CHIEF COMPLAINT: Hypoxemic respiratory distress

PRESENT ILLNESS: Mrs. [**Known lastname 8980**] is a 40 year old pregnant woman at 6 weeks EGA with
a past medical history significant for asthma admitted on [**3-3**]
for fever, cough, and dyspnea felt to be due to CAP now
transferred to the MICU for hypoxemic respiratory distress.  The
patient reports that symptoms started 3 days ago with fever to
100.7 (ear) and non-productive cough, with progressively
worsening dyspnea on minimal exertion such that on the day of
admission she had difficulty walking to her bathroom. She does
have a history of well controlled asthma, although states that
her current symptoms are not consistent with prior asthma flare
although dypsnea did improve with albuterol MDI.  She does
endorse rhinorrhea and fatigue, but denies any sore throat,
myalgias, LBP, sinus congestion, or wheezing.  Her husband had a
cough several days ago, but denies any other sick contacts or
recent travel.  She initially presented to an OSH ED, where she
had a CXR demonstrating bilateral lower lung field opacities
(R>L) felt to be CAP and was treated with CTX and azithromycin,
and was transferred to [**Hospital1 18**] for further management.
.
Her [**Hospital1 18**] course has been notable for a persistent tachcyardia,
tachypnea, and an increasing oxygen requirement now up to a 15L
face mask from 4L on admission.  ABG prior to MICU transfer
7.48/28/72 on 50% FM.  Given persistent tachycardia, tachypnea,
and increasing oxygen requirement, she was transferred to the
MICU for further management.
.
Currently, the patient states that her breathing is improved
after a neb treatment. She denies any CP, palpitations, ST, HA,
LBP, muscle aches, or wheezing.

MEDICAL HISTORY: 1. Asthma. Only requires albuterol with URI's. Under good
control
on flovent 110mcg 2 puffs [**Hospital1 **]. No nocturnal awakenings, ICU
admissions, inbutations, or ED visits.
2. B12 deficiency. Had low B12 in 180's in [**2175**] and has been on

MEDICATION ON ADMISSION: ALBUTEROL SULFATE - 90 mcg HFA Aerosol Inhaler - 2 puffs qid prn

ALLERGIES: Sulfa (Sulfonamide Antibiotics) / Progesterone in Oil

PHYSICAL EXAM: ADMISSION:
VS: 99.8 105 130/93 37 96% on 50% venturi
Gen: Labored breathing
HEENT: MM dry, OP clear, neck supple without LAD
CV: Tachy S1+S2
Pulm: Bronchial breath sounds at the bases bilaterally with
dullness to percussion. Scattered expiratory wheezes
bilaterally.
Abd: S/NT/ND +bs
Ext: No c/c/e.
Neuro: AOx3, CN II-XII intact.

FAMILY HISTORY: Mother - MI age 70, non-melanoma skin
CA, DM. Father - prostate CA, AAA, DM. Maternal aunt/uncle -
melanoma. 5 of 8 maternal aunts/uncles with CAD in 60-70's. 4 of

SOCIAL HISTORY: Married, no children, undergoing fertility tx and is currently 6
weeks pregnant. Has 8 yr old stepson. Works in HR. Tobacco -
None. EtOH - social. Denies IV, illicit or herbal drug use.
Other current conditions classifiable elsewhere of mother, antepartum condition or complication,Unspecified septicemia,Sepsis,Pulmonary eosinophilia,Acidosis,Asthma, unspecified type, unspecified,Other specified infectious and parasitic diseases of mother, antepartum condition or complication,Elderly primigravida, antepartum condition or complication,Secondary diabetes mellitus without mention of complication, not stated as uncontrolled, or unspecified,Adrenal cortical steroids causing adverse effects in therapeutic use,Transient hypertension of pregnancy, antepartum condition or complication
Oth curr cond-antepartum,Septicemia NOS,Sepsis,Pulmonary eosinophilia,Acidosis,Asthma NOS,Infect dis NEC-antepart,Elder primigravid-antepa,Sec DM wo cmp nt st uncn,Adv eff corticosteroids,Trans hyperten-antepart
Admission Date:  [**2184-3-3**]              Discharge Date:   [**2184-3-8**]

