CHIEF COMPLAINT: Choking and hypotension

PRESENT ILLNESS: 42 year old gentleman with a history of a pilocytic astrocytoma
s/p excision/rads c/b R hemiparesis, cognitive impairment,
epilepsy and recurrent hemorrhagic strokes at surgical site who
now presents after a choking episode at his group home. Per pt
and his caretaker, he was eating chicken salad [**Location (un) 6002**] and
choked. Caretaker performed [**Name2 (NI) 22699**] 4-5x, expelling a large
bolus of bread/chicken. Immediate improvment in breathing.
Coughed up more [**Location (un) 6002**] on ambulance ride. No observed altered
mental status before/after, and no new focal neuro signs.
.
He has had increasing difficulty swallowing and was treated for
pneumonia several weeks ago, after which he was placed on thick
liquid diet several weeks ago but last week converted back to
full diet by PCP.
.
On arrival to the ED initial VS were 98.0 88 121/80 18 98% HF
NRB. Mental status was at baseline per caretaker. Exam was
otherwise notable for bibasilar crackles without egophany. A CXR
showed no focal consolidation, PTX, effusion, or rib fracture.
Labs were relatively unremarkable with a WBC of 10.1 with 89.7%
PMNs and a lactate of 1.8.
.
He was initially treated with nebulizers and responded well with
sats reaching > 95% on room air however then his sats dropped to
80% on RA at rest without any associated AMS, decreased
breathing, or known remaining foreign body. Placed on high flow
NRB with sats recovering to 98%. Decided to observe him for
possible aspiration pneumonitis. He was given 1 gram of
ceftriaxone, 600mg of IV clindamycin, albuterol nebs, 1 gram of
tylenol, as well as several of his home medications.
.
He subsequently spiked a fever to 102.8 and his BPs dropped to
78/46. He was started on aggressive IVF and received a total of
4L. His SBPs remained in the 80s however. It was decided to
admit him to the MICU given his hypotension. VS at the time of
admission were 102.8 105 105/64 18 97%/4L.
.
On arrival to the MICU he appeared pleasant and comfortable and
was conversational and without any complaints.

MEDICAL HISTORY: Medullary cavernoma in [**4-13**] at site of radiation
Epilepsy (absence, complex partial, and generalized seizures)
Cerebellar pilocytic astrocytoma resection at age two s/p
brainstem radiation
Presumed radiation-induced vasculopathy with multiple strokes
Strokes:  Left internal capsule/thalamus [**2167**], left posterior
cerebellum, left cerebellar peduncle [**10/2169**], TIA with facial
droop, followed by Dr. [**Last Name (STitle) 1693**]
Presumed XRT-induced bilateral hearing loss
Hypertension
Hyperparathyroidism
Bilateral Kidney Stones (thought to be due to parathyroidism,
not
Topamax use)
Hypercalcemia
Osteopenia

MEDICATION ON ADMISSION: Preadmissions medications listed are incomplete and require
futher investigation.  Information was obtained from webOMR PCP
[**Name Initial (PRE) 12883**] .
1. Amiloride HCl 5 mg PO QAM
2. Cinacalcet 30 mg PO BID
3. Citalopram 40 mg PO DAILY
4. Dipyridamole-Aspirin 1 CAP PO BID
5. FoLIC Acid 1 mg PO DAILY
6. Levothyroxine Sodium 88 mcg PO DAILY
7. Omeprazole 20 mg PO BID
8. PredniSONE 17.5 mg PO DAILY
9. Simvastatin 80 mg PO DAILY
10. Topiramate (Topamax) 200 mg PO BID
11. Vitamin D 1000 UNIT PO DAILY
12. Vitamin E 400 UNIT PO DAILY
13. Oxcarbazepine 1500 mg PO BID
14. potassium citrate *NF* 10 mEq Oral TID
3 Tablet(s) by mouth morning and evening, 2 tabs at noon
15. lactobacillus rhamnosus GG *NF* 10 billion cell Oral daily
16. Multivitamins 1 TAB PO DAILY

ALLERGIES: hydrochlorothiazide / hydrochlorothiazide

PHYSICAL EXAM: ADMISSION PE:
Vitals: 98.6 hr 86 bp 99/61 15 95/4L
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: rhonchi bilaterally
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
GU: foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: 5/5 strength upper/lower extremities across left, 4+/5
strength across upper/lower extremities across right, grossly
normal sensation, gait deferred

FAMILY HISTORY: There is no family history of seizures. His sister died of
multiple myeloma.

