CHIEF COMPLAINT: Sepsis.

PRESENT ILLNESS: Mr. [**Known lastname 37404**] is a 32 year-old man with no significant past
medical history who presents with sepsis.

MEDICAL HISTORY: 1. Palpatations with accesory pathway
2. Low back pain
3. Tonsillitis three to four times per year as a child
4. GERD

MEDICATION ON ADMISSION: 1. Multivitamin
2. Prilosec 20mg daily

ALLERGIES: All allergies / adverse drug reactions previously recorded have
been deleted

PHYSICAL EXAM: Vitals - T 102.0, BP 143/70, HR 114, RR 18, 100%.
GEN - Overweight man, lying in bed.  Ill-appearing, but not
toxic.
HEENT - OP shows left sided tonsil with crypts.  Some erythema.
No obvious exudate.  No cervical, submandibular LAD.  RIJ in
place.  Neck is supple.  Dry MM.
CV - Tachycardic.  No murmurs.
PULM - Clear.  No wheeze/rales/rhonchi
ABD - Soft.  Non-tender.  Non-distended.
EXT - Warm.  No edema.
SKIN - Warm to hot.  Birthmark on right abdominal wall.  No
rash.
NEURO - Alert and oriented.  Non-focal.

FAMILY HISTORY: Father with diabetes mellitus.

SOCIAL HISTORY: He is an immigrant of Moroccan extraction.  He currently owns
his own limousine company.  He is married, has a 2-year-old son.
 His son, his wife, and his father all lives in his home.  He is
a former cigarette smoker, he smoked approximately less than a
pack a day.  He would over drink one to two alcoholic beverages
per week, and he has had none in over 4 years.
Unspecified septicemia,Septic shock,Acute kidney failure, unspecified,Paroxysmal ventricular tachycardia,Acidosis,Severe sepsis,Esophageal reflux,Herpes simplex without mention of complication,Streptococcal sore throat
Septicemia NOS,Septic shock,Acute kidney failure NOS,Parox ventric tachycard,Acidosis,Severe sepsis,Esophageal reflux,Herpes simplex NOS,Strep sore throat
Admission Date:  [**2183-3-6**]              Discharge Date:   [**2183-3-10**]

Date of Birth:  [**2151-1-20**]             Sex:   M

Service: MEDICINE

Allergies:
All allergies / adverse drug reactions previously recorded have
been deleted

Attending:[**First Name3 (LF) 783**]
Chief Complaint:
Sepsis.

Major Surgical or Invasive Procedure:
Central Venous Line Placement.

History of Present Illness:
Mr. [**Known lastname 37404**] is a 32 year-old man with no significant past
medical history who presents with sepsis.

The patient was in his usual state of health until the day of
admission when he began feeling nauseous with vomiting [**3-22**]
times.  He also reports a mild headache (all over) and fevers
(none recorded) and rigors.  Also with total body aches for
which he has been using tylenol.  He visited [**Country 3400**] in
[**Month (only) **], then the [**Country 13622**] Republic in [**Month (only) 404**].  Otherwise no
recent travel.

ROS:
(-) Weight change
(+) Night sweats; chronic for many years
(-) Neck stiffness
(-) Abdominal pain, diarrhea, constipation

In reviewing OMR, there are repeated visits to [**Company 191**] with
diagnosis of viral pharyngitis.  His most recent presentation
was in [**2182-11-16**] at which time he had complaints of "sore
throat" which was thought to be of viral origin.  He then
presented to [**Company 191**] on [**2182-12-20**] with continued sore throat, along
with left-sided tonsil pain.  Per the OMR note, the exam at that
time showed "Oropharynx with large edematous tonsils, left
greater than right, but only slightly erythematous.  No
exudate."  He was treated empirically with Azithromycin.  He
feels that the Azithro helped somewhat.

In the ED, initial vitals showed a T of 101.2, HR 125, BP
109/62, RR 16 and 100%.  When his blood pressure fell to 84/49
he was bolused with IVF and a sepsis line was placed.  Up to 4
liters of NS were given, along wiht CTX, levaquin and Tamiflu.


Past Medical History:
1. Palpatations with accesory pathway
2. Low back pain
3. Tonsillitis three to four times per year as a child
4. GERD


Social History:
He is an immigrant of Moroccan extraction.  He currently owns
his own limousine company.  He is married, has a 2-year-old son.
 His son, his wife, and his father all lives in his home.  He is
a former cigarette smoker, he smoked approximately less than a
pack a day.  He would over drink one to two alcoholic beverages
per week, and he has had none in over 4 years.

