CHIEF COMPLAINT: HELLP syndrome

PRESENT ILLNESS: 36yoF w/ h/o severe preeclampsia who was transferred from an OSH
for management of HELLP syndrome after emergent c-section on day
prior to transfer at 33weeks gestation.  She initially presented
to OSH 2 days PTA w/right arm and RUQ pain as well as N/V.
Initial vitals were BP 150s-170s/80s-120s max reported BP
178/123. Her platelets were 91, LFTs were AST 289 ALT 279 Uric
Acid 7.6 and Cr 1.07.
BP was stabilized and she was emergently taken to the OR for
c-section. In the OR, she received 3L IVF and had 700ccEBL.
C-section was c/b oozine [**Doctor Last Name **] bleeding at the site. She was
subsequently transfused w/1 unit of platelets and 4 units of
PRBCs. Per report, baby was stable with apgars of [**8-24**].
Post op, she received Mag sulfate bolus and then IV drip at
2mg/kg and dexamethasone 10 mg IV x 2 as well as dilaudid IV for
pain and zofran. She had episodes of hypotension throughout the
day. Labs were closely monitored and were notable for rising
potassium and Cr.
.
Prior to transfer, she had HD line placed and was emergently
dialyzed for hyperkalemia to 6.7 in the setting of possible ATN.
Per report, they were only able to ultrafilter her due to
hypotension.
.
ROS: She notes that she had spotty vision 2-3 weeks prior to
presentation. She otherwise denies HA/dizzyness/focal weakness.
The patient denies any fevers, chills, diarrhea, constipation,
melena, hematochezia, chest pain, shortness of breath,
orthopnea, PND, lower extremity edema, cough, urinary frequency,
urgency, dysuria, lightheadedness, gait unsteadiness, rash or
skin changes.

MEDICAL HISTORY: h/o severe preeclampsia requiring urgent c-section w/her first
child in '[**72**]
no h/o abnormal paps/STDs

MEDICATION ON ADMISSION: none

ALLERGIES: Acetaminophen

PHYSICAL EXAM: On Admission:
Vitals: T: 97.2 BP: 114/71 HR: 95 RR: 18 O2Sat: 94% 4LNC
GEN: anasarcic, no acute distress
HEENT: + facial edema, EOMI, PERRL, sclera anicteric, no
epistaxis or rhinorrhea, dry MM, OP Clear
NECK: difficult to assess JVP w/edema, no cervical
lymphadenopathy, trachea midline
COR: RRR, + soft systolic murmur, no G/R, normal S1 S2, radial
pulses +2
PULM: Lungs crackles at bases BL, no W/R/R
ABD: Soft, NT, ND, +BS, no HSM, no masses; wound c/d/i
EXT: No C/C/E, no palpable cords
NEURO: alert, oriented to person, place, and time. CN II ?????? XII
grossly intact. Moves all 4 extremities. Strength 5/5 in upper
and lower extremities. Patellar DTR +1. Plantar reflex
downgoing. No gait disturbance. No cerebellar dysfunction.
SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses.

FAMILY HISTORY: mother- HTN, h/o eclampsia, and sister w/h/o eclampsia; father-
throat CA.

SOCIAL HISTORY: Lives with her husband and nine year old son; no tobacco, etoh,
illicits.
Severe pre-eclampsia, postpartum condition or complication,Infections of genitourinary tract in pregnancy, postpartum condition or complication,Acute kidney failure following labor and delivery, postpartum condition or complication,Urinary tract infection, site not specified,Hepatic infarction,Other current conditions classifiable elsewhere of mother, postpartum condition or complication
Sev preeclamp-postpartum,Gu infection-postpartum,Ac kidney fail-postpart,Urin tract infection NOS,Hepatic infarction,Oth curr cond-postpartum
Admission Date:  [**2181-12-6**]              Discharge Date:   [**2181-12-13**]

Date of Birth:  [**2145-10-1**]             Sex:   F

Service: OBSTETRICS/GYNECOLOGY

Allergies:
Acetaminophen

Attending:[**First Name3 (LF) 8252**]
Chief Complaint:
HELLP syndrome

Major Surgical or Invasive Procedure:
c/section at [**Hospital **] hospital prior to admission here.


