1 Na-151*
K-4.2 Cl-111* HCO3-28 AnGap-16
[**2147-11-6**] 01:31PM BLOOD Glucose-137* UreaN-15 Creat-0.8 Na-142
K-4.1 Cl-106 HCO3-27 AnGap-13
[**2147-11-7**] 08:58AM BLOOD Na-146* K-4.3 Cl-111*
[**2147-11-10**] 06:15AM BLOOD Glucose-81 UreaN-15 Creat-0.5 Na-143
K-4.0 Cl-108 HCO3-28 AnGap-11
[**2147-11-13**] 07:40AM BLOOD Glucose-72 UreaN-11 Creat-0.6 Na-131*
K-4.3 Cl-96 HCO3-26 AnGap-13
[**2147-11-15**] 07:40AM BLOOD Glucose-109 UreaN-11 Creat-1 Na-148*
K-5.9 Cl-111 HCO3-24 AnGap-19
[**2147-11-21**] 05:00AM BLOOD Glucose-90 UreaN-15 Creat-0.6 Na-139
K-3.9 Cl-102 HCO3-27 AnGap-14


[**2147-10-30**] 02:48PM BLOOD WBC-9.9 RBC-3.87* Hgb-11.0* Hct-30.7*
MCV-79* MCH-28.3 MCHC-35.7* RDW-18.4* Plt Ct-106*
[**2147-10-31**] 02:47AM BLOOD WBC-8.0 RBC-3.73* Hgb-10.4* Hct-29.5*
MCV-79* MCH-27.9 MCHC-35.3* RDW-18.4* Plt Ct-104*
[**2147-11-1**] 03:01AM BLOOD WBC-6.4 RBC-3.40* Hgb-9.7* Hct-27.7*
MCV-82 MCH-28.5 MCHC-35.0 RDW-18.8* Plt Ct-88*
[**2147-11-2**] 03:07AM BLOOD WBC-6.1 RBC-3.18* Hgb-8.9* Hct-26.0*
MCV-82 MCH-28.0 MCHC-34.3 RDW-18.9* Plt Ct-81*
[**2147-11-5**] 06:55AM BLOOD WBC-9.5 RBC-3.58* Hgb-9.7* Hct-29.2*
MCV-82 MCH-27.2 MCHC-33.4 RDW-18.7* Plt Ct-225
[**2147-11-10**] 03:01PM BLOOD WBC-11.1* RBC-3.33* Hgb-9.3* Hct-28.3*
MCV-85 MCH-28.1 MCHC-32.9 RDW-19.3* Plt Ct-668*
[**2147-11-13**] 07:40AM BLOOD WBC-5.0 RBC-3.57* Hgb-9.8* Hct-29.7*
MCV-83 MCH-27.3 MCHC-32.8 RDW-18.5* Plt Ct-676*
[**2147-11-21**] 07:40AM BLOOD WBC-6.3 RBC-3.46* Hgb-9.6* Hct-28.9*
MCV-84 MCH-27.9 MCHC-33.3 RDW-18.4* Plt Ct-467*


Brief Hospital Course:
He was admitted to the West 1 service under Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] for
management of liver lac, altered mental status. A CVL was
inserted for IV hydration. Serial hematocrits were done and
stabilized. IV hydrocortisone, DDAVP and levoxyl were resumed.
A post pyloric feeding tube was inserted and feedings were
started. He became confused and non-responsive. He was found to
be hypernatremic and alteration of thyroid function. This was
treated with D5W infusion.

Hepatology was consulted. Elevated LFTs were attributed to shock
liver. Hepatitis serologies were sent and were negative.
Dilantin was held. Dilantin level was 24.6.

Neurology was consulted for acute mental status changes noting
up going left today. MRI was done to r/o ischemia noting no
evidence of acute ischemia, or acute hemorrhage. Bilateral ACA
infarct of uncertain chronicity, likely chronic with signal
abnormality suggesting cortical laminar necrosis and developing
encephalomalacia. There was significant residual tumor encasing
the right cavernous sinus. Altered mental status was felt to be
partially due to elevated dilantin level as well as metabolic
derangement due to pan pituitary failure in addition to hypoxic
insult due to hypotension experienced on [**10-29**]. Dilantin dose
was adjusted.

