CHIEF COMPLAINT: sepsis

PRESENT ILLNESS: HPI:

MEDICAL HISTORY: Past Medical History:

MEDICATION ON ADMISSION: Medications:

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: .

FAMILY HISTORY: -

SOCIAL HISTORY: -
Unspecified septicemia,Septic shock,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Severe sepsis,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Septicemia NOS,Septic shock,Acute kidney failure NOS,CHF NOS,Severe sepsis,Hypertension NOS,DMII wo cmp nt st uncntr
Admission Date:  [**2155-9-16**]              Discharge Date:   [**2155-9-16**]

Date of Birth:  [**2077-8-17**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 99**]
Chief Complaint:
sepsis

Major Surgical or Invasive Procedure:
placement of arterial line, femoral TLC, subclavian TLC.

History of Present Illness:
HPI:

78yo woman with history of HTN, DM2, GI bleeding,
and spinal stenosis presented to [**Hospital3 934**] Hospital
with nausea/vomiting/diarrhea for 3 days. On admit to Caritas
ED, her vitals were 97.3, 65, 20, 134/51, and 100% on RA.
There, she underwent CT of abdomen with oral contrast, which
was read as significant for the following: small hiatal hernia,
markedly distended stomach with distal gastric wall thickening
(inflammation vs. infectious process), small amount of ascites,
s/p cholecystectomy, moderate amt of stool in colon, apparent
thickning of rectal wall, "possible thickening of the large
bowel wall, but not certain due to lack of oral contrast".  She
was also diagnosed with
urinary tract infection. At Caritas ED, she was given volume
resuscitation with NS 2L, levaquin 500mg, Dilaudid 0.5mg  x 2,
reglan, pepcid, and ativan. She had WBC count of 23.9, UA with
mod blood, 30 prot, Lg LE, numerous WBC.
.
On transfer to [**Hospital1 18**] ED, she was afebrile, hemodynamically
stable
and a/o x 3.
.
Upon arrival to [**Hospital1 18**] ED, she quickly was noted to be apneic,
with right facial droop, and slumping over to right side.
She was apneic and cyanotic. She was intubated. Given
3L NS for hypotension. Given Vancomycin 1g, levaquin 500mg IV,
and flagyl 500mg IV.  She was given 3amps of bicarbonate. Given
Insulin,
D50, kayexalate, HCO3 for hyperkalemia.
.
Abdominal CT reviewed by Surgery and Radiology, who both
feel that the CT clearly reveals some mucosal thickening, which
could be consistent with C. Diff colitis.
.
Discussion with her family reveals that she has been in and out
of [**Hospital **] hospital and Rehab for significant GI bleed from UGI
ulcer one month ago, has had CHF, and has had C. diff colitis;
has
completed 8 day course of flagyl.  She had returned to home
from rehab and was doing well, but then complained of mild
nausea/vomiting/diarrhea for past 3 days.


Past Medical History:
Past Medical History:

1. DM2
2. Hypertension
3. Spinal stenosis
4. Congestive heart failure
5. h/o GI bleeding

Social History:
-

Family History:
-

Physical Exam:
.

Physical exam:

92.9, 76, 122/56, 100% on mech vent (AC, 24 x 600, FiO2 100%)

gen: intubated, sedated; following commands
heent: PERRLA, eomi
neck: no JVD
cv: irregular; regular rate; no m/r/g
resp: clear to auscultation bilaterally
abd: soft, minimally distended; hypoactive bowel sounds;
     no peritoneal signs. Guaiac negative in ED.
extr: cool extremities; no peripheral edema
neuro: no focal deficits per limited exam


