CHIEF COMPLAINT: 

PRESENT ILLNESS: This is an 83 year old female
with a history of hypertension, supraventricular tachycardia
and chronic obstructive pulmonary disease who presented to
Dr.[**Name (NI) 4025**] office with cyanosis and dyspnea.  She had
been seen in clinic on [**2106-7-19**] when she was at baseline
with a room air oxygen saturation of 93%.  On [**7-30**], she
was seen by her cardiologist where her Sotalol was increased
to 80 mg t.i.d.  Since that time the patient reported
increased shortness of breath, nonproductive cough but denied
chest pain, fever or chills.  The patient was seen [**7-29**],
in clinic.  She appeared cyanotic with oxygen saturation of
72 to 74% on room air and she was dyspneic.  Her temperature
at that time was 98.8.  She appeared mildly lethargic and
arterial blood gas was done which revealed a pH of 7.23, a
pCO2 of 56 and a pO2 of 37.  Her oxygen saturation increased
to 93% on 3 liters of oxygen.  The patient was referred to
the Medical Floor for admission.  Repeat arterial blood gases
at that time showed pH of 7.23, pCO2 of 76 and pO2 of 40.
The patient appeared increasingly lethargic and was
transferred to the Medicine Intensive Care Unit.

MEDICAL HISTORY: 1.  Chronic obstructive pulmonary disease/asthma
2.  Hypertension
3.  History of supraventricular tachycardia

MEDICATION ON ADMISSION: 1.  Fosamax
2.  Serevent 2 puffs b.i.d.
3.  Atrovent 4 puffs q.i.d.
4.  Beclovent 4 puffs q.i.d.
5.  Albuterol prn
6.  Sotalol 80 mg t.i.d.
7.  Coumadin 2 mg q.h.s.
8.  Vitamin B12
9.  Oxygen 2 liters prn

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Tobacco use-one pack per day times 67 years,
currently 2 cigarettes to ?????? pack per day.  Alcohol use-one
drink per day.  Lives with husband in [**Hospital3 **].
Pneumonia, organism unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Acute respiratory failure,Acute kidney failure, unspecified,Atrial fibrillation,Anemia, unspecified
Pneumonia, organism NOS,Obs chr bronc w(ac) exac,Acute respiratry failure,Acute kidney failure NOS,Atrial fibrillation,Anemia NOS
Admission Date:  [**2106-7-29**]       Discharge Date:


Service:  [**Hospital1 **]

HISTORY OF PRESENT ILLNESS:  This is an 83 year old female
with a history of hypertension, supraventricular tachycardia
and chronic obstructive pulmonary disease who presented to
Dr.[**Name (NI) 4025**] office with cyanosis and dyspnea.  She had
been seen in clinic on [**2106-7-19**] when she was at baseline
with a room air oxygen saturation of 93%.  On [**7-30**], she
was seen by her cardiologist where her Sotalol was increased
to 80 mg t.i.d.  Since that time the patient reported
increased shortness of breath, nonproductive cough but denied
chest pain, fever or chills.  The patient was seen [**7-29**],
in clinic.  She appeared cyanotic with oxygen saturation of
72 to 74% on room air and she was dyspneic.  Her temperature
at that time was 98.8.  She appeared mildly lethargic and
arterial blood gas was done which revealed a pH of 7.23, a
pCO2 of 56 and a pO2 of 37.  Her oxygen saturation increased
to 93% on 3 liters of oxygen.  The patient was referred to
the Medical Floor for admission.  Repeat arterial blood gases
at that time showed pH of 7.23, pCO2 of 76 and pO2 of 40.
The patient appeared increasingly lethargic and was
transferred to the Medicine Intensive Care Unit.

Of note, questioning revealed that she had no previous
history of intubation, and had been prescribed steroids on a
previous admission at [**Hospital1 **] Gluver, however, she did not
take this medication.  The patient uses oxygen at home only 2
liters at night and during naps.

PAST MEDICAL HISTORY:
1.  Chronic obstructive pulmonary disease/asthma
2.  Hypertension
3.  History of supraventricular tachycardia

MEDICATIONS ON ADMISSION:
1.  Fosamax
2.  Serevent 2 puffs b.i.d.
3.  Atrovent 4 puffs q.i.d.
4.  Beclovent 4 puffs q.i.d.
5.  Albuterol prn
6.  Sotalol 80 mg t.i.d.
7.  Coumadin 2 mg q.h.s.
8.  Vitamin B12
9.  Oxygen 2 liters prn

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  Tobacco use-one pack per day times 67 years,
currently 2 cigarettes to ?????? pack per day.  Alcohol use-one
drink per day.  Lives with husband in [**Hospital3 **].