History of Present Illness:
36yoF w/ h/o severe preeclampsia who was transferred from an OSH
for management of HELLP syndrome after emergent c-section on day
prior to transfer at 33weeks gestation.  She initially presented
to OSH 2 days PTA w/right arm and RUQ pain as well as N/V.
Initial vitals were BP 150s-170s/80s-120s max reported BP
178/123. Her platelets were 91, LFTs were AST 289 ALT 279 Uric
Acid 7.6 and Cr 1.07.
BP was stabilized and she was emergently taken to the OR for
c-section. In the OR, she received 3L IVF and had 700ccEBL.
C-section was c/b oozine [**Doctor Last Name **] bleeding at the site. She was
subsequently transfused w/1 unit of platelets and 4 units of
PRBCs. Per report, baby was stable with apgars of [**8-24**].
Post op, she received Mag sulfate bolus and then IV drip at
2mg/kg and dexamethasone 10 mg IV x 2 as well as dilaudid IV for
pain and zofran. She had episodes of hypotension throughout the
day. Labs were closely monitored and were notable for rising
potassium and Cr.
.
Prior to transfer, she had HD line placed and was emergently
dialyzed for hyperkalemia to 6.7 in the setting of possible ATN.
Per report, they were only able to ultrafilter her due to
hypotension.
.
ROS: She notes that she had spotty vision 2-3 weeks prior to
presentation. She otherwise denies HA/dizzyness/focal weakness.
The patient denies any fevers, chills, diarrhea, constipation,
melena, hematochezia, chest pain, shortness of breath,
orthopnea, PND, lower extremity edema, cough, urinary frequency,
urgency, dysuria, lightheadedness, gait unsteadiness, rash or
skin changes.


Past Medical History:
h/o severe preeclampsia requiring urgent c-section w/her first
child in '[**72**]
no h/o abnormal paps/STDs


Social History:
Lives with her husband and nine year old son; no tobacco, etoh,
illicits.

Family History:
mother- HTN, h/o eclampsia, and sister w/h/o eclampsia; father-
throat CA.

Physical Exam:
On Admission:
Vitals: T: 97.2 BP: 114/71 HR: 95 RR: 18 O2Sat: 94% 4LNC
GEN: anasarcic, no acute distress
HEENT: + facial edema, EOMI, PERRL, sclera anicteric, no
epistaxis or rhinorrhea, dry MM, OP Clear
NECK: difficult to assess JVP w/edema, no cervical
lymphadenopathy, trachea midline
COR: RRR, + soft systolic murmur, no G/R, normal S1 S2, radial
pulses +2
PULM: Lungs crackles at bases BL, no W/R/R
ABD: Soft, NT, ND, +BS, no HSM, no masses; wound c/d/i
EXT: No C/C/E, no palpable cords
NEURO: alert, oriented to person, place, and time. CN II ?????? XII
grossly intact. Moves all 4 extremities. Strength 5/5 in upper
and lower extremities. Patellar DTR +1. Plantar reflex
downgoing. No gait disturbance. No cerebellar dysfunction.
SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses.



