CHIEF COMPLAINT: "nausea, vomiting."

PRESENT ILLNESS: 26yoF with h/o leukopenia reportedly in the past when taking
Aleve and Bactrim a few years ago who presents with fever to
104, sore throat, nausea x1d, and body aches. Felt well
yesterday, went to a club in [**Location (un) 7349**], drove back before super bowl.
Woke up febrile today, took Tylenol with some relief, and had
emesis x3 (no blood). Frontal, retro-orbital headache that is
pounding/disabling. Stiff, sore neck. Pt denied diarrhea,
abdominal pain, CP, SOB, cough. Endorses sick contacts with
colds.
.
In the ED, initial vs were: 102.6 p120 98/53 20 98%RA. Pt was
found to be leukopenic with WBC count 1.4, neutrophil 54%.
Peripheral smear sent per Heme Onc recommendation; also pan
culture and start broad spectrum ABx. Pt was given Ceftriaxone
and Flagyl and 3L NS. Admit VS: Temp: 100.6, Pulse: 82, RR: 16,
BP: 114/67, O2Sat: 98, Pain: 2
.
On the floor, complaining of nausea, shortness of breath, and
body aches.  HR was sustained at 140.  Temp near 104.  Arterial
lactate was drawn and was 4.0.  Given high fevers, tachycardia,
and evidence of hypoperfusion, she was transferred to the MICU
for further evaluation.

MEDICAL HISTORY: -Leukopoenia [**2136**]
-Nipple abscess from piercing [**2136**]
-Chlamydia [**2135**]

MEDICATION ON ADMISSION: none

ALLERGIES: Bactrim / Aleve

PHYSICAL EXAM: ADMISSION EXAM
Triage 102.6 p120 98/53 20 98%RA.
Admit VS: Temp: 100.6, Pulse: 82, RR: 16, BP: 114/67, O2Sat: 98,
General: Alert, oriented, no acute distress, uncomfortable
HEENT: Sclera anicteric, MMM, oropharynx clear. tongue piercing.

FAMILY HISTORY: Mother is 37, has a history of hypertension.
Father is 40 and healthy. She has one brother who is healthy.
There is no family history of early coronary disease,
malignancies, or diabetes.

SOCIAL HISTORY: She is a nonsmoker. She drinks alcohol twice a
week on average. She denies illicit drug use. Works two jobs,
BOA and Insurance company. Previously worked as a lab tech at
[**Hospital1 2025**]. She lives alone at school with her mother when she is at
home. She has no pets. She denies exotic travel. She is sexually
active with women. Past partners have been men and women. But no
men since before [**2136**]. She has a remote history of genital warts
and chlamydia, which were treated and have not recurred.
Meningococcal meningitis,Acute systolic heart failure,Sepsis,Takotsubo syndrome,Acidosis,Neutropenia, unspecified,Fever presenting with conditions classified elsewhere,Anemia, unspecified,Disorders of magnesium metabolism,Rash and other nonspecific skin eruption
Meningococcal meningitis,Ac systolic hrt failure,Sepsis,Takotsubo syndrome,Acidosis,Neutropenia NOS,Fever in other diseases,Anemia NOS,Dis magnesium metabolism,Nonspecif skin erupt NEC
Admission Date:  [**2140-12-26**]              Discharge Date:   [**2141-1-2**]

Date of Birth:  [**2114-12-26**]             Sex:   F

Service: MEDICINE

Allergies:
Bactrim / Aleve

Attending:[**First Name3 (LF) 3853**]
Chief Complaint:
"nausea, vomiting."

