CHIEF COMPLAINT: Fevers, chills and diarrhea

PRESENT ILLNESS: Mr. [**Known lastname 1193**] is a 42 yr old male with no significant PMH who
presented to ED with several days of fevers, chills, diarrhea
and decreased PO intake. In ED found to have RLL infiltrate and
effusion, acute renal failure with Creatinine 2.6 and lactate of
4.4.  Enrolled in Sepsis Protocol for lactate and tachycardia.
Vitals otherwise stable on minimal 02 requirement.

MEDICAL HISTORY: None

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 95.9 123 141/52 29 96% 2L
WDWN, AAO X3
Tachy, RR S1+S2
Decreased BS R lung base
Sodt NT/ND
No C/C/E

FAMILY HISTORY: 

SOCIAL HISTORY: 
Unspecified septicemia,Severe sepsis,Empyema without mention of fistula,Pneumonia, organism unspecified,Acute kidney failure, unspecified,Unspecified pleural effusion,Hyposmolality and/or hyponatremia,Thoracoscopic surgical procedure converted to open procedure,Esophageal reflux,Diarrhea,Rash and other nonspecific skin eruption,Personal history of tobacco use
Septicemia NOS,Severe sepsis,Empyema w/o fistula,Pneumonia, organism NOS,Acute kidney failure NOS,Pleural effusion NOS,Hyposmolality,Thoracoscop conv to open,Esophageal reflux,Diarrhea,Nonspecif skin erupt NEC,History of tobacco use
Admission Date:  [**2161-2-7**]              Discharge Date:   [**2161-2-20**]

Date of Birth:  [**2118-4-15**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2969**]
Chief Complaint:
Fevers, chills and diarrhea


Major Surgical or Invasive Procedure:
Right thoracotomy and decortication


History of Present Illness:
Mr. [**Known lastname 1193**] is a 42 yr old male with no significant PMH who
presented to ED with several days of fevers, chills, diarrhea
and decreased PO intake. In ED found to have RLL infiltrate and
effusion, acute renal failure with Creatinine 2.6 and lactate of
4.4.  Enrolled in Sepsis Protocol for lactate and tachycardia.
Vitals otherwise stable on minimal 02 requirement.

Past Medical History:
None

Physical Exam:
95.9 123 141/52 29 96% 2L
WDWN, AAO X3
Tachy, RR S1+S2
Decreased BS R lung base
Sodt NT/ND
No C/C/E

Pertinent Results:
[**2161-2-7**] 10:10AM BLOOD WBC-13.8* RBC-4.72 Hgb-15.0 Hct-42.4
MCV-90 MCH-31.9 MCHC-35.5* RDW-12.5 Plt Ct-224
[**2161-2-14**] 06:25AM BLOOD WBC-24.2*# RBC-3.84* Hgb-12.2* Hct-36.7*
MCV-96 MCH-31.7 MCHC-33.2 RDW-13.6 Plt Ct-436
[**2161-2-19**] 07:35AM BLOOD WBC-10.4 RBC-3.14* Hgb-10.0* Hct-29.5*
MCV-94 MCH-31.8 MCHC-33.8 RDW-12.9 Plt Ct-847*
[**2161-2-14**] 06:25AM BLOOD PT-13.8* PTT-31.0 INR(PT)-1.2
[**2161-2-7**] 10:10AM BLOOD Glucose-92 UreaN-64* Creat-2.6*# Na-134
K-4.0 Cl-96 HCO3-19* AnGap-23*
[**2161-2-7**] 07:05PM BLOOD Glucose-90 UreaN-40* Creat-1.4* Na-140
K-3.2* Cl-109* HCO3-19* AnGap-15
[**2161-2-10**] 05:50AM BLOOD Glucose-64* UreaN-13 Creat-0.6 Na-136
K-3.6 Cl-102 HCO3-25 AnGap-13
[**2161-2-17**] 07:30AM BLOOD Glucose-103 UreaN-8 Creat-0.7 Na-133
K-5.1 Cl-100 HCO3-27 AnGap-11
[**2161-2-7**] 07:05PM BLOOD Calcium-7.1* Phos-2.6* Mg-1.5*
[**2161-2-9**] 06:00AM BLOOD Calcium-7.8* Phos-2.3* Mg-2.1
[**2161-2-17**] 07:30AM BLOOD Calcium-8.4 Phos-4.1 Mg-1.9
[**2161-2-7**] 10:10AM URINE Blood-NEG Nitrite-NEG Protein-TR
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.5 Leuks-NEG
[**2161-2-7**] 10:10AM URINE RBC-0 WBC-0-2 Bacteri-OCC Yeast-NONE
Epi-0-2
[**2161-2-12**] 06:46PM PLEURAL WBC-1535* RBC-465* Polys-30* Lymphs-13*
Monos-0 Macro-57*
[**2161-2-12**] 06:46PM PLEURAL TotProt-4.2 Glucose-78 LD(LDH)-732
Albumin-2.4

