CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 49-year-old
female with no past medical history, who lives in [**Country 3396**],
and who is visiting her nephew in [**Name (NI) 86**], when she developed
three days of crampy abdominal pain, nausea and vomiting
associated with decreased p.o. intake, general malaise, and
overall weakness.  The patient denied any localizing
symptoms.

MEDICAL HISTORY: Urinary tract infection several years
ago requiring hospitalization.

MEDICATION ON ADMISSION: 

ALLERGIES: Patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Patient lives in [**Location 53925**] and works at a
factory that makes sewing threads.  She is fluent in English
and she was visiting her nephew in [**Name (NI) 86**].

SOCIAL HISTORY: Patient denies any use of tobacco, alcohol,
or intravenous drugs.
Septicemia due to escherichia coli [E. coli],Pyelonephritis, unspecified,Anemia, unspecified
E coli septicemia,Pyelonephritis NOS,Anemia NOS
Admission Date:  [**2170-12-31**]     Discharge Date:  [**2171-1-3**]

Date of Birth:   [**2121-12-28**]     Sex:  F

Service:  Medicine

HISTORY OF PRESENT ILLNESS:  The patient is a 49-year-old
female with no past medical history, who lives in [**Country 3396**],
and who is visiting her nephew in [**Name (NI) 86**], when she developed
three days of crampy abdominal pain, nausea and vomiting
associated with decreased p.o. intake, general malaise, and
overall weakness.  The patient denied any localizing
symptoms.

In the Emergency Department, the patient's exam revealed only
right CVA tenderness.  Systolic blood pressure was initially
in the 110s and temperature was 99.1.  However, several hours
later, the patient developed a fever to 101.4 with a heart
rate of 112 and a blood pressure of 78/50 with increasing
confusion.  The patient was started on levofloxacin and
Flagyl in the Emergency Department and given 4 liters of
normal saline.  She remained hypotensive, therefore dopamine
was started.

Subsequently, the patient developed rigors, fever,
tachycardia to the 150s, and a systolic blood pressure in the
140s.  She was then started on ampicillin and gentamicin.
The right upper quadrant ultrasound showed free fluid around
her kidney.

On admission, white blood cell count was 14.5, hematocrit
37.9, platelets 313 with 70% neutrophils and 20 bands.
Chem-7 was normal.  Lactate was 3.4.  Urinalysis showed 21-50
white blood cells with few bacteria.  CT of the abdomen was
consistent with bilateral pyelonephritis.

The sepsis protocol was initiated, and the patient was
transferred to the Medical Intensive Care Unit.  On transfer,
central venous pressure was 6 and SVO2 was 82%.  The patient
was started on Levophed, which was quickly weaned off.  The
patient did well overnight in the Intensive Care Unit.  Blood
pressure stabilized, and the patient was able to be weaned
off all pressor medications.  Mental status resolved quickly.

Cultures came back positive for E. coli and antibiotics were
therefore changed to levofloxacin for more appropriate
coverage.  The patient was started on oral nutrition and her
antibiotics were switched to oral antibiotics on the second
day of admission.  The patient was then transferred to the
Medical [**Hospital1 **] in stable condition.

PAST MEDICAL HISTORY:  Urinary tract infection several years
ago requiring hospitalization.

MEDICATIONS ON TRANSFER TO THE MEDICAL WARDS:
1. Zolpidem 2.5 mg p.o. q.h.s.
2. Acetaminophen with codeine [**2-8**] q.4-6h. prn.
3. Neutra-Phos one packet p.o. x1.
4. Pantoprazole 40 mg p.o. q.d.
5. Heparin 5,000 units subQ q.8h.
6. Promethazine 25 mg p.o. q.6h. prn.
7. Trazodone 25 mg p.o.
8. Acetaminophen/levofloxacin 500 mg p.o. q.d. day #3 on
transfer to the wards.

ALLERGIES:  Patient has no known drug allergies.

FAMILY HISTORY:  Patient lives in [**Location 53925**] and works at a
factory that makes sewing threads.  She is fluent in English
and she was visiting her nephew in [**Name (NI) 86**].

SOCIAL HISTORY:  Patient denies any use of tobacco, alcohol,
or intravenous drugs.