Date of Birth:  [**2143-4-11**]             Sex:   F

Service: MEDICINE

Allergies:
Sulfa (Sulfonamide Antibiotics) / Progesterone in Oil

Attending:[**First Name3 (LF) 348**]
Chief Complaint:
Hypoxemic respiratory distress


Major Surgical or Invasive Procedure:
None

History of Present Illness:
Mrs. [**Known lastname 8980**] is a 40 year old pregnant woman at 6 weeks EGA with
a past medical history significant for asthma admitted on [**3-3**]
for fever, cough, and dyspnea felt to be due to CAP now
transferred to the MICU for hypoxemic respiratory distress.  The
patient reports that symptoms started 3 days ago with fever to
100.7 (ear) and non-productive cough, with progressively
worsening dyspnea on minimal exertion such that on the day of
admission she had difficulty walking to her bathroom. She does
have a history of well controlled asthma, although states that
her current symptoms are not consistent with prior asthma flare
although dypsnea did improve with albuterol MDI.  She does
endorse rhinorrhea and fatigue, but denies any sore throat,
myalgias, LBP, sinus congestion, or wheezing.  Her husband had a
cough several days ago, but denies any other sick contacts or
recent travel.  She initially presented to an OSH ED, where she
had a CXR demonstrating bilateral lower lung field opacities
(R>L) felt to be CAP and was treated with CTX and azithromycin,
and was transferred to [**Hospital1 18**] for further management.
.
Her [**Hospital1 18**] course has been notable for a persistent tachcyardia,
tachypnea, and an increasing oxygen requirement now up to a 15L
face mask from 4L on admission.  ABG prior to MICU transfer
7.48/28/72 on 50% FM.  Given persistent tachycardia, tachypnea,
and increasing oxygen requirement, she was transferred to the
MICU for further management.
.
Currently, the patient states that her breathing is improved
after a neb treatment. She denies any CP, palpitations, ST, HA,
LBP, muscle aches, or wheezing.


Past Medical History:
1. Asthma. Only requires albuterol with URI's. Under good
control
on flovent 110mcg 2 puffs [**Hospital1 **]. No nocturnal awakenings, ICU
admissions, inbutations, or ED visits.
2. B12 deficiency. Had low B12 in 180's in [**2175**] and has been on

folgard since then with normal B12 levels. This was just stopped

when she was changed to prenatal vitamin, was told that it has
B12 in it.
3. Severely atypical nevus removed from her back. Sees Dr.
[**Last Name (STitle) 8981**] yearly, saw her last over the summer.
4. Pregnancy - 6 wks EGA with IVF treatments.


Social History:
Married, no children, undergoing fertility tx and is currently 6
weeks pregnant. Has 8 yr old stepson. Works in HR. Tobacco -
None. EtOH - social. Denies IV, illicit or herbal drug use.


Family History:
Mother - MI age 70, non-melanoma skin
CA, DM. Father - prostate CA, AAA, DM. Maternal aunt/uncle -
melanoma. 5 of 8 maternal aunts/uncles with CAD in 60-70's. 4 of

paternal aunts/uncles w/ CAD in 30-50's. MGF - DM. MGM - CAD
50-60's. PGM - CAD 50-60's. No family h/o clotting disorders


Physical Exam:
ADMISSION:
VS: 99.8 105 130/93 37 96% on 50% venturi
Gen: Labored breathing
HEENT: MM dry, OP clear, neck supple without LAD
CV: Tachy S1+S2
Pulm: Bronchial breath sounds at the bases bilaterally with
dullness to percussion. Scattered expiratory wheezes
bilaterally.
Abd: S/NT/ND +bs
Ext: No c/c/e.
Neuro: AOx3, CN II-XII intact.

