CHIEF COMPLAINT: anaphylaxis/airway monitoring

PRESENT ILLNESS: 52yo otherwise healthy female who presented to the ED with
sensation of tounge/throat swelling with concern for
anaphylaxis.  She reports that she was eating a banana today and
subsequently developed the symptoms about an hour later which
included palm redness and itchiness, with eventual tounge/throat
swelling but no frank SOB. She was unable to talk [**2-14**] swelling
of tounge.  She reports that it has been many years since eating
bannanas and tried to eat them today secondary to leg cramps.
She was also drinking coffee and eating clementines at the time
both of which she eats on a regular basis. She presented to her
atrius PCP where she received IM benadryl, IV solumederol, and
an epi-pen before being referred to the ED.
.
In the ED initial VS were  98.2 122 156/94 18 97% RA.  She
received 25mg IV benadryl and pepcid 20mg IV.  Anesthesia was
made aware of the patient but given her stability and normal O2
sat on RA, no intervention was done.  She was much more
comfortable after the medications, but given the degree of her
tounge swelling, she was admitted to the MICU for further
monitoring.  VS on transfer were  105  139/87   98%ra
.
On arrival to the MICU,  VS were 97.7  98  142/102  24   97% ra.
 She reports frustration with being in the ICU and feels well
with improvement in tounge swelling.  She denies F/C, HA, CP,
SOB, abdominal pain, N/V/D
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denies cough, shortness of breath, or wheezing.
Denies chest pain, chest pressure, palpitations, or weakness.
Denies nausea, vomiting, diarrhea, constipation, abdominal pain,
or changes in bowel habits. Denies dysuria, frequency, or
urgency. Denies arthralgias or myalgias. Denies rashes or skin
changes.

MEDICAL HISTORY: -Obesity

MEDICATION ON ADMISSION: Estradiol 0.025 mg/24 hr Transdermal Patch Weekly

ALLERGIES: Banana

PHYSICAL EXAM: Vitals: T97.7  98  142/102  24   97% ra.
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL.
Tounge is slightly enlarged but not osbtructing airway
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII intact, 5/5 strength upper/lower extremities,
grossly normal sensation

FAMILY HISTORY: -Mother: Asthma, multiple allergies
-Sister: multiple allergies

SOCIAL HISTORY: Lives in the [**Hospital3 **].  Single.  Denies tobacco.  Drinks
occasional wine.  Smokes marijuana.  No other illicit drugs
Anaphylactic reaction due to fruits and vegetables,Obesity, unspecified
Anphylct react frts veg,Obesity NOS
Admission Date:  [**2109-5-2**]              Discharge Date:   [**2109-5-3**]

Date of Birth:  [**2056-12-17**]             Sex:   F

Service: MEDICINE

Allergies:
Banana

Attending:[**Last Name (NamePattern4) 290**]
Chief Complaint:
anaphylaxis/airway monitoring

Major Surgical or Invasive Procedure:
none

History of Present Illness:
52yo otherwise healthy female who presented to the ED with
sensation of tounge/throat swelling with concern for
anaphylaxis.  She reports that she was eating a banana today and
subsequently developed the symptoms about an hour later which
included palm redness and itchiness, with eventual tounge/throat
swelling but no frank SOB. She was unable to talk [**2-14**] swelling
of tounge.  She reports that it has been many years since eating
bannanas and tried to eat them today secondary to leg cramps.
She was also drinking coffee and eating clementines at the time
both of which she eats on a regular basis. She presented to her
atrius PCP where she received IM benadryl, IV solumederol, and
an epi-pen before being referred to the ED.
.
In the ED initial VS were  98.2 122 156/94 18 97% RA.  She
received 25mg IV benadryl and pepcid 20mg IV.  Anesthesia was
made aware of the patient but given her stability and normal O2
sat on RA, no intervention was done.  She was much more
comfortable after the medications, but given the degree of her
tounge swelling, she was admitted to the MICU for further
monitoring.  VS on transfer were  105  139/87   98%ra
.
On arrival to the MICU,  VS were 97.7  98  142/102  24   97% ra.
 She reports frustration with being in the ICU and feels well
with improvement in tounge swelling.  She denies F/C, HA, CP,
SOB, abdominal pain, N/V/D
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denies cough, shortness of breath, or wheezing.
Denies chest pain, chest pressure, palpitations, or weakness.
Denies nausea, vomiting, diarrhea, constipation, abdominal pain,
or changes in bowel habits. Denies dysuria, frequency, or
urgency. Denies arthralgias or myalgias. Denies rashes or skin
changes.


Past Medical History:
-Obesity


Social History:
Lives in the [**Hospital3 **].  Single.  Denies tobacco.  Drinks
occasional wine.  Smokes marijuana.  No other illicit drugs


Family History:
-Mother: Asthma, multiple allergies
-Sister: multiple allergies


Physical Exam:
Vitals: T97.7  98  142/102  24   97% ra.
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL.
Tounge is slightly enlarged but not osbtructing airway
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII intact, 5/5 strength upper/lower extremities,
grossly normal sensation


Pertinent Results:
[**2109-5-2**] 04:45PM BLOOD WBC-16.0* RBC-4.60 Hgb-13.1 Hct-40.1
MCV-87 MCH-28.6 MCHC-32.8 RDW-12.7 Plt Ct-494*
[**2109-5-2**] 04:45PM BLOOD Neuts-94.0* Lymphs-4.3* Monos-0.9*
Eos-0.5 Baso-0.2
[**2109-5-2**] 04:45PM BLOOD PT-11.4 PTT-32.1 INR(PT)-1.1
[**2109-5-2**] 04:45PM BLOOD Glucose-135* UreaN-10 Creat-0.7 Na-139
K-4.1 Cl-105 HCO3-23 AnGap-15
[**2109-5-2**] 04:45PM BLOOD ALT-14 AST-18 LD(LDH)-154 AlkPhos-81
TotBili-0.2
[**2109-5-2**] 04:45PM BLOOD Albumin-4.4 Calcium-9.4 Phos-2.3* Mg-2.0
[**2109-5-2**] 04:45PM BLOOD TRYPTASE-PND

Brief Hospital Course:
52 yof with concern for anaphylaxis after exposure to bananas.

