CHIEF COMPLAINT: anaphylaxis and hyperallergic pneumonitis

PRESENT ILLNESS: The patient is a 48 year old female with past medical history
significant for asthma (intubation x 4), severe allergies,
remote seizure (s/p head injury), sickle cell trait, and
thrombophilia (with DVT and PE) who presented to the [**Hospital1 18**] ICU
having been transferred from [**Hospital 1562**] Hospital.  The patient was
apparently in her usual state of good health and attending a
conference on HIV (she is an infection disease physician) until
she returned to her hotel room, smelled a noxious cleaning
[**Doctor Last Name 360**], and suddenly experienced neck swelling, shortness of
breath, a cough, and collapsed shortly after calling for help.
She does report having injected herself with her epinephrine pen
which she carries always given her allergy history.  At the
outside hospital, the patient had high res CT images taken which
showed a bilaterally diffuse infiltrative process.  There was
also a question of ground glass opacities.  Chest xray revealed
bilaterally diffuse infiltrates as well.  Bronchoalveolar lavage
was performed whose results are pending at the time of this
summary.  The patient was subsequently transferred to the [**Hospital1 18**]
ICU for further evaluation.

MEDICAL HISTORY: * asthma with intubation x 4
* severe allergies with history of intubations x > 4
* remote seizure secondary to head trauma
* sickle cell trait
* thrombophilia, decreased protein C and increased homocysteine
(with recurrent DVTs and pulmonary embolisms)
* ventricular tachycardia secondary to albuterol

MEDICATION ON ADMISSION: Medications as listed by outside hospital
* fluticasone nasal twice daily
* budesonide 0.5 mg twice daily
* monteleukast 10 mg daily
* ceftirizine 10 mg daily
* protonix 40 mg daily
* folate 1 mg daily
* mvi 1 tab daily
* levofloxacin 500 mg daily
* zonaflex 20 mg every night
* methylprenisolone 40 mg iv daily
* benadryl 20 mg iv daily
* enoxaparin 60 mg twice daily
* albuterol as needed

ALLERGIES: Sulfa (Sulfonamides) / Azithromycin / Codeine / Latex / Haldol

PHYSICAL EXAM: On admission to the ICU,
VITALS: 99.8  119/57  93  AC 550/12  PEEP 5  FIO2 .50 98%
GEN: intubated, sedated, lying in bed, no acute distress,
appearing stated age
HEENT: EOMI, MM slightly dry, OP clear, PERRL
COR: RRR, no m/r/g, no carotid bruits, no abd bruit, no femoral
bruits
[**Last Name (un) **]: bilaterally coarse breath sounds, inspiratory and
expiratory wheezes
ABD: soft, nontender, non distended, bowel sounds present
EXT: no edema lower extremities
NEURO: limited by sedation: 2+ reflexes throughout, doll's
bilaterally, corneal reflex bilaterally, downgoing toes,
withdrawal to pain

FAMILY HISTORY: unknown

SOCIAL HISTORY: former physician of infectious disease.  in relationship with
partner ([**Doctor First Name **]). no tobacco.  occasional ethanol.
Unspecified allergic alveolitis and pneumonitis,Asthma, unspecified type, with status asthmaticus,Acute respiratory failure,Infection and inflammatory reaction due to other vascular device, implant, and graft,Bacteremia,Unspecified drug-induced mental disorder,Other anaphylactic reaction,Unspecified drug or medicinal substance causing adverse effects in therapeutic use,Sickle-cell trait
Allerg alveol/pneum NOS,Asthma w status asthmat,Acute respiratry failure,React-oth vasc dev/graft,Bacteremia,Drug mental disorder NOS,Other anaphylactic react,Adv eff medicinal NOS,Sickle-cell trait
Admission Date:  [**2104-8-3**]              Discharge Date:   [**2104-8-12**]

Date of Birth:  [**2056-7-2**]             Sex:   F

Service: MED

Allergies:
Sulfa (Sulfonamides) / Azithromycin / Codeine / Latex / Haldol

Attending:[**First Name3 (LF) 5644**]
Chief Complaint:
anaphylaxis and hyperallergic pneumonitis