DISCHARGE:
VS: afebrile, 140s/80s, 70-80, 98% on RA
GA: AOx3, NAD
HEENT:  PERRLA. MMM. no LAD. no JVD. neck supple.
Cards:  RRR S1/S2 heard. no murmurs/gallops/rubs.
Pulm: CTAB
Abd: soft, NT, +BS. no g/r.
Extremities: wwp, no edema. DPs, PTs 2+.
Neuro/Psych: CNs II-XII intact. 5/5 strength in U/L extremities.

Pertinent Results:
RELEVANT AND REPRESENTATIVE LABS:
CBC and coags:
-[**2184-3-3**] 05:40PM BLOOD WBC-27.1*# RBC-4.37 Hgb-14.0 Hct-39.4
MCV-90 MCH-32.0 MCHC-35.5* RDW-12.6 Plt Ct-462*
   -[**2184-3-3**] 05:40PM BLOOD Neuts-77.9* Lymphs-7.6* Monos-2.8
Eos-11.6* Baso-0.2
   -[**2184-3-4**] 06:24AM BLOOD Neuts-72.9* Lymphs-8.1* Monos-2.6
Eos-15.9* Baso-0.3
-[**2184-3-5**] 03:35AM BLOOD WBC-20.4* RBC-3.94* Hgb-12.5 Hct-35.5*
MCV-90 MCH-31.7 MCHC-35.1* RDW-12.5 Plt Ct-405
   -[**2184-3-5**] 03:35AM BLOOD Neuts-84* Bands-1 Lymphs-5* Monos-6
Eos-1 Baso-0 Atyps-0 Metas-1* Myelos-2*
-[**2184-3-7**] 07:20AM BLOOD WBC-14.6* RBC-3.76* Hgb-11.6* Hct-33.9*
MCV-90 MCH-30.7 MCHC-34.1 RDW-12.6 Plt Ct-381
-[**2184-3-8**] 07:30AM BLOOD WBC-13.8* RBC-3.66* Hgb-11.7* Hct-32.7*
MCV-89 MCH-32.1* MCHC-35.9* RDW-12.5 Plt Ct-352
-[**2184-3-6**] 04:47AM BLOOD PT-13.1 PTT-23.4 INR(PT)-1.1
.
Chem:
-[**2184-3-3**] 05:40PM BLOOD Glucose-90 UreaN-8 Creat-0.6 Na-138
K-4.0 Cl-103 HCO3-21*
-[**2184-3-5**] 03:35AM BLOOD Glucose-140* UreaN-9 Creat-0.6 Na-138
K-3.7 Cl-106 HCO3-21*
-[**2184-3-7**] 07:20AM BLOOD Glucose-129* UreaN-14 Creat-0.5 Na-136
K-4.1 Cl-103 HCO3-24
-[**2184-3-8**] 07:30AM BLOOD Glucose-75 UreaN-13 Creat-0.6 Na-136
K-3.3 Cl-103 HCO3-24
.
LFTs
-[**2184-3-4**] 06:24AM BLOOD ALT-15 AST-16 LD(LDH)-238 AlkPhos-57
TotBili-0.3
.
Misc:
-[**2184-3-6**] 04:47AM BLOOD calTIBC-230* Ferritn-185* TRF-177*
-[**2184-3-4**] 02:35PM BLOOD ANCA-NEGATIVE B
-[**2184-3-3**] 05:40PM BLOOD HCG-7597
-[**2184-3-3**] 05:53PM BLOOD Lactate-1.4
.
.
IMAGING:
.
TVUS [**3-4**]:
Single live intrauterine gestation corresponding to a
gestational
age of 6 weeks 4 days.
.
CXR [**3-4**]:
Moderate-to-severe pulmonary edema, without evidence of pleural
effusions.  Borderline size of the cardiac silhouette. No
interval appearance of new parenchymal opacities.
.
SPIROMETRY	10:30 AM	Pre drug	Post drug
 	 	Actual	Pred	%Pred	Actual	%Pred	%chg
FVC	 	2.81	3.44	82	 	 	
FEV1	 	2.55	2.67	95	 	 	
MMF	 	4.09	3.13	131	 	 	
FEV1/FVC	 	91	78	117	

