CHIEF COMPLAINT: throat/mouth swelling

PRESENT ILLNESS: 51 YOM h/o DM, HTN and HLD presenting with increased throat
swelling, difficulty swallowing and voice change. Patient had
tooth ache starting approximately 1 week ago. On Saturday he
noted some submandibular swelling starting on Saturday.  He went
to the dentist office yesterday and was prescribed amoxicillin.
He began to have chills last night and this morning noted
increased swelling with difficulty swallowing.  He also noted a
change in his voice.  He has had no difficulty breathing.  He
denies any fevers.  No n/v/d.
.
ED noted: Ludwig's angina.

MEDICAL HISTORY: DM2, diet controlled
hypertension
hyperlipidemia

MEDICATION ON ADMISSION: HOME MEDS:
Diovan 160 mg Tab Oral 1 Tablet(s) Once Daily
Amlodipine 10 mg Tab Oral 1 Tablet(s) Once Daily
Simvastatin 20 mg Tab Oral 1 Tablet(s) Once Daily
.
ALLERGIES: lisinopril

ALLERGIES: Lisinopril / Ampicillin

PHYSICAL EXAM: At admission:
Vitals: T: 98 BP:130/77 P:79 R: 18 O2: 93% RA
General: in mild distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, LAD, submandibular swollen, tjm tenderness.
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: He is from the United States.  He is currently
employed by the State - Atheletic super at [**Hospital1 **].  He did smoke
- 37 year PPD.  He drink alcohol moderatly.  no IVDU.
Cellulitis and abscess of oral soft tissues,Acute kidney failure, unspecified,Pulmonary eosinophilia,Dental caries, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypoxemia,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Hematuria, unspecified,Antirheumatics [antiphlogistics] causing adverse effects in therapeutic use,Adrenal cortical steroids causing adverse effects in therapeutic use
Cellulitis/abscess mouth,Acute kidney failure NOS,Pulmonary eosinophilia,Dental caries NOS,DMII wo cmp nt st uncntr,Hypoxemia,Hypertension NOS,Hyperlipidemia NEC/NOS,Hematuria NOS,Adv eff antirheumatics,Adv eff corticosteroids
Admission Date:  [**2142-8-21**]              Discharge Date:   [**2142-8-24**]

Date of Birth:  [**2090-9-1**]             Sex:   M

Service: MEDICINE

Allergies:
Lisinopril / Ampicillin

Attending:[**First Name3 (LF) 3984**]
Chief Complaint:
throat/mouth swelling

Major Surgical or Invasive Procedure:
Direct laryngoscopy


History of Present Illness:
51 YOM h/o DM, HTN and HLD presenting with increased throat
swelling, difficulty swallowing and voice change. Patient had
tooth ache starting approximately 1 week ago. On Saturday he
noted some submandibular swelling starting on Saturday.  He went
to the dentist office yesterday and was prescribed amoxicillin.
He began to have chills last night and this morning noted
increased swelling with difficulty swallowing.  He also noted a
change in his voice.  He has had no difficulty breathing.  He
denies any fevers.  No n/v/d.
.
ED noted: Ludwig's angina.

ED Course: Initial Vitals: [**8-18**] 98.2 89 123/72 18 97% ra. Exam
was notable for woody submental fullness that is tender to
palpation,
Bilateral jugular chain LAD,  Tooth #31 appearing decayed and
it is loose.  Surrounding gingiva is mildly tender to palpation.
 Labs noted to be CR 2.3 after 1 L IVF came down to 1.9.
Recieved Unasyn 3g /Clindamycin 600mgIV.  ENT c/s: valecula,
base of tongue and cords okay. OMFS CS: got then panorex film,
but still needs CT after IVF hydration, no OR tonight, admit to
MICU will follow. Afebrile 85 117/71 18 94% RA. 2x PIV.


Past Medical History:
DM2, diet controlled
hypertension
hyperlipidemia


Social History:
He is from the United States.  He is currently
employed by the State - Atheletic super at [**Hospital1 **].  He did smoke
- 37 year PPD.  He drink alcohol moderatly.  no IVDU.


Family History:
Noncontributory

Physical Exam:
At admission:
Vitals: T: 98 BP:130/77 P:79 R: 18 O2: 93% RA
General: in mild distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, LAD, submandibular swollen, tjm tenderness.
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

Pertinent Results:
At admission:

[**2142-8-21**] 05:10PM BLOOD WBC-11.7*# RBC-4.58* Hgb-14.0 Hct-39.7*
MCV-87 MCH-30.6 MCHC-35.3* RDW-13.1 Plt Ct-262
[**2142-8-21**] 05:10PM BLOOD Neuts-77.5* Lymphs-14.3* Monos-5.4
Eos-2.5 Baso-0.3
[**2142-8-22**] 06:26AM BLOOD PT-12.1 PTT-22.2 INR(PT)-1.0
[**2142-8-21**] 05:10PM BLOOD Glucose-225* UreaN-21* Creat-2.3*# Na-141
K-3.8 Cl-102 HCO3-22 AnGap-21*
[**2142-8-21**] 05:20PM BLOOD Lactate-1.2
[**2142-8-22**] 12:20AM URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-1.007
[**2142-8-22**] 12:20AM URINE RBC-<1 WBC-5 Bacteri-NONE Yeast-NONE
Epi-0