SOCIAL HISTORY: He lives in a group home, and during the week goes to sports
program, gateway arts, and massage. He uses a wheelchair to get
around since his strokes, but does walk with assistance at his
sports class. He denies cigarette or EtOH use.
Unspecified septicemia,Pneumonitis due to inhalation of food or vomitus,Septic shock,Hemiplegia, unspecified, affecting unspecified side,Acidosis,Severe sepsis,Epilepsy, unspecified, without mention of intractable epilepsy,Obstructive sleep apnea (adult)(pediatric),Unspecified acquired hypothyroidism,Unspecified essential hypertension,Depressive disorder, not elsewhere classified,Unspecified persistent mental disorders due to conditions classified elsewhere,Dysphagia, unspecified,Unspecified hearing loss,Hyperparathyroidism, unspecified,Disorder of bone and cartilage, unspecified,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Personal history of irradiation, presenting hazards to health,Personal history of malignant neoplasm of brain,Examination of participant in clinical trial
Septicemia NOS,Food/vomit pneumonitis,Septic shock,Unsp hemiplga unspf side,Acidosis,Severe sepsis,Epilep NOS w/o intr epil,Obstructive sleep apnea,Hypothyroidism NOS,Hypertension NOS,Depressive disorder NEC,Mental disor NOS oth dis,Dysphagia NOS,Hearing loss NOS,Hyperparathyroidism NOS,Bone & cartilage dis NOS,Hx TIA/stroke w/o resid,Hx of irradiation,Hx of brain malignancy,Exam-clincal trial
Admission Date:  [**2175-8-21**]              Discharge Date:   [**2175-8-24**]

Date of Birth:  [**2132-12-29**]             Sex:   M

Service: MEDICINE

Allergies:
hydrochlorothiazide / hydrochlorothiazide

Attending:[**First Name3 (LF) 30**]
Chief Complaint:
Choking and hypotension

Major Surgical or Invasive Procedure:
None

History of Present Illness:
42 year old gentleman with a history of a pilocytic astrocytoma
s/p excision/rads c/b R hemiparesis, cognitive impairment,
epilepsy and recurrent hemorrhagic strokes at surgical site who
now presents after a choking episode at his group home. Per pt
and his caretaker, he was eating chicken salad [**Location (un) 6002**] and
choked. Caretaker performed [**Name2 (NI) 22699**] 4-5x, expelling a large
bolus of bread/chicken. Immediate improvment in breathing.
Coughed up more [**Location (un) 6002**] on ambulance ride. No observed altered
mental status before/after, and no new focal neuro signs.
.
He has had increasing difficulty swallowing and was treated for
pneumonia several weeks ago, after which he was placed on thick
liquid diet several weeks ago but last week converted back to
full diet by PCP.
.
On arrival to the ED initial VS were 98.0 88 121/80 18 98% HF
NRB. Mental status was at baseline per caretaker. Exam was
otherwise notable for bibasilar crackles without egophany. A CXR
showed no focal consolidation, PTX, effusion, or rib fracture.
Labs were relatively unremarkable with a WBC of 10.1 with 89.7%
PMNs and a lactate of 1.8.
.
He was initially treated with nebulizers and responded well with
sats reaching > 95% on room air however then his sats dropped to
80% on RA at rest without any associated AMS, decreased
breathing, or known remaining foreign body. Placed on high flow
NRB with sats recovering to 98%. Decided to observe him for
possible aspiration pneumonitis. He was given 1 gram of
ceftriaxone, 600mg of IV clindamycin, albuterol nebs, 1 gram of
tylenol, as well as several of his home medications.
.
He subsequently spiked a fever to 102.8 and his BPs dropped to
78/46. He was started on aggressive IVF and received a total of
4L. His SBPs remained in the 80s however. It was decided to
admit him to the MICU given his hypotension. VS at the time of
admission were 102.8 105 105/64 18 97%/4L.
.
On arrival to the MICU he appeared pleasant and comfortable and
was conversational and without any complaints.


