CHIEF COMPLAINT: Acute pancreatitis,
Acute Renal Failure
Acute Respiratory Distress Syndrome

PRESENT ILLNESS: This is a 50 yo male HX of ETOH abuse. He presented to an OSH
with abdominal pain and found to be extremely hypertensive
218/134, elevated lipase and
amylase. Pt was placed on the floor. WBC at this point was [**Numeric Identifier 3652**]
pan cultures were sent negative to the date. He was placed on a
CIWA scale, and  after receiving Ativan the pt became
tachypneic,
needing intubation.
After this, pt started deteriorating progressively. He became
hypoxic in spite mechanical ventilation, developed renal failure
now with a creatinine of  3.8 from 1.0 baseline.
We received this patient in the ICU on an Ativan drip of 75
mg/hour.

MEDICAL HISTORY: HTN
Splenectomy (~30 years ago)

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 100.5, 105 st, 92/45  Sao2 91% on 100% FIO2
Chest: Lungs coarse
Heart: ST
ABD: firm, decreased  BS, no obvious masses
Ext: Clammy

FAMILY HISTORY: N/C

SOCIAL HISTORY: EtOH abuse. Drinks heavily daily
Smokes tobacco
Acute pancreatitis,Alcohol withdrawal,Acute kidney failure, unspecified,Acidosis,Acute respiratory failure,Cerebral artery occlusion, unspecified with cerebral infarction,Other convulsions,Bacteremia,Other specified disorders of the teeth and supporting structures,Other and unspecified alcohol dependence, unspecified,Diarrhea,Other and unspecified complications of medical care, not elsewhere classified,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Tobacco use disorder,Unspecified essential hypertension,Metabolic encephalopathy
Acute pancreatitis,Alcohol withdrawal,Acute kidney failure NOS,Acidosis,Acute respiratry failure,Crbl art ocl NOS w infrc,Convulsions NEC,Bacteremia,Dental disorder NEC,Alcoh dep NEC/NOS-unspec,Diarrhea,Complic med care NEC/NOS,Abn react-procedure NEC,Tobacco use disorder,Hypertension NOS,Metabolic encephalopathy
Admission Date:  [**2102-2-5**]              Discharge Date:   [**2102-3-1**]

Date of Birth:  [**2051-9-1**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3223**]
Chief Complaint:
Acute pancreatitis,
Acute Renal Failure
Acute Respiratory Distress Syndrome

Major Surgical or Invasive Procedure:
Percutaneous Gastrostomy
Percutaneous Tracheostomy


History of Present Illness:
This is a 50 yo male HX of ETOH abuse. He presented to an OSH
with abdominal pain and found to be extremely hypertensive
218/134, elevated lipase and
amylase. Pt was placed on the floor. WBC at this point was [**Numeric Identifier 3652**]
pan cultures were sent negative to the date. He was placed on a
CIWA scale, and  after receiving Ativan the pt became
tachypneic,
needing intubation.
After this, pt started deteriorating progressively. He became
hypoxic in spite mechanical ventilation, developed renal failure
now with a creatinine of  3.8 from 1.0 baseline.
We received this patient in the ICU on an Ativan drip of 75
mg/hour.


Past Medical History:
HTN
Splenectomy (~30 years ago)

Social History:
EtOH abuse. Drinks heavily daily
Smokes tobacco

Family History:
N/C

Physical Exam:
VS: 100.5, 105 st, 92/45  Sao2 91% on 100% FIO2
Chest: Lungs coarse
Heart: ST
ABD: firm, decreased  BS, no obvious masses
Ext: Clammy