Pertinent Results:
Admission Labs:
[**2181-12-6**] 01:49AM   WBC-18.3*# RBC-3.02*# HGB-9.3* HCT-25.5*
MCV-84 MCH-30.7 MCHC-36.5* RDW-16.1*
[**2181-12-6**] 01:49AM   NEUTS-80.0* LYMPHS-13.2* MONOS-6.7 EOS-0.1
BASOS-0.1
[**2181-12-6**] 01:49AM   PLT COUNT-79* LPLT-1+
[**2181-12-6**] 01:49AM   PT-13.0 PTT-30.3 INR(PT)-1.1
[**2181-12-6**] 01:49AM   FIBRINOGE-301
[**2181-12-6**] 01:49AM   GLUCOSE-149* UREA N-35* CREAT-2.6*#
SODIUM-133 POTASSIUM-4.3 CHLORIDE-101 TOTAL CO2-25 ANION GAP-11
[**2181-12-6**] 01:49AM   ALT(SGPT)-[**2159**]* AST(SGOT)-2427* LD(LDH)-3055*
ALK PHOS-132* TOT BILI-0.8
[**2181-12-6**] 01:49AM   ALBUMIN-2.1* CALCIUM-4.4* PHOSPHATE-6.1*
MAGNESIUM-7.5* URIC ACID-7.0*
.