Brief Hospital Course:
Mrs. [**Known lastname 8980**] is a 40 year old pregnant woman at 6 weeks EGA by
IVF with a past medical history significant for asthma admitted
on [**3-3**] for fever, cough, and dyspnea felt to be due to CAP, but
found to have eosinophilic pneumonitis.

# Eosinophilic pneumonitis: Patient's A-a gradient was >180 with
potential etiologies including V/Q mismatch, diffusion
abnormality, or shunt.  Given absolute eosinophilic count of
>3000, fever, and acute shortness of breath, the diagnosis of
acute eosinophilic pneumonia was presumptively made.  She was
treated with solumedrol 125 Q6H with improvement in symptoms and
rapid weaning of supplemental oxygen to room air.  She was also
covered for pneumonia initially with vancomycin and
levofloxacin, but the regimen was narrowed to a 5 day course of
azithromycin, which she completed while hospitalized.  She was
also initially treated with oseltamavir, which was discontinued
after Influenza DFA returned negative.  Patient was transitioned
to prednisone 60 mg daily, and she will continue this dose until
follow-up with Dr. [**First Name8 (NamePattern2) 8982**] [**Last Name (NamePattern1) 7273**] as an outpatient.  Her
eosinophilic pneumonitis was felt to be secondary to IM
progesterone in sesame oil suspension, and progesterone was
changed to intravaginal preparation.  She will require PCP
prophylaxis if steroid course continues for longer than 1 month,
and this will be determined as an outpatient.

# Pregnancy: Intravaginal fetal u/s performed during MICU course
demonstrating viable fetus. OB consulted on the patient, and
[**Last Name (un) **] was also consulted for blood glucose control (see below).
 She will continue intravaginal progesterone as above, and
follow-up with OB/Gyn.

# Hyperglycemia: elevated FSBG in the setting of steroid use.
Patient was started on sliding scale insulin [**First Name8 (NamePattern2) **] [**Last Name (un) **] recs for
goal fingerstick <130 at one hour post-prandial.  She will
continue insulin at home and f/u with the Diabetes in Pregnancy
Center at [**Last Name (un) **].

# Asthma: Continued on nebs during admission.

# Code: full

Medications on Admission:
ALBUTEROL SULFATE - 90 mcg HFA Aerosol Inhaler - 2 puffs qid prn

FLUTICASONE [FLOVENT HFA] - 110 mcg/Actuation Aerosol - 2 puffs

twice a day
PRENATAL VIT-IRON FUMARATE-FA [PRENATAL VITAMIN] - (Prescribed
by Other Provider) - Dosage uncertain
PROGESTERONE 50 mg/mL 1 mL QHS at 8:30 pm


Discharge Medications:
1. Prenatal 10-400 mg-mcg Capsule Sig: One (1) Capsule PO once a
day.
2. progesterone micronized 8 % Gel Sig: One (1) Appl Vaginal QHS
(once a day (at bedtime)) for 4 weeks.
[**Last Name (un) **]:*QS gel* Refills:*0*
3. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
1-2 Puffs Inhalation Q6H (every 6 hours) as needed for shortness
of breath, wheeze.
4. Supplies
"Humalog Kwik-pen" 1 box of 5 pens