Major Surgical or Invasive Procedure:
none

History of Present Illness:
26yoF with h/o leukopenia reportedly in the past when taking
Aleve and Bactrim a few years ago who presents with fever to
104, sore throat, nausea x1d, and body aches. Felt well
yesterday, went to a club in [**Location (un) 7349**], drove back before super bowl.
Woke up febrile today, took Tylenol with some relief, and had
emesis x3 (no blood). Frontal, retro-orbital headache that is
pounding/disabling. Stiff, sore neck. Pt denied diarrhea,
abdominal pain, CP, SOB, cough. Endorses sick contacts with
colds.
.
In the ED, initial vs were: 102.6 p120 98/53 20 98%RA. Pt was
found to be leukopenic with WBC count 1.4, neutrophil 54%.
Peripheral smear sent per Heme Onc recommendation; also pan
culture and start broad spectrum ABx. Pt was given Ceftriaxone
and Flagyl and 3L NS. Admit VS: Temp: 100.6, Pulse: 82, RR: 16,
BP: 114/67, O2Sat: 98, Pain: 2
.
On the floor, complaining of nausea, shortness of breath, and
body aches.  HR was sustained at 140.  Temp near 104.  Arterial
lactate was drawn and was 4.0.  Given high fevers, tachycardia,
and evidence of hypoperfusion, she was transferred to the MICU
for further evaluation.


Past Medical History:
-Leukopoenia [**2136**]
-Nipple abscess from piercing [**2136**]
-Chlamydia [**2135**]


Social History:
She is a nonsmoker. She drinks alcohol twice a
week on average. She denies illicit drug use. Works two jobs,
BOA and Insurance company. Previously worked as a lab tech at
[**Hospital1 2025**]. She lives alone at school with her mother when she is at
home. She has no pets. She denies exotic travel. She is sexually
active with women. Past partners have been men and women. But no
men since before [**2136**]. She has a remote history of genital warts
and chlamydia, which were treated and have not recurred.

Family History:
Mother is 37, has a history of hypertension.
Father is 40 and healthy. She has one brother who is healthy.
There is no family history of early coronary disease,
malignancies, or diabetes.

Physical Exam:
ADMISSION EXAM
Triage 102.6 p120 98/53 20 98%RA.
Admit VS: Temp: 100.6, Pulse: 82, RR: 16, BP: 114/67, O2Sat: 98,
General: Alert, oriented, no acute distress, uncomfortable
HEENT: Sclera anicteric, MMM, oropharynx clear. tongue piercing.

Neck: supple, JVP not elevated, no LAD, lymphadenopathy along
left anterior cervical chain. tattoo along left clavicle
Chest: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Tachy and reg rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, tender LUQ, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly, umbilicus
piercing
GU: foley in place, clitoral piercing
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNs2-12 intact, motor function grossly normal
.
DISCHARGE EXAM:
99.6, 100.1, 80-90, 100-126/50-80, 18, 96-100RA
General: Alert, oriented, no acute distress, comfortable
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple,  full ROM
Lungs: CTAB
CV: RRR, normal S1 + S2, no murmurs, rubs, gallops
Abdomen: soft, non-tender, distended, normal bowel sounds no
rebound tenderness or guarding, no organomegaly
GU: exfoliative rash with scale, limited to external vulva and
surrounding skin, minimal erythema and well healed skin below
scale
Ext: warm, well perfused, 2+ pulses, bilateral calf tenderness
to palpation
Skin: Rash improved on ble