Past Medical History:
Medullary cavernoma in [**4-13**] at site of radiation
Epilepsy (absence, complex partial, and generalized seizures)
Cerebellar pilocytic astrocytoma resection at age two s/p
brainstem radiation
Presumed radiation-induced vasculopathy with multiple strokes
Strokes:  Left internal capsule/thalamus [**2167**], left posterior
cerebellum, left cerebellar peduncle [**10/2169**], TIA with facial
droop, followed by Dr. [**Last Name (STitle) 1693**]
Presumed XRT-induced bilateral hearing loss
Hypertension
Hyperparathyroidism
Bilateral Kidney Stones (thought to be due to parathyroidism,
not
Topamax use)
Hypercalcemia
Osteopenia

Social History:
He lives in a group home, and during the week goes to sports
program, gateway arts, and massage. He uses a wheelchair to get
around since his strokes, but does walk with assistance at his
sports class. He denies cigarette or EtOH use.


Family History:
There is no family history of seizures. His sister died of
multiple myeloma.

Physical Exam:
ADMISSION PE:
Vitals: 98.6 hr 86 bp 99/61 15 95/4L
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: rhonchi bilaterally
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
GU: foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: 5/5 strength upper/lower extremities across left, 4+/5
strength across upper/lower extremities across right, grossly
normal sensation, gait deferred

DISCHARGE PHYSICAL EXAM:
Vitals: 98 HR 67 BP 116/65 RR 18 97%RA I/O over 36 h [**Telephone/Fax (1) 22700**]+.
Pt made adequate urine after d/c of foley at midnight.
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Scattered coarse crackles throughout, no wheezes or
rhonchi
Abdomen: soft, non-tender, non-distended, no organomegaly
GU: No foley
Ext: warm, well perfused, R extremities cooler than L, which pt
affirms is baseline. No clubbing, cyanosis or edema
Neuro: Grossly unchanged from prior exam.


Pertinent Results:
ADMISSION LABS:
[**2175-8-21**] 04:30PM BLOOD WBC-10.1 RBC-4.89 Hgb-15.5 Hct-45.9
MCV-94 MCH-31.7 MCHC-33.7 RDW-12.4 Plt Ct-234
[**2175-8-21**] 04:30PM BLOOD Neuts-89.7* Lymphs-6.4* Monos-3.5 Eos-0.2
Baso-0.2
[**2175-8-21**] 04:30PM BLOOD Glucose-113* UreaN-18 Creat-1.0 Na-141
K-4.4 Cl-105 HCO3-26 AnGap-14
[**2175-8-21**] 04:42PM BLOOD Lactate-1.8
[**2175-8-22**] 03:06AM BLOOD Lactate-2.0

CXR [**2175-8-21**]:
FINDINGS:  Frontal and lateral chest radiographs demonstrate
clear,
well-expanded lungs without pleural effusion or pneumothorax.
The cardiac silhouette and mediastinal contours are normal.
There is no radiopaque foreign body.
IMPRESSION:  No acute chest abnormality.

EKG [**2175-8-22**]:
Sinus rhythm. Right bundle-branch block. Compared to the
previous tracing
of [**2175-6-22**] the axis is now rightward. Otherwise, no diagnostic
interim change.

VIDEO SWALLOW RECOMMENDATIONS [**2175-8-23**]:
1. PO diet of nectar thick liquids and soft consistency solids
2. Meds whole with apple sauce or pudding
3. Sit fully upright for all PO intake and maintain standard
aspiration precautions
4. TID oral care, preferably before meals, including mouthwash
5. Education provided to patient and caretakers regarding
current
diet and recommendations.
6. Suggest a repeat video swallow in house early next week or on
outpt basis in ~2 weeks which can be arranged by calling
[**Telephone/Fax (1) 3731**].

DISCHARGE LABS:
[**2175-8-24**] 07:45AM BLOOD WBC-7.4 RBC-3.65* Hgb-11.8* Hct-34.6*
MCV-95 MCH-32.5* MCHC-34.3 RDW-12.5 Plt Ct-179
[**2175-8-24**] 07:45AM BLOOD Glucose-103* UreaN-15 Creat-1.1 Na-145
K-3.5 Cl-113* HCO3-20* AnGap-16
[**2175-8-24**] 07:45AM BLOOD Calcium-9.0 Phos-3.3 Mg-1.8

Brief Hospital Course:
This is a 42 year old gentleman with a history of pilocytic
astrocytoma s/p excision and radiation c/b right hemiparesis,
cognitive impairment, epilepsy and recurrent hemorrhagic strokes
who presents after a choking episode at his group home, admitted
febrile and hypotensive.