5. Supplies
Humalog "pen needle" 31x3/16 needle, 200 needles

6. One Touch Delica Lancets     Misc Sig: One (1) lancet
Miscellaneous four times a day: fasting and 1hour post-meals.
[**Last Name (un) **]:*200 lancets* Refills:*0*
7. One Touch Test     Strip Sig: One (1) strip Miscellaneous
four times a day: fasting and 1hour post-meal.
[**Last Name (un) **]:*200 strips* Refills:*0*
8. prednisone 20 mg Tablet Sig: Three (3) Tablet PO once a day:
Take until you see pulmonary doctors.
[**Last Name (Titles) **]:*75 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Eosinophilic pneumonitis
Hyperglycemia


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


Discharge Instructions:
You were seen in the hospital for shortness of breath, likely
caused by eosinophilic pneumonitis (pneumonia associated with an
increase in a white blood cell called eosinophils).  This
improved with steroids.  Please continue taking prednisone 60 mg
daily until you see Dr. [**Last Name (STitle) 7273**] at your followup appointment.

You were also found to have elevated blood sugars after being
started on prednisone, which is a common side effect.  Please
continue taking insulin with meals as directed.  You should
follow up with an endocrinologist at the [**Hospital **] clinic as
indicated below.

Changes to your medications:
-START taking humalog insulin as directed by [**Last Name (un) **]: 6units
before breakfast, 6units before lunch, 7units before dinner
-START taking prednisone 60 mg daily until you see Dr. [**Last Name (STitle) 7273**]
[**Name (STitle) 8983**] taking progesterone IM shots, and START taking
progesterone intravaginally daily

Followup Instructions:
Dr. [**Last Name (STitle) 8984**] (maternal fetal medicine specialist, OB/Gyn)
[**Location (un) 8985**] [**Location (un) 2274**] Tuesday [**3-9**] at 2pm.  You can have an ultrasound
done on either Tuesday or Wednesday (see below).

Name: [**Name6 (MD) 6507**] [**Last Name (NamePattern4) 8986**], MD
Specialty: Fertility
When: Wednesday [**3-10**] at 1:30pm
Location: [**Hospital1 641**]
Address: [**Location (un) 4363**], [**Location (un) 86**], MA
Phone: [**Telephone/Fax (1) 8987**]

Department: INTERNAL MEDICINE
When: MONDAY [**2184-3-15**] at 3:00 PM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 8988**], MD [**Telephone/Fax (1) 4775**]
Building: [**Location (un) 2790**] ([**Location (un) **], MA) [**Location (un) 551**]
Campus: OFF CAMPUS     Best Parking: Free Parking on Site

Department: PULMONARY FUNCTION LAB
When: WEDNESDAY [**2184-3-24**] at 1:10 PM
With: PULMONARY FUNCTION LAB [**Telephone/Fax (1) 609**]
Building: [**Hospital6 29**] [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: MEDICAL SPECIALTIES
Specialty: Pulmonary
When: WEDNESDAY [**2184-3-24**] at 1:30 PM
With: DR [**Last Name (STitle) **]/DR [**Last Name (STitle) **] [**Telephone/Fax (1) 612**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: OB/GYN, [**Hospital 8989**] CLINIC (Diabetes in [**Hospital **]
Clinic)
When: FRIDAY [**2184-3-26**] at 10:00 AM
With: [**First Name11 (Name Pattern1) 8990**] [**Last Name (NamePattern4) 8991**], MD [**Telephone/Fax (1) 8992**]
Specialty: Endocrinology
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 858**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
**Please call [**Doctor Last Name 8993**] at [**Telephone/Fax (1) 8994**] once you are discharged. She
is the scheduler for the pregnancy clinic here at the hospital
and she would like to speak to you to get more information.**

**You can also call [**Telephone/Fax (1) 3681**] to set up an appointment to see
a nutritionist.**
{'Other current conditions classifiable elsewhere of mother, antepartum condition or complication,Unspecified septicemia,Sepsis,Pulmonary eosinophilia,Acidosis,Asthma, unspecified type, unspecified,Other specified infectious and parasitic diseases of mother, antepartum condition or complication,Elderly primigravida, antepartum condition or complication,Secondary diabetes mellitus without mention of complication, not stated as uncontrolled, or unspecified,Adrenal cortical steroids causing adverse effects in therapeutic use,Transient hypertension of pregnancy, antepartum 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: Hypoxemic respiratory distress