Pertinent Results:
ADMISSION LABS
[**2140-12-26**] 03:50PM BLOOD WBC-1.4*# RBC-3.88* Hgb-12.1 Hct-35.4*
MCV-91 MCH-31.2 MCHC-34.2 RDW-12.5 Plt Ct-164
[**2140-12-26**] 03:50PM BLOOD Neuts-54 Bands-4 Lymphs-27 Monos-3 Eos-0
Baso-1 Atyps-0 Metas-7* Myelos-4* NRBC-1*
[**2140-12-27**] 08:01AM BLOOD PT-18.1* PTT-31.5 INR(PT)-1.7*
[**2140-12-27**] 04:19AM BLOOD Ret Aut-1.4
[**2140-12-26**] 03:50PM BLOOD Glucose-114* UreaN-10 Creat-1.1 Na-135
K-3.6 Cl-100 HCO3-22 AnGap-17
[**2140-12-26**] 03:50PM BLOOD ALT-22 AST-25 AlkPhos-54 TotBili-0.8
[**2140-12-26**] 03:50PM BLOOD Lipase-38
[**2140-12-27**] 04:19AM BLOOD Albumin-3.1* Calcium-6.6* Phos-0.8*
Mg-0.8* UricAcd-4.8 Iron-PND
[**2140-12-27**] 04:19AM BLOOD PTH-64
[**2140-12-27**] 04:19AM BLOOD [**Doctor First Name **]-NEGATIVE
[**2140-12-27**] 08:04AM BLOOD PEP-PND IgG-693* IgM-72
[**2140-12-27**] 04:19AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2140-12-27**] 03:21AM BLOOD Type-ART pO2-89 pCO2-24* pH-7.44
calTCO2-17* Base XS--5
[**2140-12-26**] 09:12PM BLOOD Lactate-3.8*
[**2140-12-27**] 04:30AM BLOOD freeCa-0.88*
.
DISCHARGE LABS:
[**2141-1-2**] 07:40AM BLOOD WBC-9.7 RBC-3.59* Hgb-11.2* Hct-33.2*
MCV-93 MCH-31.3 MCHC-33.8 RDW-13.2 Plt Ct-286
[**2140-12-29**] 08:31PM BLOOD Neuts-77* Bands-2 Lymphs-11* Monos-6
Eos-2 Baso-1 Atyps-1* Metas-0 Myelos-0
[**2141-1-2**] 07:40AM BLOOD PT-11.1 INR(PT)-1.0
[**2141-1-2**] 07:40AM BLOOD Glucose-94 UreaN-15 Creat-0.7 Na-134
K-4.1 Cl-101 HCO3-23 AnGap-14
[**2141-1-2**] 07:40AM BLOOD Calcium-8.4 Phos-3.7 Mg-2.1
[**2140-12-29**] 05:54PM BLOOD Lactate-1.6
.
MICRO:
Blood Culture, Routine (Final [**2141-1-1**]):
      Reported to and read back by [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] [**2140-12-29**], 8:33AM.
      NEISSERIA MENINGITIDIS.    BETA LACTAMASE NEGATIVE.
Blood Culture, Routine (Final [**2141-1-1**]):
      NEISSERIA MENINGITIDIS.
         IDENTIFICATION AND SENSITIVITIES PERFORMED ON CULTURE #
340-1950R
         [**2140-12-26**].
Blood Culture, Routine (Final [**2141-1-2**]):    NO GROWTH.
Blood Culture, Routine (Final [**2141-1-3**]):    NO GROWTH.
Blood Culture, Routine (Final [**2141-1-4**]):    NO GROWTH.
.
CXR [**2140-12-26**]
Subtle left base retrocardiac opacity could relate to
atelectasis, although in the appropriate clinical setting an
early consolidation due to infection is not entirely excluded.

CT Neck with contrast [**2140-12-27**]
1. No evidence of retropharyngeal abscess.
2. Prominent lymph nodes in the carotid spaces, but none are
pathologically enlarged.
3. Ectatic right jugular vein is of unclear significance, and
likely a
chronic finding.
4. Small bilateral pleural effusions and right mid lung
opacification are
better evaluated on concurrent chest CT.

CT Abd/Pelvis/Chest [**2140-12-27**]
1. Findings consistent with multifocal pneumonia involving the
right lung
2. Small-to-moderate bilateral pleural effusions.
3. Soft tissue in the anterior mediastinum likely represents
thymic remnant. This could be confirmed with MRI if clinically
warranted.
4. Gallbladder wall edema without evidence for cholecystitis,
this may
represent third spacing. Please correlate with albumin level.