#. Sepsis: Patient received 6L total of fluid with improvement
in blood pressure to high 90s and low 100s.  Likely source is
lungs.  He was covered with ceftriaxone and clindamycin for
aspiration pneumonia.  His blood pressure continued to improve.
He was transferred to the medical floor in good condition with
no further hypotensive episodes. Stress dose steroids were
discontinue and he was sent home in stable condition on his
current home dose of prednisone 17.5 mg daily, as recommended in
discussion with his PCP.

#. Aspiration Risk: Diet advanced at his group home. Swallow
study [**2175-7-17**] suggested nectar thick liquids and soft
consistency. Pt was made NPO, and a repeat speech and swallow
was ordered, with recommendations of return to soft diet and
nectar-thickened liquids, with whole meds administered in
applesauce and pudding. Pt's diet was advanced, with no further
aspiration events.

#. Seizure Disorder: Followed by Dr. [**Last Name (STitle) 851**]. Continued
home topiramate and oxcarbazepine. No seizures during admission.

#. Likely OSA. Observed to desaturate during sleep with loud
snoring. Started on CPAP during ICU stay. He is set up for
outpatient sleep follow up.

#. Hypothyroidism: Continue home Levothyroxine.

#. HTN: Currently hypotensive. Held home amiloride in setting of
low blood pressure.

#. Depression: Continued on home Citalopram.

#. History of Strokes: Continue Dipyridamole-Aspirin and
Simvastatin

TRANSITIONAL ISSUES:
Pt was sent out with no medication changes. However, might be
worth considering reducing simvastatin to 40 mg daily, as 80 has
been shown to be associated with increased side effects with no
significant added clinical benefit.

Patient may benefit from a follow-up video swallow study.

Pt has an appointment for outpatient follow up in the sleep
clinic to evaluate for sleep apnea. Poor quality sleep may be
contributing to decreased seizure threshold.

Medications on Admission:
Preadmissions medications listed are incomplete and require
futher investigation.  Information was obtained from webOMR PCP
[**Name Initial (PRE) 12883**] .
1. Amiloride HCl 5 mg PO QAM
2. Cinacalcet 30 mg PO BID
3. Citalopram 40 mg PO DAILY
4. Dipyridamole-Aspirin 1 CAP PO BID
5. FoLIC Acid 1 mg PO DAILY
6. Levothyroxine Sodium 88 mcg PO DAILY
7. Omeprazole 20 mg PO BID
8. PredniSONE 17.5 mg PO DAILY
9. Simvastatin 80 mg PO DAILY
10. Topiramate (Topamax) 200 mg PO BID
11. Vitamin D 1000 UNIT PO DAILY
12. Vitamin E 400 UNIT PO DAILY
13. Oxcarbazepine 1500 mg PO BID
14. potassium citrate *NF* 10 mEq Oral TID
3 Tablet(s) by mouth morning and evening, 2 tabs at noon
15. lactobacillus rhamnosus GG *NF* 10 billion cell Oral daily
16. Multivitamins 1 TAB PO DAILY


Discharge Medications:
1. Cinacalcet 30 mg PO BID
2. Citalopram 40 mg PO DAILY
3. Dipyridamole-Aspirin 1 CAP PO BID
4. Levothyroxine Sodium 88 mcg PO DAILY
5. Oxcarbazepine 1500 mg PO BID
6. Topiramate (Topamax) 200 mg PO BID
7. Amiloride HCl 5 mg PO QAM
8. FoLIC Acid 1 mg PO DAILY
9. lactobacillus rhamnosus GG *NF* 10 billion cell Oral daily
10. Multivitamins 1 TAB PO DAILY
11. Omeprazole 20 mg PO BID
12. potassium citrate *NF* 10 mEq ORAL TID
3 Tablet(s) by mouth morning and evening, 2 tabs at noon
13. PredniSONE 17.5 mg PO DAILY
14. Simvastatin 80 mg PO DAILY
15. Vitamin D 1000 UNIT PO DAILY
16. Vitamin E 400 UNIT PO DAILY


Discharge Disposition:
Extended Care

Facility:
Beaver [**Doctor Last Name **] Group Home

Discharge Diagnosis:
Aspiration event


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Out of Bed with assistance to chair or
wheelchair.