Pertinent Results:
[**2155-9-16**] 08:30AM   TYPE-ART TEMP-32.8 RATES-24/ TIDAL VOL-600
PEEP-5 O2-50 PO2-177* PCO2-12* PH-7.08* TOTAL CO2-4* BASE XS--24
INTUBATED-INTUBATED
[**2155-9-16**] 08:13AM   LACTATE-17.7*
[**2155-9-16**] 07:57AM   GLUCOSE-136* UREA N-30* CREAT-1.8* SODIUM-138
POTASSIUM-6.5* CHLORIDE-110* TOTAL CO2-LESS THAN
[**2155-9-16**] 07:57AM   ALT(SGPT)-137* AST(SGOT)-427* LD(LDH)-2423*
ALK PHOS-355* TOT BILI-0.5
[**2155-9-16**] 07:57AM   ALBUMIN-1.5* CALCIUM-7.8* PHOSPHATE-6.6*
MAGNESIUM-2.1
[**2155-9-16**] 07:57AM   WBC-35.5* RBC-2.70* HGB-7.5* HCT-25.0* MCV-93
MCH-27.9 MCHC-30.1* RDW-19.2*
[**2155-9-16**] 07:57AM   PT-20.9* PTT-90.8* INR(PT)-3.1
[**2155-9-16**] 07:57AM   FIBRINOGE-413*
[**2155-9-16**] 07:07AM   LACTATE-16.6*
[**2155-9-16**] 06:11AM   LACTATE-15.6*
[**2155-9-16**] 06:10AM   LACTATE-15.8*
[**2155-9-16**] 06:10AM   O2 SAT-52
[**2155-9-16**] 05:06AM   LACTATE-15.3*
[**2155-9-16**] 02:56AM   WBC-34.5* RBC-2.75* HGB-7.6* HCT-25.0* MCV-91
MCH-27.8 MCHC-30.6* RDW-19.3*
[**2155-9-16**] 02:56AM   PLT COUNT-258
[**2155-9-16**] 02:56AM   FDP-160-320*
[**2155-9-16**] 02:56AM   FIBRINOGE-487*
[**2155-9-16**] 02:56AM   RET AUT-3.4*
[**2155-9-16**] 01:12AM   TYPE-ART PO2-536* PCO2-22* PH-7.18* TOTAL
CO2-9* BASE XS--18
[**2155-9-16**] 01:12AM   LACTATE-15.0* NA+-136 K+-4.7 CL--107 TCO2-9*
[**2155-9-15**] 10:44PM   ALT(SGPT)-15 AST(SGOT)-38 LD(LDH)-401*
CK(CPK)-28 ALK PHOS-140* AMYLASE-128* TOT BILI-0.4
[**2155-9-15**] 10:44PM   NEUTS-30* BANDS-15* LYMPHS-34 MONOS-5 EOS-1
BASOS-0 ATYPS-0 METAS-13* MYELOS-2*
[**2155-9-15**] 10:44PM   HYPOCHROM-3+ ANISOCYT-2+ POIKILOCY-1+
MACROCYT-2+ MICROCYT-NORMAL POLYCHROM-1+ SCHISTOCY-1+ BURR-1+
TEARDROP-1+
[**2155-9-15**] 10:44PM   PLT SMR-NORMAL PLT COUNT-343 PLTCLM-1+
[**2155-9-15**] 10:44PM   PT-18.2* PTT-85.7* INR(PT)-2.3
[**2155-9-15**] 10:46PM   cTropnT-0.01
[**2155-9-15**] 10:44PM   ALT(SGPT)-15 AST(SGOT)-38 LD(LDH)-401*
CK(CPK)-28 ALK PHOS-140* AMYLASE-128* TOT BILI-0.4
[**2155-9-15**] 10:44PM   LIPASE-19
[**2155-9-15**] 10:44PM   ALBUMIN-2.1* CALCIUM-8.4 PHOSPHATE-7.0*
MAGNESIUM-2.5
[**2155-9-15**] 10:44PM   WBC-38.4* RBC-3.41* HGB-9.6* HCT-33.1* MCV-97
MCH-28.3 MCHC-29.1* RDW-19.2*
[**2155-9-15**] 10:44PM   HYPOCHROM-3+ ANISOCYT-2+ POIKILOCY-1+
MACROCYT-2+ MICROCYT-NORMAL POLYCHROM-1+ SCHISTOCY-1+ BURR-1+
TEARDROP-1+
[**2155-9-15**] 10:44PM   PLT SMR-NORMAL PLT COUNT-343 PLTCLM-1+
[**2155-9-15**] 10:44PM   PT-18.2* PTT-85.7* INR(PT)-2.3
[**2155-9-15**] 10:35PM   LACTATE-13.9*

Brief Hospital Course:
78yo woman with complicated medical history presented from
outside
hospital with sepsis, and likely lactic acidosis from bowel
ischemia.
She was aggressively managed with volume resuscitation,
pressors,
broad spectrum antibiotics, and mechanical ventilaiton in the
intensive care unit.
.
Over her course, she had worsening hypotension and increasing
pressor requirements. Ultimately, family meeting was held,
and it was decided to make her comfort measures only. She
thereafter
passed away. A post-mortem examination will be performed per
the family's request.

Medications on Admission:
Medications:

Atenolol 100mg [**Hospital1 **]
lisinopril 40mg qD
MVI
Effexor 75mg qD
Allopurinol 100mg [**Hospital1 **]
KCL 40 qD
Hydralazine 10mg TID
Ativan 0.5mg prn
(Flagyl 250mg TID x 8 days - done)
anusol
lasix 40mg qD
protonix 40mg qD
Procardia XL 30mg qD
Vicodin prn
Duragesic 50mcg q72hrs

Discharge Disposition:
Expired

Discharge Diagnosis:
deceased; sepsis

Discharge Condition:
-

Discharge Instructions:
-

Followup Instructions:
-
{'Unspecified septicemia,Septic shock,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Severe sepsis,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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: HPI:

MEDICAL HISTORY: Past Medical History:

MEDICATION ON ADMISSION: Medications:

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: .

FAMILY HISTORY: -

SOCIAL HISTORY: - 

### Response:
{'Unspecified septicemia,Septic shock,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Severe sepsis,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