ECHO
The left atrium is moderately dilated. Left ventricular wall
thicknesses and cavity size are normal. There is mild global
left ventricular hypokinesis (LVEF = 45-50 %). Right ventricular
chamber size and free wall motion are normal. The diameters of
aorta at the sinus, ascending and arch levels are normal. The
aortic valve leaflets (3) appear structurally normal with good
leaflet excursion and no aortic stenosis or aortic
regurgitation. No masses or vegetations are seen on the aortic
valve. The mitral valve leaflets are structurally normal. No
mass or vegetation is seen on the mitral valve. Trivial mitral
regurgitation is seen. The estimated pulmonary artery systolic
pressure is normal. There is no pericardial effusion.


Brief Hospital Course:
26 F with hx of leukopoenia presents with leukopoenia,
neutopoenia and fever.
.
# Meningitis/Bacteremia: She wasa starteed on broad spectrum
antibiotics including ceftriaxone on admission. An lumbar
puncture was attempted twice but was unsuccessful. However blood
cultures grew neisseria meningitidis. She had high grade fevers
as well as a petechial rash that both improved throughout her
admission. Surveillance blood cultures drawn on several
following days. She did have diffuse myalgias which improved but
did not resolve by the time of her discharge so she was started
on vicodin on discharge. She completed 8 days of ceftriaxone as
per infectious disease recommendations. Follow up with
infectious disease was set up prior to discharge as well as
instructions to return to the emergency department if she had
new fevers headache or neck stiffness.
.
# Volume overload: During this admission she was given
significant volume of IV fluids and she developed significant
peripheral and pulmonary edema. She underwent an echo cardiogram
which showed global systolic dysfunction. Myocarditis was
considered but she did not have an CK, CKMB, or troponin
elevations. This was felt to be stress-induced cardiomyopathy.
The cardiomyopathy, IV fluids and leaky cappiliaries sepsis was
believed to be the cause of her edema. She was diuresed with IV
lasix and she was euvolemic on discharge.
.
# Chronic Neutropenia - She has a history of neutropenia and
presented with a WBC count of 1.4 with 50% polys. She rapidly
developed a robust WBC elevation in the setting of her
infection. Hematology was consulted though no clear cause of her
neutropenia was found. It is unclear if this low initial WBC
count predisposed her to an infection or is only an incidental
finding. She should follow up with hematology/oncology for
further work up.
.
# Transitional Issues
-Follow up pending viral stool cultures
-Follow up with ID in [**12-24**] weeks and you PCP [**Last Name (NamePattern4) **] [**11-21**] weeks and
consider Dermatology follow up if vulvar/perineal rash is not
resolving


Medications on Admission:
none

Discharge Medications:
1. ibuprofen 200 mg Tablet Sig: 2-4 Tablets PO every eight (8)
hours.
2. Vicodin 5-500 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours
as needed for pain for 1 weeks.
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
presumed n. meningitidis Meningitis
Bacteremia


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Dear Ms. [**Known lastname 8260**],
Thank you for coming to the [**Hospital1 1170**]. You were in the hospital because you had a serious
infection called meningitis and bacteria in your blood. We
treated you with IV antibiotics. We are happy that you are doing
much better. You finished your course of antibiotics and do not
need to continue taking these. You should follow up with the
infectious disease clinic as instructed.
.
You were also noted to have a low white blood cell count. White
blood cells are the cells that fight infections. It is not
likely that this made your infection worse but you should follow
up with the Hematology doctors to make sure you are not at risk
of future infections.
.
Medication Recommendations:
Please START
-Vicodin 1-2 tabs every 4-6 hours as needed for pain
-Ibuprofen 400-800 mg every eight hours as needed for pain