Discharge Instructions:
Dear Mr. [**Known lastname 7716**], It was a pleasure taking care of you during
your inpatient stay at [**Hospital1 69**]. You
were admitted with aspiration and choking. You had an episode of
low blood pressure and low oxygen saturations, so you spent some
time in the intensive care unit while your vital signs
stabilized. You also had a video swallow test which indicated
that you should drink only nectar-thickened liquids and eat only
soft foods; your PCP may arrange for another outpatient study.
You also may benefit from a sleep study; a preliminary
appointment with a sleep specialist has been set up for you. You
should follow up with your PCP and your neurologist to monitor
your medical issues.

Followup Instructions:
Department: [**Hospital3 249**]
Follow up with your PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **], and with the additional
specialists listed below. Dr. [**Last Name (STitle) **] will also arrange a
speech and swallow follow-up evaluation for you.

When: THURSDAY [**2175-8-31**] at 12:30 PM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1882**], MD [**Telephone/Fax (1) 2010**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 895**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: Pulmonary and Sleep Medicine
When: THURSDAY [**2175-10-26**] at 1:00 pm
With: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 3172**], M.D.
Building: [**Hospital6 29**] [**Location (un) **]
Campus: EAST  Best Parking: [**Hospital Ward Name 23**] Garage
The sleep clinic will call if an appointment opens up sooner.

Department: NEUROLOGY
When: MONDAY [**2175-8-28**] at 1 PM
With: [**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) 177**] [**Last Name (NamePattern1) **], M.D. [**Telephone/Fax (1) 1694**]
Building: [**Hospital6 29**] [**Location (un) 858**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: COGNITIVE NEUROLOGY UNIT
When: WEDNESDAY [**2175-8-30**] at 9:00 AM
With: [**Name6 (MD) **] [**Name8 (MD) **], MD [**Telephone/Fax (1) 1690**]
Building: Ks [**Hospital Ward Name 860**] Building ([**Hospital Ward Name 1826**]/[**Hospital Ward Name 1827**] Complex) [**Location (un) **]
Campus: EAST     Best Parking: Main Garage

Department: MEDICAL SPECIALTIES (Endocrine)
When: THURSDAY [**2175-9-14**] at 10:30 AM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 10545**], M.D. [**Telephone/Fax (1) 4586**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage



Completed by:[**2175-8-24**]
{'Unspecified septicemia,Pneumonitis due to inhalation of food or vomitus,Septic shock,Hemiplegia, unspecified, affecting unspecified side,Acidosis,Severe sepsis,Epilepsy, unspecified, without mention of intractable epilepsy,Obstructive sleep apnea (adult)(pediatric),Unspecified acquired hypothyroidism,Unspecified essential hypertension,Depressive disorder, not elsewhere classified,Unspecified persistent mental disorders due to conditions classified elsewhere,Dysphagia, unspecified,Unspecified hearing loss,Hyperparathyroidism, unspecified,Disorder of bone and cartilage, unspecified,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Personal history of irradiation, presenting hazards to health,Personal history of malignant neoplasm of brain,Examination of participant in clinical trial'}


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: Choking and hypotension

PRESENT ILLNESS: 42 year old gentleman with a history of a pilocytic astrocytoma
s/p excision/rads c/b R hemiparesis, cognitive impairment,
epilepsy and recurrent hemorrhagic strokes at surgical site who
now presents after a choking episode at his group home. Per pt
and his caretaker, he was eating chicken salad [**Location (un) 6002**] and
choked. Caretaker performed [**Name2 (NI) 22699**] 4-5x, expelling a large
bolus of bread/chicken. Immediate improvment in breathing.
Coughed up more [**Location (un) 6002**] on ambulance ride. No observed altered
mental status before/after, and no new focal neuro signs.
.
He has had increasing difficulty swallowing and was treated for
pneumonia several weeks ago, after which he was placed on thick
liquid diet several weeks ago but last week converted back to
full diet by PCP.
.
On arrival to the ED initial VS were 98.0 88 121/80 18 98% HF
NRB. Mental status was at baseline per caretaker. Exam was
otherwise notable for bibasilar crackles without egophany. A CXR
showed no focal consolidation, PTX, effusion, or rib fracture.
Labs were relatively unremarkable with a WBC of 10.1 with 89.7%
PMNs and a lactate of 1.8.
.
He was initially treated with nebulizers and responded well with
sats reaching > 95% on room air however then his sats dropped to
80% on RA at rest without any associated AMS, decreased
breathing, or known remaining foreign body. Placed on high flow
NRB with sats recovering to 98%. Decided to observe him for
possible aspiration pneumonitis. He was given 1 gram of
ceftriaxone, 600mg of IV clindamycin, albuterol nebs, 1 gram of
tylenol, as well as several of his home medications.
.
He subsequently spiked a fever to 102.8 and his BPs dropped to
78/46. He was started on aggressive IVF and received a total of
4L. His SBPs remained in the 80s however. It was decided to
admit him to the MICU given his hypotension. VS at the time of
admission were 102.8 105 105/64 18 97%/4L.
.
On arrival to the MICU he appeared pleasant and comfortable and
was conversational and without any complaints.