[**2181-12-13**] 10:16AM BLOOD WBC-7.3 RBC-2.91* Hgb-8.8* Hct-25.4*
MCV-87 MCH-30.3 MCHC-34.8 RDW-15.2 Plt Ct-137*
[**2181-12-12**] 05:39AM BLOOD WBC-8.9 RBC-2.79* Hgb-8.5* Hct-24.3*
MCV-87 MCH-30.5 MCHC-35.0 RDW-15.3 Plt Ct-114*
[**2181-12-11**] 01:52AM BLOOD WBC-10.8 RBC-2.88* Hgb-8.7* Hct-24.8*
MCV-86 MCH-30.1 MCHC-35.0 RDW-15.5 Plt Ct-165
[**2181-12-10**] 07:51PM BLOOD WBC-11.0 RBC-2.73* Hgb-8.4* Hct-23.4*
MCV-86 MCH-30.7 MCHC-35.8* RDW-15.4 Plt Ct-138*
[**2181-12-10**] 06:28AM BLOOD WBC-10.6 RBC-2.72* Hgb-8.3* Hct-23.6*
MCV-87 MCH-30.6 MCHC-35.3* RDW-15.5 Plt Ct-130*
[**2181-12-9**] 05:50AM BLOOD WBC-12.6* RBC-2.89* Hgb-8.6* Hct-24.9*
MCV-86 MCH-29.8 MCHC-34.6 RDW-15.4 Plt Ct-135*
[**2181-12-8**] 12:02PM BLOOD WBC-14.4* RBC-2.77* Hgb-8.4* Hct-23.9*
MCV-86 MCH-30.2 MCHC-35.1* RDW-16.0* Plt Ct-124*
[**2181-12-8**] 06:16AM BLOOD WBC-15.7* RBC-2.75* Hgb-8.2* Hct-23.6*
MCV-86 MCH-29.7 MCHC-34.6 RDW-16.0* Plt Ct-135*
[**2181-12-6**] 11:45PM BLOOD WBC-17.3* RBC-2.73* Hgb-8.5* Hct-23.0*
MCV-85 MCH-31.1 MCHC-36.8* RDW-16.3* Plt Ct-88*
[**2181-12-6**] 11:50AM BLOOD WBC-17.3* RBC-2.83* Hgb-8.6* Hct-23.8*
MCV-84 MCH-30.5 MCHC-36.2* RDW-15.5 Plt Ct-85*
[**2181-12-6**] 01:49AM BLOOD WBC-18.3*# RBC-3.02*# Hgb-9.3* Hct-25.5*
MCV-84 MCH-30.7 MCHC-36.5* RDW-16.1* Plt Ct-79*
[**2181-12-6**] 01:49AM BLOOD Neuts-80.0* Lymphs-13.2* Monos-6.7
Eos-0.1 Baso-0.1
[**2181-12-13**] 10:16AM BLOOD Plt Ct-137*
[**2181-12-11**] 01:52AM BLOOD Plt Ct-165
[**2181-12-11**] 01:52AM BLOOD PT-12.5 PTT-22.6 INR(PT)-1.1
[**2181-12-9**] 05:50AM BLOOD Plt Ct-135*
[**2181-12-8**] 12:02PM BLOOD Plt Ct-124*
[**2181-12-7**] 04:57PM BLOOD PT-11.7 PTT-24.0 INR(PT)-0.9
[**2181-12-6**] 01:49AM BLOOD Plt Ct-79* LPlt-1+
[**2181-12-13**] 10:16AM BLOOD Fibrino-417*
[**2181-12-12**] 05:39AM BLOOD Fibrino-516*
[**2181-12-11**] 01:52AM BLOOD Fibrino-444*
[**2181-12-8**] 12:02PM BLOOD Fibrino-347
[**2181-12-7**] 04:57PM BLOOD Fibrino-444*
[**2181-12-6**] 01:49AM BLOOD Fibrino-301
[**2181-12-13**] 10:16AM BLOOD Creat-0.7
[**2181-12-11**] 01:52AM BLOOD Creat-0.8
[**2181-12-9**] 05:50AM BLOOD Glucose-83 UreaN-37* Creat-1.1 Na-143
K-4.2 Cl-107 HCO3-29 AnGap-11
[**2181-12-8**] 05:34AM BLOOD Glucose-88 UreaN-55* Creat-1.7* Na-141
K-4.3 Cl-107 HCO3-28 AnGap-10
[**2181-12-6**] 11:45PM BLOOD Glucose-104 UreaN-52* Creat-2.5* Na-137
K-4.4 Cl-101 HCO3-24.7 AnGap-16
[**2181-12-6**] 06:39AM BLOOD Glucose-121* UreaN-43* Creat-2.8* Na-134
K-4.3 Cl-101 HCO3-25 AnGap-12
[**2181-12-13**] 10:16AM BLOOD ALT-190* AST-48* TotBili-1.4 DirBili-0.5*
IndBili-0.9
[**2181-12-11**] 01:52AM BLOOD ALT-329*
[**2181-12-10**] 06:28AM BLOOD ALT-393* AST-89*
[**2181-12-7**] 04:33AM BLOOD ALT-1205* AST-730* LD(LDH)-997*
AlkPhos-154* TotBili-1.2
[**2181-12-6**] 04:05PM BLOOD ALT-1526* AST-1304* LD(LDH)-2106*
AlkPhos-139* TotBili-0.8
[**2181-12-6**] 06:39AM BLOOD ALT-1828* AST-[**2163**]* LD(LDH)-2600*
AlkPhos-134* TotBili-0.8
[**2181-12-6**] 01:49AM BLOOD ALT-[**2159**]* AST-2427* LD(LDH)-3055*
AlkPhos-132* TotBili-0.8
[**2181-12-13**] 10:16AM BLOOD UricAcd-4.5
[**2181-12-12**] 05:39AM BLOOD UricAcd-5.0
[**2181-12-11**] 09:30AM BLOOD Albumin-2.6* Iron-46
[**2181-12-11**] 01:52AM BLOOD UricAcd-6.3*
[**2181-12-8**] 05:34AM BLOOD Calcium-6.8* Phos-5.2* Mg-3.4*
[**2181-12-7**] 04:33AM BLOOD Calcium-7.7* Phos-5.9* Mg-4.7*
UricAcd-11.0*
[**2181-12-6**] 04:05PM BLOOD Calcium-6.5* Phos-5.6* Mg-6.0*
UricAcd-9.1*
[**2181-12-6**] 01:49AM BLOOD Albumin-2.1* Calcium-4.4* Phos-6.1*
Mg-7.5* UricAcd-7.0*