PHYSICAL EXAMINATION:  Examination revealed a pleasant
elderly woman who appeared comfortable on 3 liters of oxygen
by nasal cannula.  Her vital signs revealed a temperature of
98.7, heartrate 77, blood pressure 103/60, and respiratory
rate 24 with an oxygen saturation 93% on 3 liters nasal
cannula.  Her head, eyes, ears, nose and throat revealed
pupils which were equal, round, and reactive to light and
mucous membranes which were moist.  Her neck was supple with
no jugulovenous distension.  Her heart had a regular rate and
rhythm with distant heartsounds.  Her lungs had diffuse
expiratory wheezes bilaterally with rhonchi and dullness at
the right base.  Her abdomen was soft, nontender,
nondistended with good bowel sounds.  Her extremities showed
1+ pedal edema with no clubbing or cyanosis.  Her
neurological examination revealed that she was alert,
oriented, appropriate and showed no focal deficits.

LABORATORY DATA:  White blood cell count was 13.6, hematocrit
46.9, platelets 279.  Electrolytes revealed sodium 140,
potassium 5.5, chloride 99, bicarbonate 26, BUN 13, and
creatinine 0.6, glucose 119, lactate 0.7.  Arterial blood
gases, initial blood gas revealed pH of 7.33, pCO2 56, pO2 of
37, repeat blood gas revealed pH of 7.22, pCO2 of 76 and pO2
of 40.  Chest x-ray revealed hyperinflated lungs, and a right
lower lobe infiltrate.  An electrocardiogram revealed atrial
fibrillation with a rate of 129 with a normal axis and slight
ST depressions in V3 through V5.

HOSPITAL COURSE:
1.  Chronic obstructive pulmonary disease and pneumonia - In
the Medicine Intensive Care Unit the patient was treated with
Atrovent and Albuterol nebulizers and inhalers.  She was
started on Levofloxacin 500 mg q. day for her right lower
lobe pneumonia.  She was given Salmeterol which was later
switched to Prednisone and thereafter tapered.  She was
continued on Flovent inhalers as well as an Atrovent inhaler.
After transfer to the floor the patient's oxygen demand
decreased to 2 to 2.5 liters nasal cannula.  She received
chest physical therapy and was using incentive spirometry.

2.  Supraventricular tachycardia - On hospital day #2 the
patient went into atrial fibrillation with a rate of 110 to
160.  She was given intravenous Lopressor times one and
intravenous Diltiazem times two as well as p.o. Diltiazem and
eventually converted to a sinus rate.  She was continued on
her Sotalol and remained in sinus rhythm.  Her INR was found
to be supertherapeutic while she was initially started on
Flagyl for her pneumonia, which was thought to increase the
Coumadin levels in her blood.  Coumadin was held at this
point until the INR dropped to a therapeutic level at which
point it was restarted at 2 mg q.h.s.  The Flagyl was
discontinued.

DISCHARGE STATUS:  The patient felt by physical therapy to
require rehabilitation services.  Please see physical therapy
for evaluation details.

Further details will be added in an addendum to this
discharge summary.






                            [**First Name11 (Name Pattern1) 1569**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 15074**]

Dictated By:[**Last Name (NamePattern1) 11548**]
MEDQUIST36

D:  [**2106-8-3**]  17:54
T:  [**2106-8-3**]  20:08
JOB#:  [**Job Number 26134**]


Admission Date:  [**2106-7-29**]       Discharge Date:


Service:

HISTORY OF PRESENT ILLNESS:  This is an 83 year old female
with a history of hypertension, supraventricular tachycardia
and chronic obstructive pulmonary disease who presented with
two days of increased shortness of breath, wheezing and
nonproductive cough.  On [**2106-7-19**] the patient was seen by
her pulmonologist where she was found to be at baseline with
room air saturation of 93%.  On [**7-30**], she was seen by her
cardiologist and her Sotalol was increased to 80 mg t.i.d.
Since then the patient reported increased shortness of
breath, nonproductive cough and denied chest pain, fever or
chills.  On the day of admission, the patient was seen in
Pulmonary Clinic where she appeared cyanotic with an oxygen
saturation of 72 to 74% on room air and was dyspneic.  Her
temperature at that time was 98.8 and arterial blood gas at
that time showed a pH of 7.33 with a pCO2 of 56 and a pO2 of
37.  The patient was referred to the Medical Floor for
admission.  Repeat arterial blood gases at that time showed
pH of 7.23, pCO2 of 76 and pO2 of 40.  The patient appeared
increasingly lethargic and was transferred to the Medicine
Intensive Care Unit.

Her review of systems at that time revealed that she had no
previous admission, no history of steroid use, though she had
been prescribed Prednisone in the beginning of [**Month (only) 205**] she did
not take the medicine.  The patient had baseline use of
oxygen at home only at night and during the daytime when she
naps.

PAST MEDICAL HISTORY:
1.  Chronic obstructive pulmonary disease/asthma
2.  Hypertension
3.  History of supraventricular tachycardia

MEDICATIONS ON ADMISSION:
1.  Fosamax
2.  Serevent 2 puffs b.i.d.
3.  Atrovent 4 puffs q.i.d.
4.  Beclovent 4 puffs q.i.d.
5.  Albuterol nebulizer prn
6.  Sotalol 80 mg t.i.d.
7.  Coumadin 2 mg q.h.s.
8.  Vitamin B12
9.  Calcium
10. Oxygen 2 liters prn

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  Tobacco, one pack per day times 67 years.
Still smokes approximately ?????? pack per day.  Alcohol, one
drink per day.  Lives with husband in retirement community.

PHYSICAL EXAMINATION:  On examination the patient was found
to be a pleasant elderly woman who appeared comfortable.  Her
vital signs revealed a temperature of 98.7, heartrate 77,
blood pressure 103/60, respiratory rate 24 and oxygen
saturation 93% on room air.  Her head, eyes, ears, nose and
throat revealed pupils which were equal, round, and reactive
to light and mucous membranes which were moist.  Her neck was
supple with no jugulovenous distension.  Her heart revealed a
regular rate and rhythm with distant heartsounds.  Her lungs
revealed wheezes on expiration diffusely bilaterally with
rhonchi and dullness at the right base.  Her abdomen was
soft, nontender, nondistended with good bowel sounds.  Her
extremities showed 1+ pedal edema with no clubbing or
cyanosis.  Her neurological examination revealed that she was
alert, oriented and appropriate with no focal deficits.

LABORATORY DATA:  Admission laboratory data revealed white
blood count of 13.6, hematocrit 46.9, platelets 279.  Chem-7
revealed sodium 140, potassium 5.5, chloride 99, bicarbonate
26, BUN 13, and creatinine 0.6, glucose 119, calcium 8.0,
magnesium 2.1, phosphate 3.6, lactate 0.7 and arterial blood
gas at 6 PM revealed a pH of 7.22, pCO2 76, pO2 of 40, repeat
blood gas at 8 PM revealed pH of 7.28, pCO2 of 70 and pO2 of
44.  Chest x-ray revealed hyperinflated lungs with a right
lower lobe infiltrate.  An electrocardiogram revealed rate of
129 beats/minute and atrial fibrillation with normal axis
with slight ST depression in leads V3 through V5.

HOSPITAL COURSE:
1.  Chronic obstructive pulmonary disease flare and pneumonia
- The patient was treated with Atrovent and Albuterol
nebulizers and inhalers.  Levofloxacin 500 mg q. day was
given for right lower lobe pneumonia.  The patient was
started on intravenous Solbuterol which was later changed to
oral Prednisone on the first hospital day.  The patient was
continued on Beclovent.