Pertinent Results:
CT ABDOMEN W/O CONTRAST  [**2102-2-5**] 9:22 PM
IMPRESSION:
1. Findings consistent with severe pancreatitis. Diffuse
peripancreatic stranding and multiple enlarged mesenteric lymph
nodes. Pancreatic necrosis cannot be adequately evaluated
without IV contrast. Evaluation of the surrounding vasculature
is also limited without IV contrast.
2. No evidence of intraperitoneal free air.
3. Moderate sized bilateral pleural effusions with associated
atelectasis.
4. Small foci of subcutaneous emphysema anterior to the anterior
abdominal wall.
.
CT HEAD W/O CONTRAST  [**2102-2-5**] 9:21 PM
IMPRESSION:
1. Ovoid hypodensity in the left caudate head, likely due to a
subacute lacunar infarction.
2. Moderate paranasal sinus and mastoid air cell mucosal
thickening. Equivocal sphenoid sinus air-fluid levels.
.
LIVER OR GALLBLADDER US (SINGLE ORGAN) PORT  [**2102-2-6**] 8:27 AM
IMPRESSION:
1. No definite intra or extrahepatic biliary ductal dilatation.
No gallstones seen.
2. Gallbladder wall edema likely related to the patient's
pancreatitis.
.
MR HEAD W/O CONTRAST  [**2102-2-8**] 10:10 AM
IMPRESSION:
1. Small early-subacute infarction in the subcortical white
matter of the posterior right frontal lobe, most likely embolic.
2. Chronic lacunar infarctions in the periventricular white
matter, in the head of the left caudate nucleus, in the left
pons, and in the left middle cerebellar peduncle.
3. Fluid in the sphenoid and bilateral maxillary air cells,
which may indicate acute sinusitis. Opacification of the ethmoid
and mastoid air cells may be related to intubation, but an
infectious process cannot be excluded.
4. Normal MRA of the circle of [**Location (un) 431**].
.
Cardiology Report ECHO Study Date of [**2102-2-10**]
Conclusions:
The left atrium is elongated. No thrombus/mass is seen in the
body of the left
atrium. The right atrium is moderately dilated. No atrial septal
defect is
seen by 2D or color Doppler. Left ventricular wall thicknesses
and cavity size
are normal. Regional left ventricular wall motion is normal. No
masses or
thrombi are seen in the left ventricle. Left ventricular
systolic function is
hyperdynamic (EF>75%). Right ventricular chamber size and free
wall motion are
normal. The aortic root is mildly dilated at the sinus level.
The aortic valve
leaflets (3) appear structurally normal with good leaflet
excursion and no
aortic regurgitation. No masses or vegetations are seen on the
aortic valve.
The mitral valve appears structurally normal with trivial mitral

regurgitation. No mass or vegetation is seen on the mitral
valve. The
estimated pulmonary artery systolic pressure is normal. There is
no
pericardial effusion.
.
CT CHEST W/CONTRAST  [**2102-2-14**] 4:00 PM
IMPRESSION:
1. No significant interval change in extent of peripancreatic
fat stranding involving the body and tail of the pancreas
consistent with pancreatitis. No evidence of pseudocyst, or
areas of pancreatic necrosis. Associated peripancreatic
lymphadenopathy is unchanged.
2. Normal spleen not identified in the left upper quadrant.
Multiple soft tissue density implants seen within the left upper
quadrant and left anterior abdomen are suggestive of splenosis.
4. Moderate sized bilateral pleural effusions with bibasilar
atelectasis, unchanged. Diffuse ground glass opacities in both
lungs suggestive of mild pulmonary edema.
.
CT HEAD W/O CONTRAST  [**2102-2-21**] 10:37 PM
IMPRESSION:
1. Technically limited study secondary to contrast
extravasation.
2. No evidence of acute intracranial hemorrhage.
3. Worsening sinus disease, with air-fluid levels suggesting
acute sinusitis.
.

MR HEAD W/O CONTRAST  [**2102-2-21**] 8:32 am
IMPRESSION:
1. New early-to-subacute infarction involving the left
precentral sulcus/gyrus and subcortical white matter. Normal
progression of previously identified right posterior frontal
infarct.
2. Stable appearance to chronic small vessel ischemia changes
within the periventricular white matter, left pons, left middle
cerebellar peduncle.
3. Increased opacification of paranasal sinuses.
.
CTA NECK W&W/OC & RECONS  [**2102-2-22**] 8:16 AM
IMPRESSION:
1) Minimal atherosclerotic calcification involving the carotid
bulbs and ICA origins bilaterally without evidence of
significant stenosis. Otherwise unremarkable CT angiogram of the
neck.
2) Bilateral pleural effusions with evidence of volume
overload/CHF.
3) Pansinus disease as above.
.
COMPLETE BLOOD COUNT    WBC RBC    Hgb Hct    MCV MCH MCHC RDW
  Plt Ct
[**2102-2-28**] 03:00AM    10.8 2.66* 9.1* 27.2* 102* 34.2* 33.5
15.7* 483*
RENAL & GLUCOSE      Glucose UreaN Creat Na K   Cl HCO3 AnGap
[**2102-2-28**] 03:00AM    105 14 0.9       138 4.6 102 26 15
ENZYMES & BILIRUBIN    ALT AST CK(CPK) AlkPhos TotBili DirBili
[**2102-2-27**] 10:00AM    80* 89*   31*   143*   0.4


Brief Hospital Course:
This was a 50-year-old man who had entered the hospital on
[**2102-2-5**] with acute
pancreatitis and most recently an acute cerebrovascular accident
affecting the caudate lobe.