Family History:
Father with diabetes mellitus.

Physical Exam:
Vitals - T 102.0, BP 143/70, HR 114, RR 18, 100%.
GEN - Overweight man, lying in bed.  Ill-appearing, but not
toxic.
HEENT - OP shows left sided tonsil with crypts.  Some erythema.
No obvious exudate.  No cervical, submandibular LAD.  RIJ in
place.  Neck is supple.  Dry MM.
CV - Tachycardic.  No murmurs.
PULM - Clear.  No wheeze/rales/rhonchi
ABD - Soft.  Non-tender.  Non-distended.
EXT - Warm.  No edema.
SKIN - Warm to hot.  Birthmark on right abdominal wall.  No
rash.
NEURO - Alert and oriented.  Non-focal.

Pertinent Results:
Lactate: 4.3 --> 2.3 --> 1.7
.
1.004 / 7.0
.
138  99  14
------------ 118
4.4  24  1.3
.
WBC: 18.7
PLT: 267
HCT: 42.2
N:90.9 Band:0 L:6.1 M:2.6 E:0.1 Bas:0.3
.
ABD US ([**2183-3-6**]): 1.  Increased liver echogenicity is mostly
consistent with the fatty liver, however, other liver disease
and more advanced liver disease including cirrhosis/fibrosis
cannot be excluded.
2.  Normal gallbladder with no evidence of cholecystitis or
cholelithiasis.
.
.
.
.
.
.
.
.
.
.
................................................................
RADIOLOGY  Final Report
CT NECK W/CONTRAST (EG:PAROTIDS)  [**2183-3-7**] 12:09 AM

FINDINGS: No abscess or fluid collection is noted within the
neck. Multiple pathologically enlarged nodes are noted in the
jugulodigastric regions bilaterally. For example, the large node
in the right jugulodigastric area measures 2.3 x 1 cm. The one
on the left side measures 1.6 x 1.3 cm. The nodes noted in other
stations of the neck are not pathologically enlarged. Mucosal
thickening of both maxillary sinuses is noted.

IMPRESSION: No abscess or fluid collection in the neck.
.
.
.
.
.
.
.
.
.
.
................................................................
   RADIOLOGY  Final Report
CHEST (PORTABLE AP)  [**2183-3-8**] 2:54 AM

COMPARISON: [**2183-3-7**].

As compared to the previous radiograph, there is no relevant
change. Known right-sided aortic arch. Central venous access
line in place. Normal size of the cardiac silhouette, no pleural
effusion.
.
.
.
.
.
.
.
.
.
.
................................................................