Brief Hospital Course:
36yoF w/h/o severe preeclampsia who is transferred for
management of HELLP syndrome after emergent c-section.  She is
also s/p emergent HD for hyperkalemia in the setting of ARF
prior to transfer. Pt initially admitted to ICU then transferred
once hemodynamically more stable pt transferred to postpartum
floor on [**2181-12-8**].
.
# HELLP syndrome: The patient presented with LFTs to 3000s,
platelets to 40,000s and ARF to 1.9  s/p c-section. DIC labs
were sent (details above). Once in the ICU the patient was
clinically volume overloaded and subsequently diureses 2L after
a dose of lasix. Pt treated with Mg for 24hours.  The patient's
LFTs and Cr continued to improve, while the CBC remained stable.
 Upon transfer from ICU, daily CBC and LFT's followed and
continued to trend downward. On HD#5 pt c/o increasing RUQ pain.
 Repete labs were checked and stat CT ordered to r/o hepatic
pathology. Repeat labs demonstrated decreased LFTs and Uric
Acid. Hct and Plt increased.  CT scan demonstrated perfusion
defects consistent with HELLP.  Gen [**Doctor First Name **] consulted who then
consulted hepato-billiary. Hepatobilliary requested RUQ U/S and
dopplers to r/o portal vein thrombus.  Imaging demonstrated
heterogeneous appearance of the liver, however, without focal
lesion. Widely patent portal vein, hepatic arteries and vein.
Note was made of mildly elevated velocities in the main portal
vein of undetermined
significance. LFTs continued to trend downward and pain in RUQ
decreased significantly.  Pt tolerated regular diet, was
ambulating, and having bowelm movements when discharged.
.
# Heme: The patient was initially oozing at the site, HCT stable
x 24 h; had hypotension post-op, but hemodynamically stable on
transfer to [**Hospital1 18**] ICU. Records from the OSH revealed no
subcapsular liver hematoma. CT scan from outside hospital showed
moderate intraperitoneal free fluid, likely represents
hemoperitenum.  Pt initially grossly fluid overloaded
w/increased oxygen requirement.  Pt then diuresed with IV lasix
goal.  Cr trended downward to normal range.  HCT stabilized at
24. Repete CT [**12-11**] demonstrated no subcapsular liver hematoma.
.
# Renal: ARF c/b hyperkalemia: in the setting of relative
hypotension on post-op day 1/day of transfer. A hemodialysis
catheter was placed [**12-5**] with HD subsequently performed evening
of [**12-5**] at outside hospital. Renal was consulted, the patient
was started on Cipro for a UTI.  Pt diuresed as needed by ICU
team. No need for further lasix when pt transfered to floor. Cr
and K stabilized WNL with no need for further HD. Calcium
repleted as needed.  Anion gap metabolic acidosis on arrival in
the setting of ARF and elevated BUN/Cr, no evidence of sepsis,
but also possible lactate elevated in the setting of hepatic
failure.  Resolved with resolution of HELLP.
.
# CV: Pt initially hypotensive on POD#1 and then BPs became
elevated consistent with PreEclampsia 140-160s/80-90. BP
normalized with labetolol 200mg [**Hospital1 **].
.
#Pulm: On arrival to ICU pt had oxygen requirements. Pulmonary
effusions resolved with lasix in ICU.  Transferred out of ICU on
2LNC.  Pt gradually weaned to room air.
.
#GI: Pt had illeus in ICU which resolved by time of transfer to
the floor.  Diet advanced slowly until pt able to tolerate
regular diet without problem.




Medications on Admission:
none

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
2. Labetalol 200 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
3. Ibuprofen 600 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed.
Disp:*50 Tablet(s)* Refills:*2*
4. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed.
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
s/p c/section. severe HELLP syndrome. acute tubular necrosis.
hepatic imfact.