Neuro: Patient initially on Ativan gtt. His neurologic exam on
admission was very limited given his sedation, he is not moving
any extremity or responding to pain.  Of note he does not have
any extraocular movements with dolls, which, given his history,
is concerning for Wernicke's encephalopathy.  He has a small,
ovoid, L caudate hypodensity on CT, read by radiology as
subacute.  It is hard to
tell by history how acute this is.  It is possible that it is a
small vessel lacunar infarct, which would most likely be due to
small vessel atherosclerotic disease.
He was found to have L frontal CVA, R subcortical CVA (both
subacute). Altered mental status for 2 weeks, and was very
difficult to wake. His mental status remained depressed. On
[**2-23**], Versed were weaned. He recovered on [**2-24**] and was opening
his eyes on command, much awake and afebrile. On [**2-27**], he was
stable neurologically. He now inconsistently follows commands
and was still requires Ativan for agitation and soft wrist
restraints.
.
Resp: He was started on Levaquin and Flagyl for an aspiration
PNA at the OSH.  He was intubated (reportedly for tachypnea,
although they were also increasing
Ativan at this point so this is unclear).  [**Name2 (NI) **] had a generalized
seizure during his hospital course and was given Dilantin IV for
treatment of this, along with the Ativan.  Abd CT was repeated
and showed evidence of
pneumoperitoneum, so he was transferred to [**Hospital1 18**] for further
management.
He had a prolonged course on the ventilator.  He had proven
difficult to wean from the ventilator. After consultation with
his family, it was elected to proceed with placement of a
tracheostomy and gastric feeding tube. He finally received a
Trach on [**2102-2-21**]. After tach placement, he was weaned from the
Trach vent and tried on the Trach mask. He was requiring
respiratory care for rhonchi and needing frequent suction. He
gets easily agitated and drops with O2 sats.
.
CV: He was tachycardic on admission. He was resuscitated with
several fluid boluses and ordered for IV Lopressor. He was
tachycardic at times, up to 130-150's, mostly when agitated.
.
Renal: He developed renal failure. His creatinine was 3.8 from
1.0 baseline. This slowly improved with continued fluid
resuscitation. His renal status was WNL and he was auto
diuresing well.
.
GI/Abd: His abdomen was firm and distended on admission. His
Pancreatitis resolved during this hospitalization. HIs Amylase
was 117 at admission and Lipase was 74. These both resolved
while he was NPO and getting IVF.
He was having significant diarrhea. C.diff were all negative,
and tubefeedings were temporarily held while the diarrhea
resolved. He continued with the Lansoprazole and Imodium. He was
also receiving Pancrease.
.
FEN: He was NPO, IVF, TPN. He had a PEG tube placed at the
bedside on [**2102-2-21**]. He was off TPN and tolerating tube feedings.

.
Left UE Infiltrate: On [**2102-2-21**], approximately 90cc of Optiray IV
contrast was accidentally infiltrated into the patient's left
arm. Due to the patient's baseline underlying edema, the injury
was not immediately noticed; however, within 30
minutes infiltration was confirmed via contrast enhancement of
the patient's left upper extremity on scout films. His IV was
immediately removed and a warm compress was placed. This
improved with conservative management.
.
-----Imaging: [**2-22**] CT neck: b/l no significant stenosis.
[**2-21**] MRI: new CVA in L frontal lobe, acute>subacute, precentral
area extending to subcortical white matter; LENIs: neg
[**2-20**]-TEE-PFO, LVH mild outflow tract obstruction;
[**2-18**] KUB: few dilated loops of bowel, No free air, air fluid
levels.
[**2-14**] CTA C/A/P: no change. no areas of necrosis or pseudocyst.
[**2-10**] ECHO: EF> 75%, nrm valves; [**2-9**] EEG -> very slow waves
[**2-8**] MRI/A: New post R frontal subcortical infarct, old lacunars

[**2-6**] RUQ US: gb wall edema; [**2-5**] CT: severe pancreatitis, b/l
eff.
.
-----Micro:[**2-16**] cath-NG. [**2-15**] Stool-neg, BCx - MSSE ([**1-13**]); 3/6,7
cdiff - neg; VRE+; [**2-14**] CVL/BCx/UCx - P, SCx - MRSA;
.
-----ABX: Linezolid [**2-17**], Flagyl [**2-15**], (po vanco [**2-18**])([**Last Name (un) 2830**]/fluc
[**Date range (1) 72508**])
.
Activity: He was being [**Doctor Last Name 2598**] to the chair and sitting-up for
several hours during the day.

Medications on Admission:
None

Discharge Medications:
1. Heparin (Porcine) 5,000 unit/mL Solution [**Doctor Last Name **]: One (1)
Injection TID (3 times a day).
2. Miconazole Nitrate 2 % Powder [**Doctor Last Name **]: One (1) Appl Topical [**Hospital1 **]
(2 times a day) as needed for apply to groin & L foot erythema.