[**2142-8-22**] BLOOD CULTURE Blood Culture, Routine-PENDING
INPATIENT
[**2142-8-22**] BLOOD CULTURE Blood Culture, Routine-PENDING
INPATIENT
[**2142-8-22**] MRSA SCREEN MRSA SCREEN-PENDING INPATIENT
[**2142-8-22**] URINE URINE CULTURE-PENDING INPATIENT
[**2142-8-21**] BLOOD CULTURE Blood Culture, Routine-PENDING
EMERGENCY [**Hospital1 **]
[**2142-8-21**] BLOOD CULTURE Blood Culture, Routine-PENDING
EMERGENCY [**Hospital1 **]

[**8-22**]: CT NECK W/CONTRAST (EG:PAROTIDS)
IMPRESSION:
1. No abscess or fluid collection in the floor of mouth, or
elsewhere.
2. Asymmetry of the parapharyngeal fat and adjacent palatine
tonsil may
represent early phlegmon; this finding should be correlated with
direct
visualization.

The study and the report were reviewed by the staff radiologist.


[**8-23**]: CXR
FINDINGS: The lung volumes are low. Borderline size of the
cardiac
silhouette. Tortuosity of the thoracic aorta. No pleural
effusions, no
pneumonia. No lung nodules or masses.


Brief Hospital Course:
51 y/o man with a PMH significant for DM (diet controlled), HLD
and HTN who presented to the ED on [**2142-8-21**] with throat swelling
and dysphagia.
.
# Ludwig's Angina: classic findings:  He noted a tooth ache
about 1 week prior to admission that was accompanied by
submandibular swelling. For this he took 1600mg Ibuprofen TID
without relief. He went to the dentist on [**2142-8-20**] and was
prescribed Amoxacillin. The following day he noted dysphagia,
drooling, voice changes and chills and presented to the ED for
further evaluation.
.
In the ED VS were stable (T 98.2 HR 89 BP 123/72 RR 18 O2 Sat
97% RA). ENT noted a widely patent airway and OMFS was consulted
and panorex was obtained. OMFS felt there was bilateral jugular
chain LAD and tooth #31 was noted to be decaying with local
gingival erythema and swelling. He received IV Unasyn/Clinda and
was admitted to the MICU for Ludwig's Angina. CT neck was
obtained in the MICU that showed - no abscess or fluid
collection in the floor of mouth, or elsewhere. asymmetry of the
parapharyngeal fat and adjacent palatine tonsil may represent
early phlegmon; this finding should be correlated with direct
visualization. He was monitored overnight in the MICU and called
out to the floor on hospital day 2.
.
During his fisrt night on the floor, the MICU resident was paged
because of tongue swelling. He did not have stridor. There was a
question of whether he had angioedema from the unasyn. He was
given IV Dex 10mg (q8h), benadryl 50 IV x1, famotidine 20 IV x1
was given. He denied lip swelling, pruritis or rash. In the
morning, ENT evaluated his airway by laryngoscopy and felt that
the edema had worsened and was not characteristic of angioedema
as there was increased elevation of the floor of his mouth. His
antibiotics were changed to clinda IV and levofloxacin. The oral
surgeons were contact[**Name (NI) **] and extraction of the infected tooth was
recommended.
.
He was transferred to the ICU for closer monitoring of his
airway. On arrival he is breathing comofrtably without stridor.
He notes imporvement in the swelling that he attributes either
to steroids or the change in antibiotics. He is able to swallow
secretions without difficulty. He has only one allergy to
lisinopril and that was an episode of pancreatitis several years
ago. He again denies any sense of ithcy throat, lip swelling or
bronchospasm.
.
His ICU course was remarkable for dramatic improvement after the
steroids in terms of the face swelling. Also, patient noted
great improvement upon massaging of submandibular area and
resulting expression of green-colored, purulant material drained
from gum area adjacent to dental caries (spontaneous
decompression of absesss).  ID saw him and advised a final
regimen of Clindamycin PO w/o steroids and no further
levofloxacin.
.
# ARF: pt has been taking 1600mg ibuprofen three times day for 4
days.  decreased PO intake. This improved with IVF.
.
# DM2, diet controlled: diabetic diet. Blood sugars were
elevated [**1-10**] steroids.
.
# hypertension: continued norvasc/diovan
.
# hyperlipidemia: continued simvastatin
# Communication: Patient
# Code: Full (discussed with patient)

Transitions of care: his CXR from [**2142-8-23**] was concerning for
left apical opacity which deserves interval attention and
followup with primary care physician as an outpatient as well as
a PPD for Tuberculosis screening. Finally he was told to refrain
from NSAID use, and to see the oral surgeons for tooth
extraction as well as to f/u with he PCP [**Last Name (NamePattern4) **]: following her blood
glucose which was elevated [**1-10**] steroids.