                            [**First Name11 (Name Pattern1) 1569**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 15074**]

Dictated By:[**Last Name (NamePattern1) 11548**]
MEDQUIST36

D:  [**2106-8-3**]  17:32
T:  [**2106-8-3**]  19:52
JOB#:  [**Job Number 3164**]


Admission Date:  [**2106-7-29**]     Discharge Date:


Service:  [**Hospital1 212**]

HISTORY OF PRESENT ILLNESS: This is an eighty-three-year-old
woman with a history of hypertension, supraventricular
tachycardia and chronic obstructive pulmonary disease who was
admitted from her pulmonologist's office because she appeared
cyanotic and had an oxygen saturation of 72% to 74% on room
air and was dyspneic. The patient had been seen by her
pulmonologist previously on [**2106-7-19**], when she was at
baseline with her room air saturation of 93% on room air. On
the third of [**2106-7-18**], she was seen by her cardiologist who
increased her Sotalol dose to 80 mg three times a day. Since
then, the patient reported increased shortness of breath and
a non-productive cough. The patient denied chest pain, fever
or chills. On the day of [**2106-7-29**], the patient's
temperature was 98.8 F and her peak flow was 75 with a
baseline greater then 175. The patient appeared mildly
lethargic. Arterial blood gas revealed a pH of 7.23, PCO2 of
50 and a PO2 of 37. The patient was placed on three liters of
oxygen with an increase in her oxygen saturation to 93%. The
patient was referred to the medical floor for admission. A
repeat arterial blood gas revealed a pH of 7.23, PCO2 of 76
and PO2 of 40. The patient appeared increasingly lethargic
and was transferred to the Medical Intensive Care Unit for
further care. The patient had not previously been intubated
and did not have a history of steroid use. The patient's home
oxygen use was limited to night time and napping use only.

PAST MEDICAL HISTORY: 1) Chronic obstructive pulmonary
disease. Pulmonary function tests on [**2106-7-28**], revealed
an FVC which was 51% of predicted FEV1, 38% of predicted and
a FEV1/FVC ratio 74% of predicted. 2) Hypertension. 3)
History of supraventricular tachycardia.

MEDICATIONS ON ADMISSION: 1) Fosamax. 2) Serevent 2 puffs
twice a day. 3) Atrovent 4 puffs four times a day. 4)
Beclovent 4 puffs four times a day. 5) Albuterol 2 puffs as
needed. 6) Sotalol 80 mg three times a day. 7) Coumadin. 8)
Vitamin B12.

ALLERGIES: None.

SOCIAL HISTORY: Positive tobacco history, one pack per day
times sixty-seven years, still smoking up to one-half pack
per day prior to admission. Also, positive alcohol history
with one drink per day. The patient lives with her husband in
an independent living facility.

PHYSICAL EXAMINATION: In general, this is a pleasant elderly
woman who appears comfortable. The patient's vital signs
revealed a temperature of 98.7 F, pulse 77, blood pressure
103/60, respirations 24, oxygen saturation 93% on three
liters oxygen by nasal cannula. The patient's head, eyes,
ears, nose and throat examination revealed pupils which were
equal, round and reactive to light and mucous membranes were
moist. The patient's neck was supple with no jugular venous
distension. The patient's heart had a regular rate and rhythm
with distant heart sounds. The patient's lungs were wheezy,
diffusely bilaterally on expiration. The patient had rhonchi
and dullness at the right base. The patient's abdomen was
soft, nontender and nondistended with good bowel sounds. The
patient's extremities revealed 1+ pedal edema, no clubbing or
cyanosis. The patient's neurological examination was
appropriate. The patient was alert and oriented and had no
focal deficits.

LABORATORY DATA: Significant laboratory values, white blood
cell count 13.6, hematocrit 46.9, platelet count 279,000.

Sodium 140, potassium 5.5, chloride 99, bicarbonate 26,
blood, urea and nitrogen 13 and creatinine 0.6, glucose 119.

Calcium 8.0, magnesium 2.1, phosphorous 3.6, free calcium
1.18.

Prothrombin time 27.3, international normalized ratio 4.9.

The patient's lactate level was 0.7.

The patient's arterial blood gas had a pH of 7.22, PCO2 of 76
and PO2 of 40.

Chest x-ray, hyperinflated lungs, right lower lobe
infiltrate.

HOSPITAL COURSE: This is an eighty-three-year-old woman with
hypertension, supraventricular tachycardia and chronic
obstructive pulmonary disease who was admitted with right
lower lobe infiltrate, consistent with pneumonia and a
chronic obstructive pulmonary disease exacerbation. The
[**Hospital 228**] hospital course by systems is as follows.

