CHIEF COMPLAINT: fever

PRESENT ILLNESS: 46 year-old gentleman with history of pancreas divisum and
recurrent pancreatitis presents for his Whipple operation today.

MEDICAL HISTORY: PMHx: Recurrent pancreatitis with known divisum s/p EUS with
non-diagnostic FNA by Dr. [**Last Name (STitle) **] of pancreatic head "fullness",
peptic ulcer disease, PTSD from war, Fe-def anemia, chronic back
pain
.
PSHx: Cervical fusion 5yrs ago, left inguinal hernia treated
remotely, EUS with biopsy

MEDICATION ON ADMISSION: Iron 325 mg qd, Nexium 40 mg qd, Zoloft 100 mg [**Hospital1 **],
Vit C 500 mg qday

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: Tm 101.4, Tc 100.8, 82, 132/74, RR 18, 100% RA
GEN: NAD, A&O x 3
HEENT: scalp wounds healing - no active drainage
LUNGS: Clear B/L
CV: RRR, nl S1 and S2
ABD: Soft, NT, ND
EXT: L arm with PICC - slight erythema at PICC insertion site;
no clubbing/cyanosis/edema of LE B/L

FAMILY HISTORY: Father with stomach, lung, throat CA. Mother died of MI and had
DM2.

SOCIAL HISTORY: Married, lives with wife. [**Name (NI) 1403**] as supervisor for Army Corps of
Engineers. Non-smoker, recovering alcoholic with no current
alcohol x 7months, denies illicit substance use.
Chronic pancreatitis,Septicemia due to serratia,Severe sepsis,Septic shock,Other and unspecified infection due to central venous catheter,Surgical or other procedure not carried out because of contraindication,Iron deficiency anemia, unspecified
Chronic pancreatitis,Serratia septicemia,Severe sepsis,Septic shock,Oth/uns inf-cen ven cath,No proc/contraindication,Iron defic anemia NOS
Admission Date:  [**2188-10-1**]              Discharge Date:   [**2188-10-9**]

Date of Birth:  [**2142-3-20**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 148**]
Chief Complaint:
fever

Major Surgical or Invasive Procedure:
none


History of Present Illness:
46 year-old gentleman with history of pancreas divisum and
recurrent pancreatitis presents for his Whipple operation today.

However, he was found to be febrile in the pre-op area to 101.4.
The patient has not checked his fevers in the past few days and
has not noticed any chills. However, he reports that he
completed
a course of antibiotics for a scalp wound infection 3 weeks ago.

Futhermore, he has a PICC line in place since [**9-9**] for TPN. His
PICC line was pulled back 4 days ago, and he has had pain with
infusions since then.  The patient feels well otherwise - he
reports no nausea or vomiting and is able to tolerate a low fat
diet.  Because the patient is febrile without a clear etiology,
his Whipple has been postponed. He will be admitted to Dr.[**Name (NI) 60612**] service for fever workup.


Past Medical History:
PMHx: Recurrent pancreatitis with known divisum s/p EUS with
non-diagnostic FNA by Dr. [**Last Name (STitle) **] of pancreatic head "fullness",
peptic ulcer disease, PTSD from war, Fe-def anemia, chronic back
pain
.
PSHx: Cervical fusion 5yrs ago, left inguinal hernia treated
remotely, EUS with biopsy


Social History:
Married, lives with wife. [**Name (NI) 1403**] as supervisor for Army Corps of
Engineers. Non-smoker, recovering alcoholic with no current
alcohol x 7months, denies illicit substance use.


Family History:
Father with stomach, lung, throat CA. Mother died of MI and had
DM2.


Physical Exam:
VS: Tm 101.4, Tc 100.8, 82, 132/74, RR 18, 100% RA
GEN: NAD, A&O x 3
HEENT: scalp wounds healing - no active drainage
LUNGS: Clear B/L
CV: RRR, nl S1 and S2
ABD: Soft, NT, ND
EXT: L arm with PICC - slight erythema at PICC insertion site;
no clubbing/cyanosis/edema of LE B/L


Pertinent Results:
[**2188-10-1**] 05:20PM   WBC-5.7 RBC-4.08* HGB-10.5* HCT-31.8* MCV-78*
MCH-25.6* MCHC-32.9 RDW-14.1
[**2188-10-1**] 05:20PM   PLT COUNT-353
[**2188-10-1**] 05:20PM   PT-14.7* PTT-35.3* INR(PT)-1.3*
[**2188-10-1**] 05:20PM   GLUCOSE-109* UREA N-14 CREAT-0.9 SODIUM-138
POTASSIUM-3.1* CHLORIDE-104 TOTAL CO2-23 ANION GAP-14
[**2188-10-1**] 05:20PM   ALT(SGPT)-47* AST(SGOT)-33 CK(CPK)-51 ALK
PHOS-93 AMYLASE-38 TOT BILI-0.9