Major Surgical or Invasive Procedure:
intubation


History of Present Illness:
The patient is a 48 year old female with past medical history
significant for asthma (intubation x 4), severe allergies,
remote seizure (s/p head injury), sickle cell trait, and
thrombophilia (with DVT and PE) who presented to the [**Hospital1 18**] ICU
having been transferred from [**Hospital 1562**] Hospital.  The patient was
apparently in her usual state of good health and attending a
conference on HIV (she is an infection disease physician) until
she returned to her hotel room, smelled a noxious cleaning
[**Doctor Last Name 360**], and suddenly experienced neck swelling, shortness of
breath, a cough, and collapsed shortly after calling for help.
She does report having injected herself with her epinephrine pen
which she carries always given her allergy history.  At the
outside hospital, the patient had high res CT images taken which
showed a bilaterally diffuse infiltrative process.  There was
also a question of ground glass opacities.  Chest xray revealed
bilaterally diffuse infiltrates as well.  Bronchoalveolar lavage
was performed whose results are pending at the time of this
summary.  The patient was subsequently transferred to the [**Hospital1 18**]
ICU for further evaluation.

Past Medical History:
* asthma with intubation x 4
* severe allergies with history of intubations x > 4
* remote seizure secondary to head trauma
* sickle cell trait
* thrombophilia, decreased protein C and increased homocysteine
(with recurrent DVTs and pulmonary embolisms)
* ventricular tachycardia secondary to albuterol

Social History:
former physician of infectious disease.  in relationship with
partner ([**Doctor First Name **]). no tobacco.  occasional ethanol.

Family History:
unknown

Physical Exam:
On admission to the ICU,
VITALS: 99.8  119/57  93  AC 550/12  PEEP 5  FIO2 .50 98%
GEN: intubated, sedated, lying in bed, no acute distress,
appearing stated age
HEENT: EOMI, MM slightly dry, OP clear, PERRL
COR: RRR, no m/r/g, no carotid bruits, no abd bruit, no femoral
bruits
[**Last Name (un) **]: bilaterally coarse breath sounds, inspiratory and
expiratory wheezes
ABD: soft, nontender, non distended, bowel sounds present
EXT: no edema lower extremities
NEURO: limited by sedation: 2+ reflexes throughout, doll's
bilaterally, corneal reflex bilaterally, downgoing toes,
withdrawal to pain

Pertinent Results:
[**2104-8-5**] 03:55AM BLOOD WBC-8.8 RBC-3.62* Hgb-9.6* Hct-28.6*
MCV-79* MCH-26.5* MCHC-33.7 RDW-16.0* Plt Ct-219
[**2104-8-3**] 09:00PM BLOOD Neuts-92.3* Lymphs-4.4* Monos-2.4 Eos-0.9
Baso-0
[**2104-8-5**] 03:55AM BLOOD Plt Ct-219
[**2104-8-5**] 03:55AM BLOOD PT-15.1* PTT-89.7* INR(PT)-1.4
[**2104-8-4**] 09:05AM BLOOD PTT-69.3*
[**2104-8-4**] 04:13AM BLOOD Plt Ct-184
[**2104-8-4**] 04:13AM BLOOD PT-14.6* PTT-64.7* INR(PT)-1.4
[**2104-8-5**] 03:55AM BLOOD Glucose-130* UreaN-13 Creat-0.6 Na-144
K-4.0 Cl-107 HCO3-29 AnGap-12
[**2104-8-4**] 04:13AM BLOOD Glucose-132* UreaN-11 Creat-0.7 Na-142
K-4.0 Cl-102 HCO3-31* AnGap-13
[**2104-8-5**] 03:55AM BLOOD Calcium-8.2* Phos-3.7 Mg-2.8*
[**2104-8-4**] 04:13AM BLOOD Calcium-8.6 Phos-3.9 Mg-2.3
[**2104-8-3**] 09:00PM BLOOD calTIBC-241* Ferritn-30 TRF-185*

Brief Hospital Course:
1) PULMONARY: Etiology of the patient's acute shortness of
breath was attributed to a combination of hyperallergenic
pneumonitis, status asthmaticus, and anaphylaxis.  High
resolution CT images were reviewed by radiology and it was felt
that the bilaterally diffuse infiltrates were consistent with
the above although a maligant process could not be ruled out.
The patient was intubated at presentation, and she was extubated
on [**8-5**] after it was shown that her throat edema had decreased
(cuff leak present).  Between intubation and extubation, she was
treated with high dose steroids, histamine blockers,
levofloxacin, and nebulizers.  She maintained oxygen saturations
well throughout her hospital course, always maintaining
saturations in the upper 90%.  Infectious etiologies were also
considered, but the patient was negative for legionella and
cryptococcus.  Repeat chest xrays showed clearing of the
infiltrative process.  She was on high dose steroids (> 100
mg/day of prednisone or equivalent) for 7 day, then began a 5
day steroid taper to off.  She did not have flaring of her
pulmonary process during the taper.