EXAMINATION ON TRANSFER TO THE MEDICAL WARDS:  Temperature
was 99.8, pulse was 78, blood pressure 117/72, oxygen
saturation was 95% on room air.  Fluid balance length of stay
patient was positive 2 liters.  In general, the patient was a
pleasant healthy-appearing female in no acute distress.
HEENT:  Pupils are equal, round, and reactive to light and
accommodation.  Extraocular muscles are intact.  Sclerae were
anicteric.  Mucous membranes were moist.  Neck:  There was no
lymphadenopathy, no jugular venous distention.  Thorax:
Clear to auscultation bilaterally.  Cardiovascular:  Regular
with no murmurs, rubs, or gallops.  Abdomen is soft,
nontender, nondistended with bowel sounds.  Back:  No
costovertebral angle tenderness.  Extremities:  No edema.
Neurologic:  Alert and oriented times three with nonfocal
neurologic examination.

RELEVANT LABORATORIES ON TRANSFER:  White blood cell count
8.7, hematocrit 29.0, platelets 248.  Chem-7 was within
normal limits.  Iron was 69, TIBC 205, ferritin 398.

HOSPITAL COURSE:  The patient was admitted to the Medical
[**Hospital1 **] for further treatment and stabilization.

1. Sepsis:  On transfer to the Medical [**Hospital1 **], all sepsis
physiology had completely resolved.  The patient maintained a
normal blood pressure.  White blood cell count had
normalized.  Patient was afebrile and mental status was
intact.  Patient was hemodynamically stable off all pressors.

2. Bacteremia:  Patient was admitted with E. coli
pyelonephritis, and sepsis.  She will be continued on a total
of two weeks of levofloxacin for E. coli bacteremia.  All
other antibiotics were discontinued.  White blood cell count
did normalize and the patient was afebrile.

3. Anemia:  Unclear etiology.  Hematocrit remains stable.
Most likely anemia is dilutional.  The patient received over
4 liters of fluid.  Patient's iron studies were within normal
limits.  Therefore, recommend further anemia workup as an
outpatient in [**Country 53925**].

4. Nutrition:  Patient's diet was advanced to full diet and
she tolerated this well.

5. Patient was eager to return to [**Country 53925**] as soon as possible
due to her acute illness.  As she was fully medically stable,
she was discharged.  As the patient is not a United States
citizen or [**State 350**] resident, she is not eligible for
any free aid and therefore, would have to pay out of pocket
for all her antibiotic coverage.  Therefore, effort was made
to discharge the patient on the most economical antibiotic
regimen that would also be effective for treatment of her
current illness.

After some discussion, it was decided the patient should be
discharged on ciprofloxacin 500 mg p.o. b.i.d. for 10 days to
complete a 14 day course of antibiotics.  The patient was
given a prescription for ciprofloxacin and for levofloxacin,
and told that she should take only one, but could fill the
one that was cheapest for her.

DISCHARGE CONDITION:  Good.

DISCHARGE STATUS:  Home.

DISCHARGE MEDICATIONS:
1. Ciprofloxacin 500 mg one p.o. b.i.d. for 10 days.
2. Acetaminophen with codeine 300/15 mg one p.o. q.4h. prn.
3. Ambien 2.5 mg one p.o. q.h.s.

FOLLOWUP:  The patient is to followup with her primary care
physician in [**Name9 (PRE) 53925**] and with a urologist in [**Country 53925**] for
further imaging.  Patient was given a copy of her medical
chart to take to [**Country 53925**].



                          [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], M.D. [**MD Number(1) 22711**]

Dictated By:[**Last Name (NamePattern1) 5615**]

MEDQUIST36

D:  [**2171-2-11**]  11:37
T:  [**2171-2-11**]  13:20
JOB#:  [**Job Number 53926**]
{'Septicemia due to escherichia coli [E. coli],Pyelonephritis, unspecified,Anemia, unspecified'}


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: 

PRESENT ILLNESS: The patient is a 49-year-old
female with no past medical history, who lives in [**Country 3396**],
and who is visiting her nephew in [**Name (NI) 86**], when she developed
three days of crampy abdominal pain, nausea and vomiting
associated with decreased p.o. intake, general malaise, and
overall weakness.  The patient denied any localizing
symptoms.

MEDICAL HISTORY: Urinary tract infection several years
ago requiring hospitalization.

MEDICATION ON ADMISSION: 

ALLERGIES: Patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Patient lives in [**Location 53925**] and works at a
factory that makes sewing threads.  She is fluent in English
and she was visiting her nephew in [**Name (NI) 86**].

SOCIAL HISTORY: Patient denies any use of tobacco, alcohol,
or intravenous drugs. 

### Response:
{'Septicemia due to escherichia coli [E. coli],Pyelonephritis, unspecified,Anemia, unspecified'}