 All [**2188-10-1**] [**2188-10-2**] [**2188-10-3**] [**2188-10-4**]  All BLOOD
CULTURE CATHETER TIP-IV MRSA SCREEN SPUTUM STOOL URINE    All
INPATIENT
[**2188-10-4**]  STOOL CLOSTRIDIUM DIFFICILE TOXIN A & B TEST-FINAL
INPATIENT
[**2188-10-4**]  URINE URINE CULTURE-FINAL INPATIENT
[**2188-10-4**]  SPUTUM GRAM STAIN-FINAL; RESPIRATORY CULTURE-FINAL;
LEGIONELLA CULTURE-PRELIMINARY; FUNGAL CULTURE-PRELIMINARY; ACID
FAST SMEAR-FINAL; ACID FAST CULTURE-PRELIMINARY INPATIENT
[**2188-10-3**]  BLOOD CULTURE Blood Culture, Routine-FINAL INPATIENT

[**2188-10-3**]  SPUTUM GRAM STAIN-FINAL; RESPIRATORY CULTURE-FINAL
INPATIENT
[**2188-10-2**]  STOOL FECAL CULTURE-FINAL; CAMPYLOBACTER
CULTURE-FINAL; OVA + PARASITES-FINAL; FECAL CULTURE - R/O
VIBRIO-FINAL; FECAL CULTURE - R/O YERSINIA-FINAL; FECAL CULTURE
- R/O E.COLI 0157:H7-FINAL; Cryptosporidium/Giardia (DFA)-FINAL;
CLOSTRIDIUM DIFFICILE TOXIN A & B TEST-FINAL INPATIENT
[**2188-10-2**]  MRSA SCREEN MRSA SCREEN-FINAL INPATIENT
[**2188-10-1**]  CATHETER TIP-IV WOUND CULTURE-FINAL {SERRATIA
MARCESCENS} INPATIENT
[**2188-10-1**]  BLOOD CULTURE Blood Culture, Routine-FINAL INPATIENT

[**2188-10-1**]  BLOOD CULTURE Blood Culture, Routine-FINAL {SERRATIA
MARCESCENS}; Aerobic Bottle Gram Stain-FINAL; Anaerobic Bottle
Gram Stain-FINAL INPATIENT
[**2188-10-1**]  URINE URINE CULTURE-FINAL INPATIENT

[**2188-10-1**] Cardiac echo ; The left atrium is normal in size. The
right atrial pressure is indeterminate. Left ventricular wall
thicknesses and cavity size are normal. There is mild to
moderate global left ventricular hypokinesis (LVEF = 40 %).
Right ventricular chamber size is normal with mild global free
wall hypokinesis. The ascending aorta is mildly dilated. The
aortic valve leaflets (3) appear structurally normal with good
leaflet excursion and no aortic regurgitation. The mitral valve
leaflets are mildly thickened. Mild (1+) mitral regurgitation is
seen. There is mild pulmonary artery systolic hypertension.
There is a trivial/physiologic pericardial effusion.

IMPRESSION: Mild to moderate global biventricular systolic
dysfunction. Mild mitral regurgitation.


Brief Hospital Course:
Mr. [**Known lastname 41684**] was admitted to the hospital for his Whipple procedure
which was cancelled due to a temperature of 101.  He was
transferred to the Surgical floor for a fever work up and
subsequently spiked to 103.  He was pan cultured and his PICC
line was removed and in the interim became hypotensive with
rigors  prompting transfer to the ICU.

He required pressor support and was placed on broad spectrum
antibiotics.  the Infectious Disease service was consulted for
further management and review of his initial cultures show i/2
blood cultures + serratia as well as the PICC tip.  Meropenum
was initiated and he remained afebrile with a normal WBC.  His
pressors were weaned off and he maintained stable hemodynamics.

Following transfer to the surgical floor he continued to make
good progress.  He remained afebrile and eventually was switched
to oral antibiotics.  His TPN continued as he began a clear
liquid diet and over a 48 hour period he was advanced to a
regular diet which was tolerated well.  On [**2188-10-9**] his TPN was
weaned off and his central line was removed.