2) HEMATOLOGY: The patient has been in a hypercoagulable state
due to the genetic disorder described above.  She was kept on
anticoagulation throughout her hospital stay.  She informed the
staff that she was recently seen by her primary care physician
who performed dopplers of her lower extremities where it was
found that she had no occlusions.  As such, she was sent on her
regular dose of 100 mg daily. The patient was found to be anemic
on presentation with a Hct of 25.0.  Iron studies were
suggestive of chronic disease.  Hct increased to 28.6 at
discharge without intervention.

3) LINE INFECTION: At the outside hospital a femoral central
catheter was placed.  Multiple blood cultures drawn in the ICU
were positive for coagulase negative staph (oxacillin
resistant).  The femoral line was pulled and the tip culture
also grew this organism.  The patient received an 8 day course
of Vancomycin IV.  She remained afebrile with normal blood
pressure throughout her hospital stay.  TTE [**2104-8-12**] negative for
vegetation.

4) PSYCHOTIC EPISODE: Patient developed a strange affect while
in the intensive care unit.  She remained oriented x 3 the
entire time, but did not make complete sense.  She was started
on Zyprexa daily.  Upon transfer to the floor, she became
agitated and was observed to be pinching herself and banging on
the walls.  A single dose of IV Haldol was given to which the
patient had a dystonic reaction (jaw clenching, drooling, and
arm stiffness).  Benadryl was immediately given with relief
within 5 minutes or so.  Patient slept most of the day.  There
was some question of seizure vs. dystonia, as patient has a
remote h/o seizures in the past.  EEG was done the following
morning - results still pending.  Psychiatry was consulted and
they felt this was likely delirium/psychosis and confirmed
history of steroid-induced psychosis with patient's outside
psychiatrist.  After 2 days of steroid taper, patient's mental
status began to clear and she was baseline by the time of
discharge.  Patient reports that she feels depressed but denies
suicidal ideation.  She will discuss starting an SSRI with her
PCP.


5) DIARRHEA: Developed after being on Vanco IV x 4 or 5 days.
C. difficile toxin was negative x 1, however started empiric
treatment of Flagyl 500 mg po tid.  Will continue to complete a
10 day course.  Diarrhea has resolved by the time of discharge.


Medications on Admission:
Medications as listed by outside hospital
* fluticasone nasal twice daily
* budesonide 0.5 mg twice daily
* monteleukast 10 mg daily
* ceftirizine 10 mg daily
* protonix 40 mg daily
* folate 1 mg daily
* mvi 1 tab daily
* levofloxacin 500 mg daily
* zonaflex 20 mg every night
* methylprenisolone 40 mg iv daily
* benadryl 20 mg iv daily
* enoxaparin 60 mg twice daily
* albuterol as needed

Home medications:
1. Advair [**Hospital1 **]
2. Lovenox 100 mg SC qd
3. Xopenex 0.63% or 1.25% prn
4. Zyolaire 225 mg SC q2weeks (only had 1 dose so far)


Discharge Medications:
1. Enoxaparin Sodium 100 mg/mL Syringe Sig: One Hundred (100) mg
Subcutaneous Q24H (every 24 hours).
2. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO QD
(once a day).
Disp:*30 Tablet(s)* Refills:*2*
3. Olanzapine 5 mg Tablet, Rapid Dissolve Sig: One (1) Tablet,
Rapid Dissolve PO QD (once a day).
Disp:*30 Tablet, Rapid Dissolve(s)* Refills:*0*
4. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) for 7 days.
Disp:*21 Tablet(s)* Refills:*0*
5. Advair Diskus 250-50 mcg/Dose Disk with Device Sig: One (1)
Inhalation twice a day.
6. Xopenex 0.63 mg/3 mL Solution Sig: One (1)  Inhalation every
six (6) hours as needed for shortness of breath or wheezing.
7. Xyolaire - as directed by [**Hospital1 21765**]


Discharge Disposition:
Home

Discharge Diagnosis:
allergic pneumonitis
anaphylaxis
status asthmaticus
line infection/bacteremia
steroid-induced psychosis
diarrhea


Discharge Condition:
good

Discharge Instructions:
1. Please take all of your outpatient medications.
2. Please seek medical attention should you experience any of
the following: shortness of breath, chest pain, palpitations,
sudden weakness, lightheadedness, dizziness, loss of
consciousness, fainting, nausea, vomiting, fever, chills,
depression, or any other concerns.