PRESENT ILLNESS: Mrs. [**Known lastname 8980**] is a 40 year old pregnant woman at 6 weeks EGA with
a past medical history significant for asthma admitted on [**3-3**]
for fever, cough, and dyspnea felt to be due to CAP now
transferred to the MICU for hypoxemic respiratory distress.  The
patient reports that symptoms started 3 days ago with fever to
100.7 (ear) and non-productive cough, with progressively
worsening dyspnea on minimal exertion such that on the day of
admission she had difficulty walking to her bathroom. She does
have a history of well controlled asthma, although states that
her current symptoms are not consistent with prior asthma flare
although dypsnea did improve with albuterol MDI.  She does
endorse rhinorrhea and fatigue, but denies any sore throat,
myalgias, LBP, sinus congestion, or wheezing.  Her husband had a
cough several days ago, but denies any other sick contacts or
recent travel.  She initially presented to an OSH ED, where she
had a CXR demonstrating bilateral lower lung field opacities
(R>L) felt to be CAP and was treated with CTX and azithromycin,
and was transferred to [**Hospital1 18**] for further management.
.
Her [**Hospital1 18**] course has been notable for a persistent tachcyardia,
tachypnea, and an increasing oxygen requirement now up to a 15L
face mask from 4L on admission.  ABG prior to MICU transfer
7.48/28/72 on 50% FM.  Given persistent tachycardia, tachypnea,
and increasing oxygen requirement, she was transferred to the
MICU for further management.
.
Currently, the patient states that her breathing is improved
after a neb treatment. She denies any CP, palpitations, ST, HA,
LBP, muscle aches, or wheezing.

MEDICAL HISTORY: 1. Asthma. Only requires albuterol with URI's. Under good
control
on flovent 110mcg 2 puffs [**Hospital1 **]. No nocturnal awakenings, ICU
admissions, inbutations, or ED visits.
2. B12 deficiency. Had low B12 in 180's in [**2175**] and has been on

MEDICATION ON ADMISSION: ALBUTEROL SULFATE - 90 mcg HFA Aerosol Inhaler - 2 puffs qid prn

ALLERGIES: Sulfa (Sulfonamide Antibiotics) / Progesterone in Oil

PHYSICAL EXAM: ADMISSION:
VS: 99.8 105 130/93 37 96% on 50% venturi
Gen: Labored breathing
HEENT: MM dry, OP clear, neck supple without LAD
CV: Tachy S1+S2
Pulm: Bronchial breath sounds at the bases bilaterally with
dullness to percussion. Scattered expiratory wheezes
bilaterally.
Abd: S/NT/ND +bs
Ext: No c/c/e.
Neuro: AOx3, CN II-XII intact.

FAMILY HISTORY: Mother - MI age 70, non-melanoma skin
CA, DM. Father - prostate CA, AAA, DM. Maternal aunt/uncle -
melanoma. 5 of 8 maternal aunts/uncles with CAD in 60-70's. 4 of

SOCIAL HISTORY: Married, no children, undergoing fertility tx and is currently 6
weeks pregnant. Has 8 yr old stepson. Works in HR. Tobacco -
None. EtOH - social. Denies IV, illicit or herbal drug use. 

### Response:
{'Other current conditions classifiable elsewhere of mother, antepartum condition or complication,Unspecified septicemia,Sepsis,Pulmonary eosinophilia,Acidosis,Asthma, unspecified type, unspecified,Other specified infectious and parasitic diseases of mother, antepartum condition or complication,Elderly primigravida, antepartum condition or complication,Secondary diabetes mellitus without mention of complication, not stated as uncontrolled, or unspecified,Adrenal cortical steroids causing adverse effects in therapeutic use,Transient hypertension of pregnancy, antepartum condition or complication'}