Discharge Condition:
stable


Discharge Instructions:
per post c/section instruction sheet. call for increased abd
pain, headache, vaginal bleeding

Followup Instructions:
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] [**Name12 (NameIs) **] Phone:[**Telephone/Fax (1) 17200**]
Date/Time:[**2181-12-20**] 1:30
{'Severe pre-eclampsia, postpartum condition or complication,Infections of genitourinary tract in pregnancy, postpartum condition or complication,Acute kidney failure following labor and delivery, postpartum condition or complication,Urinary tract infection, site not specified,Hepatic infarction,Other current conditions classifiable elsewhere of mother, postpartum condition or complication'}


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: HELLP syndrome

PRESENT ILLNESS: 36yoF w/ h/o severe preeclampsia who was transferred from an OSH
for management of HELLP syndrome after emergent c-section on day
prior to transfer at 33weeks gestation.  She initially presented
to OSH 2 days PTA w/right arm and RUQ pain as well as N/V.
Initial vitals were BP 150s-170s/80s-120s max reported BP
178/123. Her platelets were 91, LFTs were AST 289 ALT 279 Uric
Acid 7.6 and Cr 1.07.
BP was stabilized and she was emergently taken to the OR for
c-section. In the OR, she received 3L IVF and had 700ccEBL.
C-section was c/b oozine [**Doctor Last Name **] bleeding at the site. She was
subsequently transfused w/1 unit of platelets and 4 units of
PRBCs. Per report, baby was stable with apgars of [**8-24**].
Post op, she received Mag sulfate bolus and then IV drip at
2mg/kg and dexamethasone 10 mg IV x 2 as well as dilaudid IV for
pain and zofran. She had episodes of hypotension throughout the
day. Labs were closely monitored and were notable for rising
potassium and Cr.
.
Prior to transfer, she had HD line placed and was emergently
dialyzed for hyperkalemia to 6.7 in the setting of possible ATN.
Per report, they were only able to ultrafilter her due to
hypotension.
.
ROS: She notes that she had spotty vision 2-3 weeks prior to
presentation. She otherwise denies HA/dizzyness/focal weakness.
The patient denies any fevers, chills, diarrhea, constipation,
melena, hematochezia, chest pain, shortness of breath,
orthopnea, PND, lower extremity edema, cough, urinary frequency,
urgency, dysuria, lightheadedness, gait unsteadiness, rash or
skin changes.

MEDICAL HISTORY: h/o severe preeclampsia requiring urgent c-section w/her first
child in '[**72**]
no h/o abnormal paps/STDs

MEDICATION ON ADMISSION: none

ALLERGIES: Acetaminophen

PHYSICAL EXAM: On Admission:
Vitals: T: 97.2 BP: 114/71 HR: 95 RR: 18 O2Sat: 94% 4LNC
GEN: anasarcic, no acute distress
HEENT: + facial edema, EOMI, PERRL, sclera anicteric, no
epistaxis or rhinorrhea, dry MM, OP Clear
NECK: difficult to assess JVP w/edema, no cervical
lymphadenopathy, trachea midline
COR: RRR, + soft systolic murmur, no G/R, normal S1 S2, radial
pulses +2
PULM: Lungs crackles at bases BL, no W/R/R
ABD: Soft, NT, ND, +BS, no HSM, no masses; wound c/d/i
EXT: No C/C/E, no palpable cords
NEURO: alert, oriented to person, place, and time. CN II ?????? XII
grossly intact. Moves all 4 extremities. Strength 5/5 in upper
and lower extremities. Patellar DTR +1. Plantar reflex
downgoing. No gait disturbance. No cerebellar dysfunction.
SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses.

FAMILY HISTORY: mother- HTN, h/o eclampsia, and sister w/h/o eclampsia; father-
throat CA.

SOCIAL HISTORY: Lives with her husband and nine year old son; no tobacco, etoh,
illicits. 

### Response:
{'Severe pre-eclampsia, postpartum condition or complication,Infections of genitourinary tract in pregnancy, postpartum condition or complication,Acute kidney failure following labor and delivery, postpartum condition or complication,Urinary tract infection, site not specified,Hepatic infarction,Other current conditions classifiable elsewhere of mother, postpartum condition or complication'}