[**2183-3-10**] 04:55AM BLOOD WBC-8.3 RBC-5.55 Hgb-14.8 Hct-43.3
MCV-78* MCH-26.8* MCHC-34.3 RDW-12.8 Plt Ct-325
[**2183-3-9**] 04:02AM BLOOD WBC-9.2 RBC-5.18 Hgb-13.8* Hct-41.2
MCV-80* MCH-26.7* MCHC-33.6 RDW-12.5 Plt Ct-239
[**2183-3-8**] 04:27AM BLOOD WBC-16.3* RBC-4.39* Hgb-12.0* Hct-34.3*
MCV-78* MCH-27.3 MCHC-34.9 RDW-12.7 Plt Ct-196
[**2183-3-7**] 12:55AM BLOOD WBC-20.3* RBC-4.74 Hgb-12.8* Hct-36.6*
MCV-77* MCH-26.9* MCHC-34.9 RDW-12.1 Plt Ct-229
[**2183-3-6**] 06:35PM BLOOD WBC-18.7*# RBC-5.43 Hgb-14.9 Hct-42.2
MCV-78* MCH-27.4 MCHC-35.2* RDW-12.2 Plt Ct-267
[**2183-3-10**] 04:55AM BLOOD Neuts-51.4 Lymphs-39.5 Monos-5.6 Eos-2.2
Baso-1.4
[**2183-3-9**] 04:02AM BLOOD Neuts-63.8 Lymphs-29.3 Monos-5.2 Eos-1.1
Baso-0.6
[**2183-3-6**] 06:35PM BLOOD Neuts-90.9* Bands-0 Lymphs-6.1* Monos-2.6
Eos-0.1 Baso-0.3
[**2183-3-10**] 04:55AM BLOOD Plt Ct-325
[**2183-3-9**] 04:02AM BLOOD Plt Ct-239
[**2183-3-8**] 04:27AM BLOOD Plt Ct-196
[**2183-3-8**] 04:27AM BLOOD PT-14.7* PTT-27.0 INR(PT)-1.3*
[**2183-3-7**] 12:55AM BLOOD Plt Ct-229
[**2183-3-7**] 12:55AM BLOOD PT-15.1* PTT-27.9 INR(PT)-1.3*
[**2183-3-6**] 06:35PM BLOOD Plt Smr-NORMAL Plt Ct-267
[**2183-3-7**] 12:55AM BLOOD ESR-4
[**2183-3-10**] 04:55AM BLOOD Glucose-111* UreaN-18 Creat-1.1 Na-138
K-4.2 Cl-102 HCO3-26 AnGap-14
[**2183-3-9**] 04:02AM BLOOD Glucose-110* UreaN-11 Creat-1.0 Na-140
K-4.1 Cl-102 HCO3-28 AnGap-14
[**2183-3-8**] 06:16PM BLOOD Glucose-111* UreaN-9 Creat-0.9 Na-138
K-3.7 Cl-102 HCO3-28 AnGap-12
[**2183-3-8**] 04:27AM BLOOD Glucose-128* UreaN-9 Creat-0.8 Na-141
K-3.6 Cl-106 HCO3-26 AnGap-13
[**2183-3-7**] 12:55AM BLOOD Glucose-147* UreaN-10 Creat-1.0 Na-140
K-3.6 Cl-108 HCO3-21* AnGap-15
[**2183-3-6**] 06:35PM BLOOD Glucose-118* UreaN-14 Creat-1.3* Na-138
K-4.4 Cl-99 HCO3-24 AnGap-19
[**2183-3-7**] 12:55AM BLOOD ALT-38 AST-28 LD(LDH)-132 CK(CPK)-75
AlkPhos-70 Amylase-66 TotBili-0.7
[**2183-3-7**] 12:55AM BLOOD Lipase-20
[**2183-3-7**] 12:55AM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2183-3-10**] 04:55AM BLOOD Calcium-10.0 Phos-5.4* Mg-2.0
[**2183-3-9**] 04:02AM BLOOD Calcium-9.6 Phos-4.4 Mg-1.9
[**2183-3-8**] 06:16PM BLOOD Calcium-9.4 Phos-2.9 Mg-2.1
[**2183-3-8**] 04:27AM BLOOD Calcium-8.5 Phos-2.4* Mg-1.7
[**2183-3-7**] 12:55AM BLOOD Albumin-3.9 Calcium-8.5 Phos-1.8* Mg-1.3*
[**2183-3-7**] 10:27AM BLOOD Cortsol-35.9*
[**2183-3-7**] 10:27AM BLOOD Cortsol-32.1*
[**2183-3-7**] 12:55AM BLOOD Cortsol-43.2*
[**2183-3-7**] 12:55AM BLOOD IgG-816 IgA-128 IgM-24*
[**2183-3-9**] 04:02AM BLOOD C3-169 C4-37
[**2183-3-6**] 11:17PM BLOOD Lactate-2.0
[**2183-3-6**] 10:17PM BLOOD Lactate-1.7
[**2183-3-6**] 07:58PM BLOOD Lactate-2.3*
[**2183-3-6**] 06:50PM BLOOD Lactate-4.3*

Brief Hospital Course:
ASSESSMENT/PLAN:
32 man with no past medical history who presents with septic
shock.
.
# Sepsis / Septic shock:  Presents with leukoctyosis,
tachycardia and hypotension along with evidence of end-organ
injury (acute renal failure) and mild lactic acidosis.  There is
no clear source of infection, though the oropharynx appears a
possible source; CT neck did not show any drainable collection
or abscess.  Central line was placed and he received IV fluids
and brief pressor support.  Cortisol testing demonstrated an
intact adrenal axis.  His ICU course was complicated by an
episode of wide complex tachycardia which was felt to likely
represent atrial tachycardia with bypass tract.  ID consultation
was obtained.  Although the etiology of his sepsis-like syndrome
was initially unclear despite extensive evaluation, he was
treated empirically with broad-spectrum antibiotics for possible
bacterial source.  Laboratory testing failed to confirm a
specific viral pathogen; HIV antibody and HIV viral load tests
returned negative, and influenza testing also returned negative
as well.  He improved clinically.  Throat culture from [**2183-3-7**]
eventually returned positive for sparse growth of Group A
beta-hemolytic strep.  He was discharged on [**3-10**] with a
presumptive diagnosis of GABHS pharyngitis complicated by
sepsis, with instructions to continue antibiotics and follow up
with Dr [**Last Name (STitle) **] in [**Company 191**].  He was also discharged with a
prescription for acyclovir in the setting of newly-developed
herpes labialis.