1) Pulmonary: the patient was admitted with chronic
obstructive pulmonary disease flare in the setting of a right
lower lobe pneumonia and a recent increase in her Sotalol
dose to 80 mg three times a day. The patient was treated with
Levofloxacin and Flagyl for a total of nineteen days during
her admission. In the Intensive Care Unit, she was initially
treated with Solu-Medrol which was then switched to
Prednisone, as well as nebulized Albuterol and Atrovent. The
patient was transferred to the floor on [**2106-8-2**].
However, the patient's pulmonary status failed to improve.
The Sotalol was discontinued on the premise that her
continued cyanosis was due to continued bronchospasm,
secondary to the beta effect of the Sotalol, and she was
started on Disopyramide for her supraventricular tachycardia.
The patient was also started on Diamox on the floor, which
resulted in a severe acidemia which resulted in respiratory
failure. On [**2106-8-10**], the patient was found to be
obtunded with an arterial blood gas with a pH of 7.01, PCO2
of 152 and a PO2 of 67. A respiratory code was called and she
was intubated and returned to the Medical Intensive Care
Unit. In the Medical Intensive Care Unit for the second time,
she briefly required pressors, however, was able to be
extubated on [**2106-8-13**]. However, she failed extubation
and early on [**2106-8-14**], required re-intubation. During
her Medical Intensive Care Unit course, she was again treated
with Solu-Medrol and later switched to Prednisone. On [**2106-8-19**], she was able to tolerate extubation. The patient's
continued respiratory distress in the Medical Intensive Care
Unit was felt to be secondary to a combination of her chronic
obstructive pulmonary disease flare and congestive heart
failure in the setting of supraventricular tachycardia.
Post-extubation, she continued to require three to five
liters of nasal cannula to achieve an oxygen saturation of
86% to 92%.

2) Cardiovascular: the patient has a history of
supraventricular tachycardia and had recently increased her
Sotalol dose prior to admission. On admission, her heart rate
remained stable on Sotalol, however, the Sotalol was
discontinued after her first transfer to the medical floor,
as it was felt that the Sotalol was contributing to her
respiratory failure. Shortly, the patient was switched to
Disopyramide, however, she reverted to atrial
fibrillation/atrial flutter. Diltiazem was added with good
control. During her second unit stay, she was restarted on
Sotalol, however, she re-entered atrial fibrillation/atrial
flutter and was subsequently changed to Amiodarone and
Diltiazem in various combinations and various routes of
administration. The patient failed to convert back to normal
sinus rhythm and continued to have variable rate control.
After transfer to the floor on [**2106-8-23**], she continued
to be in atrial flutter with a rate which ranged from the
70's to 150's. DC cardioversion was planned for [**2106-8-27**].

3) Heme: the patient was anticoagulated on admission for her
history of atrial fibrillation. On [**2106-8-14**], she was
found to have a sudden hematocrit drop from 34 to 25, with
guaiac positive stools. The patient received five units of
packed red blood cells in the Intensive Care Unit and
subsequently her hematocrit has been stable with guaiac
negative stools.

This summarizes the [**Hospital 228**] hospital course from [**2106-7-29**], to [**2106-8-26**]. The remainder of her admission will
be summarized in an addendum to this discharge summary.




                          [**First Name11 (Name Pattern1) 1569**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 15074**]

Dictated By:[**Last Name (NamePattern1) 11548**]

MEDQUIST36

D:  [**2106-8-26**]  17:29
T:  [**2106-9-2**]  08:27
JOB#:  [**Job Number 26135**]


Name:  [**Known lastname 4496**], [**Known firstname 4497**]                       Unit No:  [**Numeric Identifier 4498**]

Admission Date:  [**2106-8-26**]     Discharge Date:  [**2106-8-30**]

Date of Birth:   [**2023-1-30**]     Sex:  F

Service:  Medicine

This is an addendum to the discharge summary dated [**2106-8-26**].  This summary covers the [**Hospital 1325**] hospital course from
[**2106-8-26**] to discharge on [**2106-8-30**].

1. Cardiovascular:  The patient remained in atrial flutter
with variable block.  She was started on amiodarone and
diltiazem.  On [**8-27**], the patient underwent DC
cardioversion and her amiodarone was subsequently changed to
a once daily dose.  Following cardioversion, she remained in
normal sinus rhythm, however, her blood pressure fell and
therefore her diltiazem dosing was decreased.  She remained
on Coumadin.