[**2161-2-8**] 8:09 am SPUTUM
GRAM STAIN (Final [**2161-2-8**]):
>25 PMNs and <10 epithelial cells/100X field.
NO MICROORGANISMS SEEN.
RESPIRATORY CULTURE (Final [**2161-2-10**]):
SPARSE GROWTH OROPHARYNGEAL FLORA.
LEGIONELLA CULTURE (Final [**2161-2-18**]):    NO LEGIONELLA ISOLATED

[**2161-2-7**] 12:35 pm BLOOD CULTURE
AEROBIC BOTTLE (Final [**2161-2-13**]):    NO GROWTH.
ANAEROBIC BOTTLE (Final [**2161-2-13**]):    NO GROWTH.

[**2161-2-12**] 6:46 pm PLEURAL FLUID
GRAM STAIN (Final [**2161-2-12**]):
1+    (<1 per 1000X FIELD):   POLYMORPHONUCLEAR LEUKOCYTES.
NO MICROORGANISMS SEEN.
FLUID CULTURE (Final [**2161-2-15**]):    NO GROWTH.
ANAEROBIC CULTURE (Final [**2161-2-18**]):    NO GROWTH.

[**2161-2-16**] 11:30 am TISSUE      RIGHT PLEURAL TISSUE.
GRAM STAIN (Final [**2161-2-16**]):
NO POLYMORPHONUCLEAR LEUKOCYTES SEEN.
NO MICROORGANISMS SEEN.
TISSUE (Final [**2161-2-19**]):    NO GROWTH.
ANAEROBIC CULTURE (Preliminary):    NO GROWTH.
ACID FAST SMEAR (Final [**2161-2-18**]):
NO ACID FAST BACILLI SEEN ON DIRECT SMEAR.
ACID FAST CULTURE (Pending):
FUNGAL CULTURE (Preliminary):    NO FUNGUS ISOLATED.
POTASSIUM HYDROXIDE PREPARATION (Final [**2161-2-16**]):
NO FUNGAL ELEMENTS SEEN.

SPECIMEN SUBMITTED: RT. PLEURAL TISSUE.
Organizing hemorrhage, acute and chronic
inflammation, and  fibrin deposition; no evidence
of malignancy.

CT CHEST W/CONTRAST  [**2161-2-13**] 2:35 PM
IMPRESSION:
1. Findings again consistent with pneumonia, most pronounced in
the right lower and middle lobes with associated small
multiloculated pleural effusions.
2. Left lower lobe dependent atelectasis/consolidation with an
associated small effusion.


Brief Hospital Course:
Mr. [**Known lastname 1193**] is a 42 yr old male without significant PMH
presenting with fever, chills and diarrhea found to have RLL/RML
PNA, ARF.