Followup Instructions:
Department: [**Hospital3 249**]
When: FRIDAY [**2141-1-6**] at 1:30 PM
With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2967**], RNC [**Telephone/Fax (1) 250**]
Building: [**Hospital6 29**] None
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: INFECTIOUS DISEASE
When: TUESDAY [**2141-2-14**] at 9:00 AM
With: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 4091**], MD [**Telephone/Fax (1) 457**]
Building: LM [**Hospital Ward Name **] Bldg ([**Last Name (NamePattern1) **]) [**Hospital 1422**]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage

Department: HEMATOLOGY/ONCOLOGY
When: WEDNESDAY [**2141-1-25**] at 2:00 PM
With: [**First Name11 (Name Pattern1) 2295**] [**Last Name (NamePattern4) 11222**], MD [**Telephone/Fax (1) 22**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 24**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
{'Meningococcal meningitis,Acute systolic heart failure,Sepsis,Takotsubo syndrome,Acidosis,Neutropenia, unspecified,Fever presenting with conditions classified elsewhere,Anemia, unspecified,Disorders of magnesium metabolism,Rash and other nonspecific skin eruption'}


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: "nausea, vomiting."

PRESENT ILLNESS: 26yoF with h/o leukopenia reportedly in the past when taking
Aleve and Bactrim a few years ago who presents with fever to
104, sore throat, nausea x1d, and body aches. Felt well
yesterday, went to a club in [**Location (un) 7349**], drove back before super bowl.
Woke up febrile today, took Tylenol with some relief, and had
emesis x3 (no blood). Frontal, retro-orbital headache that is
pounding/disabling. Stiff, sore neck. Pt denied diarrhea,
abdominal pain, CP, SOB, cough. Endorses sick contacts with
colds.
.
In the ED, initial vs were: 102.6 p120 98/53 20 98%RA. Pt was
found to be leukopenic with WBC count 1.4, neutrophil 54%.
Peripheral smear sent per Heme Onc recommendation; also pan
culture and start broad spectrum ABx. Pt was given Ceftriaxone
and Flagyl and 3L NS. Admit VS: Temp: 100.6, Pulse: 82, RR: 16,
BP: 114/67, O2Sat: 98, Pain: 2
.
On the floor, complaining of nausea, shortness of breath, and
body aches.  HR was sustained at 140.  Temp near 104.  Arterial
lactate was drawn and was 4.0.  Given high fevers, tachycardia,
and evidence of hypoperfusion, she was transferred to the MICU
for further evaluation.

MEDICAL HISTORY: -Leukopoenia [**2136**]
-Nipple abscess from piercing [**2136**]
-Chlamydia [**2135**]

MEDICATION ON ADMISSION: none

ALLERGIES: Bactrim / Aleve

PHYSICAL EXAM: ADMISSION EXAM
Triage 102.6 p120 98/53 20 98%RA.
Admit VS: Temp: 100.6, Pulse: 82, RR: 16, BP: 114/67, O2Sat: 98,
General: Alert, oriented, no acute distress, uncomfortable
HEENT: Sclera anicteric, MMM, oropharynx clear. tongue piercing.

FAMILY HISTORY: Mother is 37, has a history of hypertension.
Father is 40 and healthy. She has one brother who is healthy.
There is no family history of early coronary disease,
malignancies, or diabetes.

SOCIAL HISTORY: She is a nonsmoker. She drinks alcohol twice a
week on average. She denies illicit drug use. Works two jobs,
BOA and Insurance company. Previously worked as a lab tech at
[**Hospital1 2025**]. She lives alone at school with her mother when she is at
home. She has no pets. She denies exotic travel. She is sexually
active with women. Past partners have been men and women. But no
men since before [**2136**]. She has a remote history of genital warts
and chlamydia, which were treated and have not recurred. 

### Response:
{'Meningococcal meningitis,Acute systolic heart failure,Sepsis,Takotsubo syndrome,Acidosis,Neutropenia, unspecified,Fever presenting with conditions classified elsewhere,Anemia, unspecified,Disorders of magnesium metabolism,Rash and other nonspecific skin eruption'}