2. Pulmonary:  The patient was continued on her medications
for congestive obstructive pulmonary disease.  These included
multiple-dose inhalers and steroid taper.  Her oxygenation
improved following her cardioversion.

3. Fluids, electrolytes, and nutrition:  The patient was
diuresed gently for her fluid overload and pleural effusions
secondary to her diastolic dysfunction.  Her effusions were
clinically improved at the time of discharge.

4. GI:  The patient was constipated and required aggressive
bowel regimen to improve this.

CONDITION ON DISCHARGE:  The patient was discharged to
rehabilitation hospital secondary to her deconditioning.  She
was in fair condition at discharge.  She will be followed up
with Dr. [**Last Name (STitle) 1614**] and Dr. [**Last Name (STitle) **] of Cardiology.

DISCHARGE DIAGNOSES:
1. Congestive obstructive pulmonary disease.
2. Atrial flutter.
3. Hypoxic and hypercarbic respiratory failure.
4. Pleural effusion.
5. Status post direct-current cardioversion.

DISCHARGE MEDICATIONS:
1. Tums one po tid.
2. Serevent multiple-dosed inhaler two puffs inhaled [**Hospital1 **].
3. Amiodarone 800 mg po q day changed to 600 mg po q day on
[**8-31**].
4. Coumadin 3 mg po q hs.
5. Beclovent MDI two puffs qid.
6. Atrovent MDI two puffs qid.
7. Lactulose 30 cc po bid prn.
8. Nicotine patch 7 mg topical q day.
9. Albuterol MDI two puffs q4-6 hours prn.
10. Lasix 20 mg po q6 hours.
11. Colace 100 mg po bid.
12. Vitamin D 400 mg po q day.
13. Folate 1 mg po q day.
14. Protonix 40 mg po q day.
15. Prednisone taper to end [**2106-9-2**].
16. Diltiazem CD 120 mg po q day.






                          [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 3570**]

Dictated By:[**Last Name (NamePattern1) 4499**]

MEDQUIST36

D:  [**2107-10-13**]  22:19
T:  [**2107-10-17**]  08:02
JOB#:  [**Job Number **]
{'Pneumonia, organism unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Acute respiratory failure,Acute kidney failure, unspecified,Atrial fibrillation,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: This is an 83 year old female
with a history of hypertension, supraventricular tachycardia
and chronic obstructive pulmonary disease who presented to
Dr.[**Name (NI) 4025**] office with cyanosis and dyspnea.  She had
been seen in clinic on [**2106-7-19**] when she was at baseline
with a room air oxygen saturation of 93%.  On [**7-30**], she
was seen by her cardiologist where her Sotalol was increased
to 80 mg t.i.d.  Since that time the patient reported
increased shortness of breath, nonproductive cough but denied
chest pain, fever or chills.  The patient was seen [**7-29**],
in clinic.  She appeared cyanotic with oxygen saturation of
72 to 74% on room air and she was dyspneic.  Her temperature
at that time was 98.8.  She appeared mildly lethargic and
arterial blood gas was done which revealed a pH of 7.23, a
pCO2 of 56 and a pO2 of 37.  Her oxygen saturation increased
to 93% on 3 liters of oxygen.  The patient was referred to
the Medical Floor for admission.  Repeat arterial blood gases
at that time showed pH of 7.23, pCO2 of 76 and pO2 of 40.
The patient appeared increasingly lethargic and was
transferred to the Medicine Intensive Care Unit.

MEDICAL HISTORY: 1.  Chronic obstructive pulmonary disease/asthma
2.  Hypertension
3.  History of supraventricular tachycardia

MEDICATION ON ADMISSION: 1.  Fosamax
2.  Serevent 2 puffs b.i.d.
3.  Atrovent 4 puffs q.i.d.
4.  Beclovent 4 puffs q.i.d.
5.  Albuterol prn
6.  Sotalol 80 mg t.i.d.
7.  Coumadin 2 mg q.h.s.
8.  Vitamin B12
9.  Oxygen 2 liters prn

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Tobacco use-one pack per day times 67 years,
currently 2 cigarettes to ?????? pack per day.  Alcohol use-one
drink per day.  Lives with husband in [**Hospital3 **]. 

### Response:
{'Pneumonia, organism unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Acute respiratory failure,Acute kidney failure, unspecified,Atrial fibrillation,Anemia, unspecified'}