On [**11-1**]: Endocrinology was consulted. TSH was low 0.029 with
low T3 & T4. Levoxyl was given IV then switched to po once diet
was resumed. Hydrocortisone dose was increased. Hyernatremia was
felt to be from not enough free water and not diabetes
insipidus. Free water was given via the tube feeding with
improvement of sodium. Cabergoline was resumed when diet was
resumed. Hydrocortisone doses were decreased.

On [**11-2**]: a CXR was done noting a large right pleural effusion
with adjacent large atelectasis of the right middle and right
lobes with increased left lower lobe opacities consistent with
increasing atelectasis and small pleural effusion.

On [**11-3**]: PO 0.1 mg PO BID DDAVP,and SQH were started.IV free
water replacement was stopped and, free water replacement via
dobhoff was increased to 315 Q6H.
On [**11-4**], patient was discharged to the floor however late that
night the patient devloped fevers and had NA upto 153,so he was
transferred back to the ICU.

[**11-5**]: He was restarted on D5W gtt. CT A/P showed bile lakes
secondary to hepatic arterial infarct/ischemia, but no e/o
abscess. Large right pleural effusion w/ associated collapse of
the RLL.A right side IJ line for access.

[**11-6**]: IV D5W was increased to 150cc/hr. Desmopressin dose was
changed from 0.1mg PO BID to 1 mcg SC BID. PICC line was placed
but it was coiled,  so it was pulled back to midline. The
patient was again febrile to 101.6, repeat cultures.

[**11-7**]: The PICC line got rewired in IR. The patient had an
episode of AFib w/ response of ~130BPM. The rythm converted to
sinus when his CVL was removed, and was given 5mg lopressor. He
passed S&S, started on pureed diet/thin liquids. His IV D5W was
D/ced as his Na levels improved.

[**11-8**]: He got 2U RBCs for Hct of 21.His post transfusion Hct was
27.8. His G-tube flushes were decreased to Q6hr given improving
Na 134.

[**11-9**]: He was transferred to the floor.His foley was d/ced.

[**11-10**]:His free water flush through the tube feeds was increased
to 500cc/q6h from 300 q6h because of increasing sodium levels.
Also because if his low blood dilaintin levels he was given
increased doses of dilantin.

[**11-11**]:His dilantin level continued to stay low despite an
increased dose, so he was given 1200 mg of IV dilantin over an
hour.Free water flush through the tube feeds was decreased to
400cc/q6h.

[**11-12**]:He was started on Phenytoin Infatab and po
demporessin.Free water flush through the tube feeds was
decreased to 350 cc/q6h. He pulled off his dobhoff tube.

[**11-13**]: His blood sodium levels continued to be stable.An IR
guided postpyloric dobhoff was replaced.

[**11-14**]:His diet was advanced to thin liquids.Blood sodium checks
continued.

[**11-15**]:Patients serum sodium was high (148-151).Free water
flushes were increased to 500cc q4h.

[**11-16**]: As the phenytoin levels continued to be low despite
trying various formulations,a/p neuro recs the patient was
started on Levetiracetam with the plan to bridge and later d/c
phenytoin on an outpatient basis.

[**11-17**]:Patients serum sodium continued to stay high. Free water
flushes were increased to 500cc q3h.

[**11-18**]:Desmopressin Acetate was increased to 0.2 mg PO BID due to
high serum sodium levels.

[**11-20**]:Serum sodium was decreasing to around 140.The free water
flushes were decreased to 500 q 6hrs.

[**11-21**]: The serum sodium level continued to stay normal at 141 on
this regimen.

On the day of discharge the patient was tolerating tubefeeds,
tolerating a thin regular diet,having stable sodium levels on
the current tubefeeds regimen,and having improving mentation. He
would need regular daily sodium checks and would be following up
in neurology clinic in 2 weeks for appropriate management of the
antiseizure medication.