Mr. [**Known lastname 41684**] was discharged home on [**2188-10-9**] and will continue oral
antibiotics through [**2188-10-16**].  He will return for surgery on
[**2188-10-30**] with Dr. [**Last Name (STitle) **]


Medications on Admission:
Iron 325 mg qd, Nexium 40 mg qd, Zoloft 100 mg [**Hospital1 **],
Vit C 500 mg qday


Discharge Medications:
1. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
2. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Sertraline 100 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
4. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
5. Cipro 500 mg Tablet Sig: One (1) Tablet PO twice a day.
Disp:*18 Tablet(s)* Refills:*1*
6. Clindamycin HCl 300 mg Capsule Sig: One (1) Capsule PO four
times a day.
Disp:*36 Capsule(s)* Refills:*1*
7. Quetiapine 50 mg Tablet Sig: Two (2) Tablet PO HS (at
bedtime).
Disp:*60 Tablet(s)* Refills:*0*
8. Dilaudid 2 mg Tablet Sig: One (1) Tablet PO every 4-6 hours
as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
sepsis


Discharge Condition:
stable


Discharge Instructions:
Please call your doctor or nurse practitioner or return to the
Emergency Department for any of the following:

*You experience new chest pain, pressure, squeezing or
tightness.

*New or worsening cough, shortness of breath, or wheeze.

*If you are vomiting and cannot keep down 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.

*You experience burning when you urinate, have blood in your
urine, or experience a discharge.

*Your pain in not improving within 8-12 hours or is not gone
within 24 hours. Call or return immediately if your pain is
getting worse or changes location or moving to your chest or
back.

*You have shaking chills, or fever greater than 101.5 degrees
Fahrenheit or 38 degrees Celsius.

*Any change in your symptoms, or any new symptoms that concern
you.

Please resume all regular home medications , unless specifically
advised not to take a particular medication. Also, please take
any new medications as prescribed.

Please get plenty of rest, continue to ambulate several times
per day, and drink adequate amounts of fluids. Avoid lifting
weights greater than [**6-22**] lbs until you follow-up with your
surgeon.

Avoid driving or operating heavy machinery while taking pain
medications.


Followup Instructions:
Your operation  with Dr. [**Last Name (STitle) **] ([**Telephone/Fax (1) 1231**]) is booked for
[**2188-10-30**].  His secretary will call you the day before to let you
know where to report and the time to report.  NOTHING TO EAT OR
DRINK AFTER MIDNIGHT [**2188-10-30**].



Completed by:[**2188-10-9**]
{'Chronic pancreatitis,Septicemia due to serratia,Severe sepsis,Septic shock,Other and unspecified infection due to central venous catheter,Surgical or other procedure not carried out because of contraindication,Iron deficiency 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: fever

PRESENT ILLNESS: 46 year-old gentleman with history of pancreas divisum and
recurrent pancreatitis presents for his Whipple operation today.

MEDICAL HISTORY: PMHx: Recurrent pancreatitis with known divisum s/p EUS with
non-diagnostic FNA by Dr. [**Last Name (STitle) **] of pancreatic head "fullness",
peptic ulcer disease, PTSD from war, Fe-def anemia, chronic back
pain
.
PSHx: Cervical fusion 5yrs ago, left inguinal hernia treated
remotely, EUS with biopsy

MEDICATION ON ADMISSION: Iron 325 mg qd, Nexium 40 mg qd, Zoloft 100 mg [**Hospital1 **],
Vit C 500 mg qday

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: Tm 101.4, Tc 100.8, 82, 132/74, RR 18, 100% RA
GEN: NAD, A&O x 3
HEENT: scalp wounds healing - no active drainage
LUNGS: Clear B/L
CV: RRR, nl S1 and S2
ABD: Soft, NT, ND
EXT: L arm with PICC - slight erythema at PICC insertion site;
no clubbing/cyanosis/edema of LE B/L

FAMILY HISTORY: Father with stomach, lung, throat CA. Mother died of MI and had
DM2.

SOCIAL HISTORY: Married, lives with wife. [**Name (NI) 1403**] as supervisor for Army Corps of
Engineers. Non-smoker, recovering alcoholic with no current
alcohol x 7months, denies illicit substance use. 

### Response:
{'Chronic pancreatitis,Septicemia due to serratia,Severe sepsis,Septic shock,Other and unspecified infection due to central venous catheter,Surgical or other procedure not carried out because of contraindication,Iron deficiency anemia, unspecified'}