Medications on Admission:
1. Multivitamin
2. Prilosec 20mg daily

Discharge Medications:
1. Prilosec 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO at bedtime.
2. Hexavitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
3. Acyclovir 200 mg Capsule Sig: Two (2) Capsule PO TID (3 times
a day) for 4 days.
Disp:*22 Capsule(s)* Refills:*0*
4. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 6 days.
Disp:*6 Tablet(s)* Refills:*0*
5. Clindamycin HCl 150 mg Capsule Sig: Two (2) Capsule PO Q6H
(every 6 hours) for 6 days.
Disp:*48 Capsule(s)* Refills:*0*
6. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed.


Discharge Disposition:
Home

Discharge Diagnosis:
strep pharyngitis
shock

Secondary:
GERD
WPW
recurrant pharyngitis


Discharge Condition:
good


Discharge Instructions:
You were admitted and treated for your low blood pressure and
presumed infection.  You have had many tests sent - some are
still not resulted yet.  You also have gotten antibiotics - some
of which you will need to continue for the next several days.
You are much improved and ready for discharge.

You will need to take all medications as instructed.
You have been started on three antibiotics: levaquin,
clindamycin, and acyclovir -> you need to continue taking these.
Please continue all of your home medications.

You will need to keep all of your follow-up appointments as
scheduled.

You need to call your doctor or return to the ED if T>101.5,
chills, nausea, vomiting, rash, or any other concern.

Followup Instructions:
You have a follow-up appointment scheduled on [**2183-3-20**] at
10:20am with Dr.[**Name (NI) 20819**] nurse practitioner.  It is very
important that you keep this appointment.  Please call to
confirm [**Telephone/Fax (1) 250**].


                             [**First Name11 (Name Pattern1) 734**] [**Last Name (NamePattern1) 735**] MD, [**MD Number(3) 799**]

Completed by:[**0-0-0**]
{'Unspecified septicemia,Septic shock,Acute kidney failure, unspecified,Paroxysmal ventricular tachycardia,Acidosis,Severe sepsis,Esophageal reflux,Herpes simplex without mention of complication,Streptococcal sore throat'}


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: Sepsis.

PRESENT ILLNESS: Mr. [**Known lastname 37404**] is a 32 year-old man with no significant past
medical history who presents with sepsis.

MEDICAL HISTORY: 1. Palpatations with accesory pathway
2. Low back pain
3. Tonsillitis three to four times per year as a child
4. GERD

MEDICATION ON ADMISSION: 1. Multivitamin
2. Prilosec 20mg daily

ALLERGIES: All allergies / adverse drug reactions previously recorded have
been deleted

PHYSICAL EXAM: Vitals - T 102.0, BP 143/70, HR 114, RR 18, 100%.
GEN - Overweight man, lying in bed.  Ill-appearing, but not
toxic.
HEENT - OP shows left sided tonsil with crypts.  Some erythema.
No obvious exudate.  No cervical, submandibular LAD.  RIJ in
place.  Neck is supple.  Dry MM.
CV - Tachycardic.  No murmurs.
PULM - Clear.  No wheeze/rales/rhonchi
ABD - Soft.  Non-tender.  Non-distended.
EXT - Warm.  No edema.
SKIN - Warm to hot.  Birthmark on right abdominal wall.  No
rash.
NEURO - Alert and oriented.  Non-focal.

FAMILY HISTORY: Father with diabetes mellitus.

SOCIAL HISTORY: He is an immigrant of Moroccan extraction.  He currently owns
his own limousine company.  He is married, has a 2-year-old son.
 His son, his wife, and his father all lives in his home.  He is
a former cigarette smoker, he smoked approximately less than a
pack a day.  He would over drink one to two alcoholic beverages
per week, and he has had none in over 4 years. 

### Response:
{'Unspecified septicemia,Septic shock,Acute kidney failure, unspecified,Paroxysmal ventricular tachycardia,Acidosis,Severe sepsis,Esophageal reflux,Herpes simplex without mention of complication,Streptococcal sore throat'}
