CHIEF COMPLAINT: Hypotension
Fevers

PRESENT ILLNESS: 67M s/p Whipple procedure [**2187-7-3**] for ampullary adenoma who was
readmitted post-op intra-abdominal fluid collections [**2187-7-25**],
and again on [**8-16**] for fevers and hypotension and E.Coli
bacteremia, who presents again after transfer from an outside
hospital with fevers and hypotension. Fevers at the OSH were
102.
The patient was discharged on his last admission with PO
antibiotics for 6 weeks (augmentin).  His antibiotic course was
stopped just prior to this admission. Feeding as an outpatient
was continued with a dobhoff tube feeds. The patient was seen in
clinic 5 days prior to admission and reported good progress with
weight gain, and was afebrile since his last admission.

MEDICAL HISTORY: Past Medical History:
ampullary adenoma, likely diagnosis of familial adenomatous
polyposis, ypertension, coronary artery disease, chronic
obstructive pulmonary disease (COPD), arthritis and peripheral
vascular disease

MEDICATION ON ADMISSION: Simvastatin 10', Aspirin 325', Lopressor 50'', Omeprazole 20',
reglan 10"", dilaudid 1-2q4hp, colace 100"

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals- 97.4 97.4 75 100/52 15 97% 2L
Gen- NAD, alert
Head and neck- NC/AT, No JVD
Heart-RRR, SEM at LSB, II/VI
Lungs-clear bilaterally
Abd-soft, osteomy pink, dark green watery stool
Ext-no edema

FAMILY HISTORY: Family History:
His family history is significant for his maternal grandfather
that was affected with colorectal cancer, mother that was
affected with polyposis, brother that was affected with
colorectal cancer, 2 daughters that are affected with polyposis,
a grandson that is affected with polyposis, a brother that was
lost to colorectal cancer and a son that is also affected with
polyposis.

SOCIAL HISTORY: His social history is significant for positive tobacco.  He
smokes half pack per day, no alcohol and no IV drugs use, and no
intranasal cocaine use.
Bacteremia,Hypotension, unspecified,Fever presenting with conditions classified elsewhere,Unspecified essential hypertension,Coronary atherosclerosis of unspecified type of vessel, native or graft,Chronic airway obstruction, not elsewhere classified,Peripheral vascular disease, unspecified,Ileostomy status,Personal history of malignant neoplasm of other gastrointestinal tract,Aortocoronary bypass status,Acquired absence of intestine (large) (small)
Bacteremia,Hypotension NOS,Fever in other diseases,Hypertension NOS,Cor ath unsp vsl ntv/gft,Chr airway obstruct NEC,Periph vascular dis NOS,Ileostomy status,Hx of GI malignancy NEC,Aortocoronary bypass,Acquire absnce intestine
Name:  [**Known lastname 12688**],[**Known firstname **] W              Unit No:   [**Numeric Identifier 12689**]

Admission Date:  [**2187-10-5**]              Discharge Date:   [**2187-10-9**]

Date of Birth:  [**2120-3-30**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 4987**]
Addendum:
The patient was discharged home with Augmentin once/day x 4
weeks.

Discharge Disposition:
Home With Service

Facility:
[**Location (un) **] visiting nurses

                             [**Name6 (MD) 116**] [**Last Name (NamePattern4) 4988**] MD [**MD Number(1) 4989**]

Completed by:[**2187-10-9**]

Admission Date:  [**2187-10-5**]              Discharge Date:   [**2187-10-9**]

Date of Birth:  [**2120-3-30**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 473**]
Chief Complaint:
Hypotension
Fevers

Major Surgical or Invasive Procedure:
None


History of Present Illness:
67M s/p Whipple procedure [**2187-7-3**] for ampullary adenoma who was
readmitted post-op intra-abdominal fluid collections [**2187-7-25**],
and again on [**8-16**] for fevers and hypotension and E.Coli
bacteremia, who presents again after transfer from an outside
hospital with fevers and hypotension. Fevers at the OSH were
102.
The patient was discharged on his last admission with PO
antibiotics for 6 weeks (augmentin).  His antibiotic course was
stopped just prior to this admission. Feeding as an outpatient
was continued with a dobhoff tube feeds. The patient was seen in
clinic 5 days prior to admission and reported good progress with
weight gain, and was afebrile since his last admission.