1. RML/RML PNA and R pleural effusion: Pt was admitted to the
[**Hospital Unit Name 153**] for 1 night, given his elevated lactate level and
tachycardia on admission.  He was started on IVFs and IV
Azithromycin and Ceftriaxone(Day 1--[**2161-2-7**]) with some
improvement in his symptoms.  Of note, legionella and flu
negative.  He was transferred to floor on HD#2 with some
symptomatic relief but persistent fevers.  IV Flagyl added to
the ABX regimen. A thoracentesis on [**2-12**] removed 1 liter or
serous exudative fluid.  There was no pneumothorax after the
procedure.  Pt felt worsening pleuritic chest pain and continued
to have fevers after thoracentesis.  A CT scan showed multiple
small loculated fluid collections in this right lung, with no
evidence of empyema. Pt transferred to the [**Hospital Ward Name **] and taken
to the OR on [**2160-2-16**] for a bronchoscopy and right video-assisted
drainage of empyema with conversion to limited thoracotomy and
right decortication. Pt tolerated the surgery well. CT placed
and set to suction at 20 cm. Pt started on sips POD #0 and
advanced after the next few days, Pt tol reg diet well. Foley
d/c'd, CT placed at water seal on [**2-17**]. PCA d/c'd on [**2-19**] and pt
started on PO Percocet. Pt tolerated pain well. Cultures results
negative, some results still pending. CT d/c'd on [**2-20**]. Pt
continued to improve clinically. Pt d/c'd home after PICC
placement for a continued 2 weeks of IV ceftriaxone in addition
to PO Flagyl. Pt stable at discharge. Pt instructed to follow-up
with Dr. [**Last Name (STitle) **] in 2 weeks.

2. Diarrhea: Pt initially presented with diarrhea that improved
over the first few days of his hospitalization.  The etiology
was likely viral.  C Diff negative.  His electrolytes were
repleted.

3. ARF: Resolved with IVF.

4. Hyponatremia: Resolved.



Discharge Medications:
1. Acetaminophen 500 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed for fever, pain.
2. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO TID (3 times a day).
3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed.
Disp:*30 Tablet(s)* Refills:*1*
4. Ceftriaxone Sodium in D5W 20 mg/mL Piggyback Sig: One (1)
Intravenous  Q24H (every 24 hours) for 2 weeks.
Disp:*14 * Refills:*0*
5. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO three
times a day for 2 weeks.
Disp:*42 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 5065**] Healthcare

Discharge Diagnosis:
Empyema


Discharge Condition:
Stable

Discharge Instructions:
Return for all follow-up appointments
Take all medications as directed
Please call your doctor or return to the hospital if any
increased shortness of breath, fevers greater than 101, chest
pain, redness or swelling around the incision, or nausea and
vomitting

Followup Instructions:
Please call [**Telephone/Fax (1) 170**] to schedule a follow-up appointment
with Dr. [**Last Name (STitle) **] in 2 weeks



Completed by:[**2161-2-20**]
{'Unspecified septicemia,Severe sepsis,Empyema without mention of fistula,Pneumonia, organism unspecified,Acute kidney failure, unspecified,Unspecified pleural effusion,Hyposmolality and/or hyponatremia,Thoracoscopic surgical procedure converted to open procedure,Esophageal reflux,Diarrhea,Rash and other nonspecific skin eruption,Personal history of tobacco use'}


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: Fevers, chills and diarrhea

PRESENT ILLNESS: Mr. [**Known lastname 1193**] is a 42 yr old male with no significant PMH who
presented to ED with several days of fevers, chills, diarrhea
and decreased PO intake. In ED found to have RLL infiltrate and
effusion, acute renal failure with Creatinine 2.6 and lactate of
4.4.  Enrolled in Sepsis Protocol for lactate and tachycardia.
Vitals otherwise stable on minimal 02 requirement.

MEDICAL HISTORY: None

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 95.9 123 141/52 29 96% 2L
WDWN, AAO X3
Tachy, RR S1+S2
Decreased BS R lung base
Sodt NT/ND
No C/C/E

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Unspecified septicemia,Severe sepsis,Empyema without mention of fistula,Pneumonia, organism unspecified,Acute kidney failure, unspecified,Unspecified pleural effusion,Hyposmolality and/or hyponatremia,Thoracoscopic surgical procedure converted to open procedure,Esophageal reflux,Diarrhea,Rash and other nonspecific skin eruption,Personal history of tobacco use'}