MEDICAL HISTORY: Medullary cavernoma in [**4-13**] at site of radiation
Epilepsy (absence, complex partial, and generalized seizures)
Cerebellar pilocytic astrocytoma resection at age two s/p
brainstem radiation
Presumed radiation-induced vasculopathy with multiple strokes
Strokes:  Left internal capsule/thalamus [**2167**], left posterior
cerebellum, left cerebellar peduncle [**10/2169**], TIA with facial
droop, followed by Dr. [**Last Name (STitle) 1693**]
Presumed XRT-induced bilateral hearing loss
Hypertension
Hyperparathyroidism
Bilateral Kidney Stones (thought to be due to parathyroidism,
not
Topamax use)
Hypercalcemia
Osteopenia

MEDICATION ON ADMISSION: Preadmissions medications listed are incomplete and require
futher investigation.  Information was obtained from webOMR PCP
[**Name Initial (PRE) 12883**] .
1. Amiloride HCl 5 mg PO QAM
2. Cinacalcet 30 mg PO BID
3. Citalopram 40 mg PO DAILY
4. Dipyridamole-Aspirin 1 CAP PO BID
5. FoLIC Acid 1 mg PO DAILY
6. Levothyroxine Sodium 88 mcg PO DAILY
7. Omeprazole 20 mg PO BID
8. PredniSONE 17.5 mg PO DAILY
9. Simvastatin 80 mg PO DAILY
10. Topiramate (Topamax) 200 mg PO BID
11. Vitamin D 1000 UNIT PO DAILY
12. Vitamin E 400 UNIT PO DAILY
13. Oxcarbazepine 1500 mg PO BID
14. potassium citrate *NF* 10 mEq Oral TID
3 Tablet(s) by mouth morning and evening, 2 tabs at noon
15. lactobacillus rhamnosus GG *NF* 10 billion cell Oral daily
16. Multivitamins 1 TAB PO DAILY

ALLERGIES: hydrochlorothiazide / hydrochlorothiazide

PHYSICAL EXAM: ADMISSION PE:
Vitals: 98.6 hr 86 bp 99/61 15 95/4L
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: rhonchi bilaterally
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
GU: foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: 5/5 strength upper/lower extremities across left, 4+/5
strength across upper/lower extremities across right, grossly
normal sensation, gait deferred

FAMILY HISTORY: There is no family history of seizures. His sister died of
multiple myeloma.

SOCIAL HISTORY: He lives in a group home, and during the week goes to sports
program, gateway arts, and massage. He uses a wheelchair to get
around since his strokes, but does walk with assistance at his
sports class. He denies cigarette or EtOH use. 

### Response:
{'Unspecified septicemia,Pneumonitis due to inhalation of food or vomitus,Septic shock,Hemiplegia, unspecified, affecting unspecified side,Acidosis,Severe sepsis,Epilepsy, unspecified, without mention of intractable epilepsy,Obstructive sleep apnea (adult)(pediatric),Unspecified acquired hypothyroidism,Unspecified essential hypertension,Depressive disorder, not elsewhere classified,Unspecified persistent mental disorders due to conditions classified elsewhere,Dysphagia, unspecified,Unspecified hearing loss,Hyperparathyroidism, unspecified,Disorder of bone and cartilage, unspecified,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Personal history of irradiation, presenting hazards to health,Personal history of malignant neoplasm of brain,Examination of participant in clinical trial'}