3. Albuterol 90 mcg/Actuation Aerosol [**Hospital1 **]: Six (6) Puff
Inhalation Q4-6H (every 4 to 6 hours) as needed.
4. Hydralazine 25 mg Tablet [**Hospital1 **]: One (1) Tablet PO Q6H (every 6
hours) as needed for SBP >140.
5. Acetaminophen 325 mg Tablet [**Hospital1 **]: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
6. Aspirin 325 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY (Daily).
7. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
8. Clonidine 0.1 mg/24 hr Patch Weekly [**Last Name (STitle) **]: One (1) Patch Weekly
Transdermal QFRI (every Friday).
9. Amylase-Lipase-Protease 20,000-4,500- 25,000 unit Capsule,
Delayed Release(E.C.) [**Last Name (STitle) **]: Two (2) Cap PO TID W/MEALS (3 TIMES A
DAY WITH MEALS).
10. Metoprolol Tartrate 50 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO BID
(2 times a day).
11. Levothyroxine 100 mcg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY
(Daily).
12. Linezolid 600 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO Q12H (every
12 hours) for 2 days.
13. Insulin Regular Human 100 unit/mL Solution [**Last Name (STitle) **]: Regular
Sliding Scale  Injection ASDIR (AS DIRECTED): See Sliding Scale.

14. Albuterol 90 mcg/Actuation Aerosol [**Last Name (STitle) **]: Six (6) Puff
Inhalation Q4-6H (every 4 to 6 hours) as needed.
15. Lorazepam 1 mg Tablet [**Last Name (STitle) **]: Two (2) Tablet PO QID (4 times a
day).


Discharge Disposition:
Extended Care

Facility:
[**Hospital **] Medical Center - [**Hospital1 3597**]

Discharge Diagnosis:
Pancreatitis
Alcohol withdrawl
Acute Renal Failure
Acute Respiratory Distress Syndrome
CVA
Deconditioning
Mental Status Change


Discharge Condition:
Fair


Discharge Instructions:
* Increasing pain
* Fever (>101.5 F)
* Persistent vomiting
* Inability to pass gas or stool
* Increasing shortness of breath
* Chest pain
.
Please resume all of your regular medications and take any new
meds as ordered.
.

Followup Instructions:
Please follow-up with Dr. [**Last Name (STitle) 519**] as needed. Call ([**Telephone/Fax (1) 5323**]
with questions or concerns.
Please follow-up with Neurology in [**1-15**] weeks. Call ([**Telephone/Fax (1) 8951**] to schedule an appointment.


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 520**] MD, [**MD Number(3) 3226**]

Completed by:[**2102-2-28**]
{'Acute pancreatitis,Alcohol withdrawal,Acute kidney failure, unspecified,Acidosis,Acute respiratory failure,Cerebral artery occlusion, unspecified with cerebral infarction,Other convulsions,Bacteremia,Other specified disorders of the teeth and supporting structures,Other and unspecified alcohol dependence, unspecified,Diarrhea,Other and unspecified complications of medical care, not elsewhere classified,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Tobacco use disorder,Unspecified essential hypertension,Metabolic encephalopathy'}


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: Acute pancreatitis,
Acute Renal Failure
Acute Respiratory Distress Syndrome

PRESENT ILLNESS: This is a 50 yo male HX of ETOH abuse. He presented to an OSH
with abdominal pain and found to be extremely hypertensive
218/134, elevated lipase and
amylase. Pt was placed on the floor. WBC at this point was [**Numeric Identifier 3652**]
pan cultures were sent negative to the date. He was placed on a
CIWA scale, and  after receiving Ativan the pt became
tachypneic,
needing intubation.
After this, pt started deteriorating progressively. He became
hypoxic in spite mechanical ventilation, developed renal failure
now with a creatinine of  3.8 from 1.0 baseline.
We received this patient in the ICU on an Ativan drip of 75
mg/hour.

MEDICAL HISTORY: HTN
Splenectomy (~30 years ago)

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 100.5, 105 st, 92/45  Sao2 91% on 100% FIO2
Chest: Lungs coarse
Heart: ST
ABD: firm, decreased  BS, no obvious masses
Ext: Clammy

FAMILY HISTORY: N/C

SOCIAL HISTORY: EtOH abuse. Drinks heavily daily
Smokes tobacco 

### Response:
{'Acute pancreatitis,Alcohol withdrawal,Acute kidney failure, unspecified,Acidosis,Acute respiratory failure,Cerebral artery occlusion, unspecified with cerebral infarction,Other convulsions,Bacteremia,Other specified disorders of the teeth and supporting structures,Other and unspecified alcohol dependence, unspecified,Diarrhea,Other and unspecified complications of medical care, not elsewhere classified,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Tobacco use disorder,Unspecified essential hypertension,Metabolic encephalopathy'}