Past Medical History:
Past Medical History:
ampullary adenoma, likely diagnosis of familial adenomatous
polyposis, ypertension, coronary artery disease, chronic
obstructive pulmonary disease (COPD), arthritis and peripheral
vascular disease

PSH: Whipple procedure, coronary artery bypass graft (CABG) and
carotid endarterectomy, total abdominal colectomy and end
ileostomy, ex-lap's for SBO, EVAR


Social History:
His social history is significant for positive tobacco.  He
smokes half pack per day, no alcohol and no IV drugs use, and no
intranasal cocaine use.


Family History:
Family History:
His family history is significant for his maternal grandfather
that was affected with colorectal cancer, mother that was
affected with polyposis, brother that was affected with
colorectal cancer, 2 daughters that are affected with polyposis,
a grandson that is affected with polyposis, a brother that was
lost to colorectal cancer and a son that is also affected with
polyposis.


Physical Exam:
Vitals- 97.4 97.4 75 100/52 15 97% 2L
Gen- NAD, alert
Head and neck- NC/AT, No JVD
Heart-RRR, SEM at LSB, II/VI
Lungs-clear bilaterally
Abd-soft, osteomy pink, dark green watery stool
Ext-no edema


Pertinent Results:
[**2187-10-6**] 12:12AM BLOOD WBC-7.7 RBC-3.43* Hgb-10.5* Hct-30.4*
MCV-89 MCH-30.6 MCHC-34.5 RDW-16.1* Plt Ct-146*
[**2187-10-7**] 01:12AM BLOOD WBC-5.0 RBC-3.38* Hgb-10.3* Hct-29.2*
MCV-86 MCH-30.5 MCHC-35.3* RDW-16.2* Plt Ct-145*
[**2187-10-7**] 01:12AM BLOOD Glucose-145* UreaN-9 Creat-0.5 Na-137
K-3.8 Cl-110* HCO3-21* AnGap-10
[**2187-10-8**] 06:00AM BLOOD ALT-55* AST-29 LD(LDH)-152 AlkPhos-157*
TotBili-0.4
[**2187-10-6**] 12:12AM BLOOD Lipase-61*
[**2187-10-7**] 01:12AM BLOOD Albumin-2.9* Calcium-7.8* Phos-2.1*
Mg-1.9
[**2187-10-8**] 06:00AM BLOOD Albumin-3.2* Mg-1.7
.
Blood Cultures OSH
E.coli pan-sensitive
.

Brief Hospital Course:
This is a 67 readmitted for hypotension, fevers, in the context
of
prior fluid collection, E.coli sepsis. He was sent from OSH for
1 day of rigors and malaise. Was reportedly hypotensive at OSH
ED, given 4 liters crystalloids w/ transient improvement. BP
90s/50-110/60s on arrival.

CT abdomen @ OSH - per ED report no free air or acute process.
It was reviewed by Gold surgery as having no acute issue/cause
for sepsis.

He was admitted to the SICU. He was Pan culture and started on
Vanc/zosyn.

He responded to IVF and his BP was stable.

Pain - minimal, continue to monitor
CARDIOVASCULAR:  Hypotension - low CVP, most likely vasodilatory
[**1-6**] ?infection, given bolus to maintain SBP and responded well.
GI / ABD:  He was restarted on PO's and tube feeds
HEMATOLOGY:  Stable anemia, follow
ID: OSH blood cultures were pan-sensitive E.coli. He was
discharged home with 2 weeks of Levofloxacin

He was stable at time of discharge and will follow-up with Dr.
[**Last Name (STitle) 468**] in a few weeks.


Medications on Admission:
Simvastatin 10', Aspirin 325', Lopressor 50'', Omeprazole 20',
reglan 10"", dilaudid 1-2q4hp, colace 100"

Discharge Medications:
1. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
3. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
4. Metoclopramide 10 mg Tablet Sig: One (1) Tablet PO QIDACHS (4
times a day (before meals and at bedtime)).
5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
6. Vytorin 10-40 10-40 mg Tablet Sig: One (1) Tablet PO once a
day.
7. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 2 weeks.
Disp:*14 Tablet(s)* Refills:*0*
8. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO twice
a day.