Medications on Admission:
HOME MEDS:
Diovan 160 mg Tab Oral 1 Tablet(s) Once Daily
Amlodipine 10 mg Tab Oral 1 Tablet(s) Once Daily
Simvastatin 20 mg Tab Oral 1 Tablet(s) Once Daily
.
ALLERGIES: lisinopril


Discharge Medications:
1. valsartan 160 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

2. simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day.
3. amlodipine 10 mg Tablet Sig: One (1) Tablet PO once a day.
4. chlorhexidine gluconate 0.12 % Mouthwash Sig: One (1) ML
Mucous membrane [**Hospital1 **] (2 times a day).
Disp:*60 ML(s)* Refills:*0*
5. clindamycin HCl 300 mg Capsule Sig: One (1) Capsule PO every
eight (8) hours for 14 days.
Disp:*42 Capsule(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Submandibular space infection/cellulitis


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


Discharge Instructions:
You were admitted to [**Hospital1 18**] with throat swelling. You were
evaluated by the Ear, Nose and Throat as well as Oral Maxofacial
Surgery services. There was a concern for neck space infection
related to an infected tooth. You were started on antibiotics
and steroids. Your condition improved.

Your kidney function was found to be low on admission, which was
likely due to taking a lot of ibuprofen in the setting of not
drinking enough fluids. Please stop taking ibuprofen until you
are seen by your primary care physician (PCP).

Your blood sugars were also elevated during this hospitalization
likely because you were on steroids but you should also check
with your PCP about this.

Please consider at this time that you may have an allergy to
penicillin and to consider getting testing for this as an
outpatient.

Finally, a chest x-ray done here at [**Hospital1 18**] showed an area of
possible scarring in the left upper lobe which is of uncertain
significance. Please ask your PCP to consider [**Name9 (PRE) 77267**]
another chest x-ray as well as test a PPD for potential latent
tuberculosis.

Please continue your home medications with the following
changes:
1. START taking clindamycin - an antibiotic

Please STOP:
-Nonsteroidal Anti-inflammatory medications (ie. ibuprofen)
until you see your primary care doctor


Followup Instructions:
Please schedule an appointment with oral surgery at [**Hospital 2082**] as soon as possible to have the tooth extraction.
If you cannot keep the appointment then he will be seen on 23rd
of [**Month (only) **] at 2pm. Contact Please call [**Telephone/Fax (1) 77268**] with any
questions for appointment sceduling.


                             [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2437**] MD [**MD Number(1) 2438**]

Completed by:[**2142-8-25**]
{'Cellulitis and abscess of oral soft tissues,Acute kidney failure, unspecified,Pulmonary eosinophilia,Dental caries, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypoxemia,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Hematuria, unspecified,Antirheumatics [antiphlogistics] causing adverse effects in therapeutic use,Adrenal cortical steroids causing adverse effects in therapeutic 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: throat/mouth swelling

PRESENT ILLNESS: 51 YOM h/o DM, HTN and HLD presenting with increased throat
swelling, difficulty swallowing and voice change. Patient had
tooth ache starting approximately 1 week ago. On Saturday he
noted some submandibular swelling starting on Saturday.  He went
to the dentist office yesterday and was prescribed amoxicillin.
He began to have chills last night and this morning noted
increased swelling with difficulty swallowing.  He also noted a
change in his voice.  He has had no difficulty breathing.  He
denies any fevers.  No n/v/d.
.
ED noted: Ludwig's angina.

MEDICAL HISTORY: DM2, diet controlled
hypertension
hyperlipidemia

MEDICATION ON ADMISSION: HOME MEDS:
Diovan 160 mg Tab Oral 1 Tablet(s) Once Daily
Amlodipine 10 mg Tab Oral 1 Tablet(s) Once Daily
Simvastatin 20 mg Tab Oral 1 Tablet(s) Once Daily
.
ALLERGIES: lisinopril

ALLERGIES: Lisinopril / Ampicillin

PHYSICAL EXAM: At admission:
Vitals: T: 98 BP:130/77 P:79 R: 18 O2: 93% RA
General: in mild distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, LAD, submandibular swollen, tjm tenderness.
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: He is from the United States.  He is currently
employed by the State - Atheletic super at [**Hospital1 **].  He did smoke
- 37 year PPD.  He drink alcohol moderatly.  no IVDU. 

### Response:
{'Cellulitis and abscess of oral soft tissues,Acute kidney failure, unspecified,Pulmonary eosinophilia,Dental caries, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypoxemia,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Hematuria, unspecified,Antirheumatics [antiphlogistics] causing adverse effects in therapeutic use,Adrenal cortical steroids causing adverse effects in therapeutic use'}