Medications on Admission:
Levothyroxine 125 po qd,
Cabergoline 0.5po qd,
Hydrocortisone 20 po qd,
Desmopressin 0.1 po qd,
pantoprazole 40 po qd,
Loratadine 10 po qd,
Ferrous sulfate 325 po qd,
Lisinopril 5po qd,
Magnesium oxide 400 po bid,
Methylphenidate (dosage uncertain),
Phenytoin 150 q8h,
Potassium Chloride 40mg po qd


Discharge Medications:
1. heparin (porcine) 5,000 unit/mL Solution [**Month/Day (2) **]: One (1) inj
Injection TID (3 times a day).
2. hydrocortisone 5 mg Tablet [**Month/Day (2) **]: Three (3) Tablet PO DAILY
(Daily): AM dose.
Disp:*30 Tablet(s)* Refills:*2*
3. hydrocortisone 5 mg Tablet [**Month/Day (2) **]: One (1) Tablet PO QPM (once a
day (in the evening)).
Disp:*20 Tablet(s)* Refills:*2*
4. lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
Disp:*20 Tablet,Rapid Dissolve, DR(s)* Refills:*2*
5. levothyroxine 125 mcg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY
(Daily).
6. acetaminophen 650 mg/20.3 mL Solution [**Last Name (STitle) **]: One (1)  PO Q6H
(every 6 hours) as needed for fevers.
7. cabergoline 0.5 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO 3X/WEEK (3
times a week).
8. miconazole nitrate 2 % Powder [**Last Name (STitle) **]: One (1) Appl Topical [**Hospital1 **]
(2 times a day) as needed for rash.
9. insulin regular human 100 unit/mL Solution [**Hospital1 **]: as per
sliding scale  Injection ASDIR (AS DIRECTED).
10. levetiracetam 500 mg Tablet [**Hospital1 **]: 1.5 Tablets PO BID (2 times
a day).
Disp:*30 Tablet(s)* Refills:*2*
11. desmopressin 0.1 mg Tablet [**Hospital1 **]: Two (2) Tablet PO BID (2
times a day).
Disp:*120 Tablet(s)* Refills:*2*
12. phenytoin 50 mg Tablet, Chewable [**Hospital1 **]: Six (6) Tablet,
Chewable PO three times a day: 300 mg TID. Please follow weekly
level, dose adjustment in hospital.


Discharge Disposition:
Extended Care

Facility:
[**Hospital **] Hospital - [**Hospital1 8**]

Discharge Diagnosis:
liver laceration s/p fall
shock liver r/t hypotension
pituitary macroadenoma rxn/XRT ([**4-/2147**]),


Discharge Condition:
Mental Status: Confused - always.
Level of Consciousness: Alert and interactive.
Activity Status: Out of Bed with assistance to chair or
wheelchair.
Fall Risk


Discharge Instructions:
You will be transferred to [**Hospital3 **] in [**Hospital1 8**]
Please call [**Hospital1 2177**] Endocrine -Dr. [**Last Name (STitle) 63100**]  (on vacation,
back in 2 weeks but will have coverage for emergencies)
[**Last Name (NamePattern1) 63101**].
[**Location (un) 20473**] Family Building- [**Location (un) 551**]
[**Location (un) 86**], [**Numeric Identifier 13108**]
Fax [**Telephone/Fax (1) 63102**]

PCP [**Name9 (PRE) **] Center- [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 951**]
[**Location (un) 63103**], [**Numeric Identifier 25248**]
[**Telephone/Fax (1) 6951**]
fax [**Telephone/Fax (1) 63104**]
***
Patient needs daily sodium level drawn. Please follow closely
and discuss with endocrinologist as indicated

Followup Instructions:
[**Hospital1 2177**] Endocrine -Dr. [**Last Name (STitle) 63100**] [**Last Name (NamePattern1) 63101**].
[**Location (un) 20473**] Family Building- [**Location (un) 551**]
[**Location (un) 86**], [**Numeric Identifier 13108**]
Fax [**Telephone/Fax (1) 63102**]

PCP [**Name9 (PRE) **] Center- [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 951**]
[**Location (un) 63103**], [**Numeric Identifier 25248**]
[**Telephone/Fax (1) 6951**]
fax [**Telephone/Fax (1) 63104**]