Appears secondary to bananas, as it has been several years since
she has had this.  No other identifiable exposures that the
patient can identify.  Admitted to MICU for airway monitoring
though remained stable on room air without signs of airway
comprimise.  Patient's case was discussed with allergist on call
and  after overnight monitoring she was discharged with steroid
taper and famotidine.  She was recommended to arrange close PCP
follow up and referral to allergist.  She was also educated to
avoid bananas and instructed on the use of an epipen.


Medications on Admission:
Estradiol 0.025 mg/24 hr Transdermal Patch Weekly


Discharge Medications:
1. famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 6 days.
Disp:*12 Tablet(s)* Refills:*0*
2. prednisone 20 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily): for 2 more days, then 2 tablets daily for 2 days, then
1 tablet daily for 2 days.
Disp:*12 Tablet(s)* Refills:*0*
3. epinephrine 0.3 mg/0.3 mL Pen Injector Sig: One (1) Pen
Injector Intramuscular ONCE MR1 (Once and may repeat 1 time) for
1 doses.
Disp:*2 Pen Injector(s)* Refills:*2*
4. diphenhydramine HCl 25 mg Capsule Sig: One (1) Capsule PO
every six (6) hours as needed for allergy symptoms.
Disp:*40 Capsule(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
Anaphylaxis


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


Discharge Instructions:
Ms. [**Known lastname 110486**],

You were admitted to the hospital with an anaphylactic reaction
which was likely due to bananas.  You were given benadryl,
epipen, and famotidine (antihistamine) which helped your
symptoms.

You had no further reactions in the hospital and you are safe
for discharge.  Please call your PCP today to set up a follow up
appointment and to discuss an allergist referral.

Please avoid bananas as it seems this set off you reaction.

We made the following changes to your medications:

START Prednisone 60mg by mouth for 2 more days, then 40mg for 2
days, then 20mg for 2 days
START Famotodine 20mg by mouth twice daily while you are on
prednisone
START Epipen as needed for anaphylactic reaction

Followup Instructions:
Please call your PCP today to set up a follow up appointment and
to discuss an allergy referral.


                             [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**]

Completed by:[**2109-5-3**]
{'Anaphylactic reaction due to fruits and vegetables,Obesity, unspecified'}


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/airway monitoring

PRESENT ILLNESS: 52yo otherwise healthy female who presented to the ED with
sensation of tounge/throat swelling with concern for
anaphylaxis.  She reports that she was eating a banana today and
subsequently developed the symptoms about an hour later which
included palm redness and itchiness, with eventual tounge/throat
swelling but no frank SOB. She was unable to talk [**2-14**] swelling
of tounge.  She reports that it has been many years since eating
bannanas and tried to eat them today secondary to leg cramps.
She was also drinking coffee and eating clementines at the time
both of which she eats on a regular basis. She presented to her
atrius PCP where she received IM benadryl, IV solumederol, and
an epi-pen before being referred to the ED.
.
In the ED initial VS were  98.2 122 156/94 18 97% RA.  She
received 25mg IV benadryl and pepcid 20mg IV.  Anesthesia was
made aware of the patient but given her stability and normal O2
sat on RA, no intervention was done.  She was much more
comfortable after the medications, but given the degree of her
tounge swelling, she was admitted to the MICU for further
monitoring.  VS on transfer were  105  139/87   98%ra
.
On arrival to the MICU,  VS were 97.7  98  142/102  24   97% ra.
 She reports frustration with being in the ICU and feels well
with improvement in tounge swelling.  She denies F/C, HA, CP,
SOB, abdominal pain, N/V/D
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denies cough, shortness of breath, or wheezing.
Denies chest pain, chest pressure, palpitations, or weakness.
Denies nausea, vomiting, diarrhea, constipation, abdominal pain,
or changes in bowel habits. Denies dysuria, frequency, or
urgency. Denies arthralgias or myalgias. Denies rashes or skin
changes.

MEDICAL HISTORY: -Obesity

MEDICATION ON ADMISSION: Estradiol 0.025 mg/24 hr Transdermal Patch Weekly

ALLERGIES: Banana

PHYSICAL EXAM: Vitals: T97.7  98  142/102  24   97% ra.
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL.
Tounge is slightly enlarged but not osbtructing airway
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII intact, 5/5 strength upper/lower extremities,
grossly normal sensation

FAMILY HISTORY: -Mother: Asthma, multiple allergies
-Sister: multiple allergies

SOCIAL HISTORY: Lives in the [**Hospital3 **].  Single.  Denies tobacco.  Drinks
occasional wine.  Smokes marijuana.  No other illicit drugs 

### Response:
{'Anaphylactic reaction due to fruits and vegetables,Obesity, unspecified'}