Followup Instructions:
1. Please follow up with your PCP, [**Name10 (NameIs) **], and Psychiatrist
regarding this hospital admission within the next 1-2 weeks.
2. Call [**Hospital1 18**] to follow up on your EEG results.
{'Unspecified allergic alveolitis and pneumonitis,Asthma, unspecified type, with status asthmaticus,Acute respiratory failure,Infection and inflammatory reaction due to other vascular device, implant, and graft,Bacteremia,Unspecified drug-induced mental disorder,Other anaphylactic reaction,Unspecified drug or medicinal substance causing adverse effects in therapeutic use,Sickle-cell trait'}


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: anaphylaxis and hyperallergic pneumonitis

PRESENT ILLNESS: The patient is a 48 year old female with past medical history
significant for asthma (intubation x 4), severe allergies,
remote seizure (s/p head injury), sickle cell trait, and
thrombophilia (with DVT and PE) who presented to the [**Hospital1 18**] ICU
having been transferred from [**Hospital 1562**] Hospital.  The patient was
apparently in her usual state of good health and attending a
conference on HIV (she is an infection disease physician) until
she returned to her hotel room, smelled a noxious cleaning
[**Doctor Last Name 360**], and suddenly experienced neck swelling, shortness of
breath, a cough, and collapsed shortly after calling for help.
She does report having injected herself with her epinephrine pen
which she carries always given her allergy history.  At the
outside hospital, the patient had high res CT images taken which
showed a bilaterally diffuse infiltrative process.  There was
also a question of ground glass opacities.  Chest xray revealed
bilaterally diffuse infiltrates as well.  Bronchoalveolar lavage
was performed whose results are pending at the time of this
summary.  The patient was subsequently transferred to the [**Hospital1 18**]
ICU for further evaluation.

MEDICAL HISTORY: * asthma with intubation x 4
* severe allergies with history of intubations x > 4
* remote seizure secondary to head trauma
* sickle cell trait
* thrombophilia, decreased protein C and increased homocysteine
(with recurrent DVTs and pulmonary embolisms)
* ventricular tachycardia secondary to albuterol

MEDICATION ON ADMISSION: Medications as listed by outside hospital
* fluticasone nasal twice daily
* budesonide 0.5 mg twice daily
* monteleukast 10 mg daily
* ceftirizine 10 mg daily
* protonix 40 mg daily
* folate 1 mg daily
* mvi 1 tab daily
* levofloxacin 500 mg daily
* zonaflex 20 mg every night
* methylprenisolone 40 mg iv daily
* benadryl 20 mg iv daily
* enoxaparin 60 mg twice daily
* albuterol as needed

ALLERGIES: Sulfa (Sulfonamides) / Azithromycin / Codeine / Latex / Haldol

PHYSICAL EXAM: On admission to the ICU,
VITALS: 99.8  119/57  93  AC 550/12  PEEP 5  FIO2 .50 98%
GEN: intubated, sedated, lying in bed, no acute distress,
appearing stated age
HEENT: EOMI, MM slightly dry, OP clear, PERRL
COR: RRR, no m/r/g, no carotid bruits, no abd bruit, no femoral
bruits
[**Last Name (un) **]: bilaterally coarse breath sounds, inspiratory and
expiratory wheezes
ABD: soft, nontender, non distended, bowel sounds present
EXT: no edema lower extremities
NEURO: limited by sedation: 2+ reflexes throughout, doll's
bilaterally, corneal reflex bilaterally, downgoing toes,
withdrawal to pain

FAMILY HISTORY: unknown

SOCIAL HISTORY: former physician of infectious disease.  in relationship with
partner ([**Doctor First Name **]). no tobacco.  occasional ethanol. 

### Response:
{'Unspecified allergic alveolitis and pneumonitis,Asthma, unspecified type, with status asthmaticus,Acute respiratory failure,Infection and inflammatory reaction due to other vascular device, implant, and graft,Bacteremia,Unspecified drug-induced mental disorder,Other anaphylactic reaction,Unspecified drug or medicinal substance causing adverse effects in therapeutic use,Sickle-cell trait'}