Completed by:[**2147-11-21**]
{'Injury to liver without mention of open wound into cavity laceration, unspecified,Acute and subacute necrosis of liver,Hyperosmolality and/or hypernatremia,Glucocorticoid deficiency,Closed fracture of five ribs,Unspecified pleural effusion,Pulmonary collapse,Diabetes insipidus,Mechanical complication due to other implant and internal device, not elsewhere classified,Acute posthemorrhagic anemia,Other specified hypotension,Other conditions of brain,Unspecified acquired hypothyroidism,Unspecified psychosis,History of fall,Personal history of benign neoplasm of the brain,Personal history of irradiation, presenting hazards to health,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Unspecified fall,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: liver laceration s/p fall
shock liver r/t hypotension
pituitary macroadenoma rxn/XRT ([**4-/2147**]),

PRESENT ILLNESS: 51M s/p pituitary macroadenoma resection [**4-/2147**] c/b intracranial
hemorrhage (details unknown) s/p post-op radiation therapy
(completed 2 weeks ago) presented to [**Hospital 8**] Hospital from
[**Hospital3 **] [**Hospital1 8**] (where he has been since operation)
after [**2147**] (CT head negative for acute injury)
but on [**2147-10-29**], he was found to be unresponsive,
hypotensive(SBP 60s) and hypoxic (O2 sats 70s) w/ Hct 22 in ED.
CT abd w/ PO contrast only (had acute renal failure)
demonstrated liver laceration/hematoma and 3 right-sided rib
fractures.  He was resuscitated w/ crystalloid (3L) and 4 pRBCs
and no pressors were required - has been hemodynamically stable
since.  At baseline,he ambulates, speaks normally but is
oriented to only person and has memory issues.  However, his
mental status had significantly declined and was only responding
to noxious stimuli.  Repeat head CT [**10-29**] did not demonstrate
any new evidence of acute changes. His transminases were
increasing and were >2800 on transfer,TBili 1.2.  He was
transferred to [**Hospital1 18**] for further management.

MEDICAL HISTORY: pituitary macroadenoma s/p resection via craniotomy and
radiation completed 2 weeks prior to admission c/b ICH w/
residual cortical encephalomacia; hypothyroidism; adrenal
insufficiency; diabetes insipidus; psychosis; s/p falls x2

MEDICATION ON ADMISSION: Levothyroxine 125 po qd,
Cabergoline 0.5po qd,
Hydrocortisone 20 po qd,
Desmopressin 0.1 po qd,
pantoprazole 40 po qd,
Loratadine 10 po qd,
Ferrous sulfate 325 po qd,
Lisinopril 5po qd,
Magnesium oxide 400 po bid,
Methylphenidate (dosage uncertain),
Phenytoin 150 q8h,
Potassium Chloride 40mg po qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: O: T: 97.3   HR: 89  BP: 151/95   R: 21   O2Sats: 96% 4L NC
Gen: WD/WN, comfortable, NAD.
HEENT: R eye edema and ecchymosis
Neck: Supple; RIJ CVL C/D/I
Lungs: diminished bilaterally.
Cardiac: RRR
Abd: decreased BS, Soft, +TTP RUQ (patient grimaces), +mild
distension, no fluid wave, no rebound
Extrem: 1+ edema bilaterally
Neuro:
Mental status: lethargic, wakes to noxious stimuli and voices
intermittently, oriented to person only.
Language: says name, mumbles.

FAMILY HISTORY: unable ot obtain

SOCIAL HISTORY: previously worked in construction, lives in [**Location 5110**],MA; married
w/ two children; +smoking hx >35 pack years; no EtOH;occasional
marijuana use in past 

### Response:
{'Injury to liver without mention of open wound into cavity laceration, unspecified,Acute and subacute necrosis of liver,Hyperosmolality and/or hypernatremia,Glucocorticoid deficiency,Closed fracture of five ribs,Unspecified pleural effusion,Pulmonary collapse,Diabetes insipidus,Mechanical complication due to other implant and internal device, not elsewhere classified,Acute posthemorrhagic anemia,Other specified hypotension,Other conditions of brain,Unspecified acquired hypothyroidism,Unspecified psychosis,History of fall,Personal history of benign neoplasm of the brain,Personal history of irradiation, presenting hazards to health,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Unspecified fall,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