Discharge Disposition:
Home With Service

Facility:
[**Location (un) **] visiting nurses

Discharge Diagnosis:
E.Coli bacteremia
hypotensive
febrile


Discharge Condition:
Good


Discharge Instructions:
Please call your doctor or return to the ER for any of the
following:
* You experience new chest pain, pressure, squeezing or
tightness.
* New or worsening cough or wheezing.
* If you are vomiting and cannot keep in fluids or your
medications.
* You are getting dehydrated due to continued vomiting, diarrhea
or other reasons.
* Signs of dehydration include dry mouth, rapid heartbeat or
feeling dizzy or faint when standing.
* You see blood or dark/black material when you vomit or have a
bowel movement.
* Your skin, or the whites of your eyes become yellow.
* Your pain is not improving within 8-12 hours or not gone
within 24 hours. Call or return immediately if your pain is
getting worse or is changing location or moving to your chest or
back.
* You have shaking chills, or a fever greater than 101.5 (F)
degrees or 38(C) degrees.
* Any serious change in your symptoms, or any new symptoms that
concern you.
.
* Take all new meds as ordered.
* Do not drive or operate heavy machinery while taking any
narcotic pain medication. You may have constipation when taking
narcotic pain medications (oxycodone, percocet, vicodin,
hydrocodone, dilaudid, etc.); you should continue drinking
fluids, you may take stool softeners, and should eat foods that
are high in fiber.
* Continue to increase activity daily
* Continue with tubefeedings as directed

Followup Instructions:
Provider: [**First Name8 (NamePattern2) 251**] [**Name11 (NameIs) **], MD Phone:[**Telephone/Fax (1) 476**] Date/Time:[**2187-11-12**]
11:00



Completed by:[**2187-10-9**]
{'Bacteremia,Hypotension, unspecified,Fever presenting with conditions classified elsewhere,Unspecified essential hypertension,Coronary atherosclerosis of unspecified type of vessel, native or graft,Chronic airway obstruction, not elsewhere classified,Peripheral vascular disease, unspecified,Ileostomy status,Personal history of malignant neoplasm of other gastrointestinal tract,Aortocoronary bypass status,Acquired absence of intestine (large) (small)'}


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: Hypotension
Fevers

PRESENT ILLNESS: 67M s/p Whipple procedure [**2187-7-3**] for ampullary adenoma who was
readmitted post-op intra-abdominal fluid collections [**2187-7-25**],
and again on [**8-16**] for fevers and hypotension and E.Coli
bacteremia, who presents again after transfer from an outside
hospital with fevers and hypotension. Fevers at the OSH were
102.
The patient was discharged on his last admission with PO
antibiotics for 6 weeks (augmentin).  His antibiotic course was
stopped just prior to this admission. Feeding as an outpatient
was continued with a dobhoff tube feeds. The patient was seen in
clinic 5 days prior to admission and reported good progress with
weight gain, and was afebrile since his last admission.

MEDICAL HISTORY: Past Medical History:
ampullary adenoma, likely diagnosis of familial adenomatous
polyposis, ypertension, coronary artery disease, chronic
obstructive pulmonary disease (COPD), arthritis and peripheral
vascular disease

MEDICATION ON ADMISSION: Simvastatin 10', Aspirin 325', Lopressor 50'', Omeprazole 20',
reglan 10"", dilaudid 1-2q4hp, colace 100"

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals- 97.4 97.4 75 100/52 15 97% 2L
Gen- NAD, alert
Head and neck- NC/AT, No JVD
Heart-RRR, SEM at LSB, II/VI
Lungs-clear bilaterally
Abd-soft, osteomy pink, dark green watery stool
Ext-no edema

FAMILY HISTORY: Family History:
His family history is significant for his maternal grandfather
that was affected with colorectal cancer, mother that was
affected with polyposis, brother that was affected with
colorectal cancer, 2 daughters that are affected with polyposis,
a grandson that is affected with polyposis, a brother that was
lost to colorectal cancer and a son that is also affected with
polyposis.

SOCIAL HISTORY: His social history is significant for positive tobacco.  He
smokes half pack per day, no alcohol and no IV drugs use, and no
intranasal cocaine use. 

### Response:
{'Bacteremia,Hypotension, unspecified,Fever presenting with conditions classified elsewhere,Unspecified essential hypertension,Coronary atherosclerosis of unspecified type of vessel, native or graft,Chronic airway obstruction, not elsewhere classified,Peripheral vascular disease, unspecified,Ileostomy status,Personal history of malignant neoplasm of other gastrointestinal tract,Aortocoronary bypass status,Acquired absence of intestine (large) (small)'}
