CHIEF COMPLAINT: Hypoxic Respiratory Failure

PRESENT ILLNESS: 55 year h/o AML, s/p BMT w/ chronic GVHD of the liver, skin, and
eye, reporting 3 days of productive cough, malaise, nausea,
non-bilious, non-bloody vomiting x1 and weakness who was seen in
[**Hospital 3242**] clinic today with fever to 101, hypotension 90's/50's, tachy
120's, hypoxia 91% on RA, 93-94% on 2 L via NC. An EKG was
obtained with showed V4-V6 Twave inversions prompting further
evaluation in the ED. Prior to leaving the clinic he received 1
Liter NS, 60 mg Solumedrol (stress dose as pt on chronic
steroids), vancomycin 1gm IV with blood cultures sent from
clinic.
.
In the ED, initial vs were: T 101.9 HR 117 BP 107/73 RR 24 POX
89% on RA. Improved to 95% on a NRB, then on ventimask 50%.
Repeat blood cultures and urine culture were sent. Patient was
given dilaudid, aztreonam 2gm IV, benadryl and prochloperazine
for headache/belly ache. IV access 2 18g PIVs. CTA negative for
PE, but did show scatteredtree in [**Male First Name (un) 239**] opacities. EKG was not far
from baseline and plan established to trend CEs per BMT team, no
aspirin given [**1-18**] low platelets. VS 90 126/78 16 97% on 50%
ventimask prior to transfer.
.
On the floor, patient denied shortness of breath but did report
vague diffuse chest discomfort, headache, and nausea. Wife
reported recent course of azithromycin.
.
Review of sytems:
(+) Per HPI, has baseline rhinorrhea that is unchanged,
(-) Denies chills, night sweats, recent weight loss or gain.
Denies sinus tenderness or congestion. Denied palpitations.
Denied diarrhea, constipation or abdominal pain. No recent
change in bowel or bladder habits. No dysuria. Denied
arthralgias or myalgias.

MEDICAL HISTORY: - Type 2 DM, steroid induced
- Hyperlipidemia
- H/o AVN bilateral hips
- HTN
- H/o nephrolithiasis, lithotripsy and previous nephrostomy tube
and emergent surgery to repair ureteral damage
- h/o left interpolar renal lesion, followed with MRs
- h/o BCC s/p excision
- h/o SCC left cheek, s/p Mohs' [**5-/2144**]
- h/o multiple back surgeries: Lumbar L5-S1 surgery x 3, and
cervical spine fusion (bone graft, no hardware)
- h/o anterior cervical diskectomy and instrument arthrodesis at
C5-C6 and C6-C7 for degenerative cervical spondylitic disease
with spinal cord compression and foraminal stenosis at C5-C6 and
C6-C7 [**2-/2144**]- Dr. [**Last Name (STitle) 548**]
- Chronic numbness, neuropathic pain in left upper extremity.
- Multilevel compression fractures T11, T12, L1 and mild
compression L3 and L4.
- h/o pulmonary embolism [**11-23**] on anticoagulated from
[**Date range (1) 72256**]
- h/o RSV [**11/2144**] requiring ICU admission
- h/o OSA, on BIPAP followed by [**Location (un) 4507**]

MEDICATION ON ADMISSION: Acyclovir 400 mg PO Q8H
Folic Acid 1 mg PO DAILY
Prednisone 10 mg PO DAILY
Pantoprazole 40 mg Tablet PO Q12H
Trimethoprim-Sulfamethoxazole 80-400 mg PO DAILY
Oxycodone SR (60 mg)QAM , (20 mg) Q2PM, and 60mg QPM
Ranitidine HCl 150 mg PO HS
Budesonide 3 mg SR PO three times a day.
Cholecalciferol (Vitamin D3) 400 unit PO DAILY
Humulin N Twelve (12) units Subcutaneous twice a day.
Insulin Lispro QACHS Per sliding scale.

ALLERGIES: Cefepime / Cipro

PHYSICAL EXAM: General: Sleepy but easily arousable, oriented x3, no acute
distress, speaking in full sentences w/out accessory muscle use

FAMILY HISTORY: Mother died suddenly in her 70s. Father died of unknown cancer
with tumors visible across body. One sister has thyroid cancer.
One brother has diabetes and kidney stones. One sister has
[**Name (NI) 5895**].

SOCIAL HISTORY: Lives with his wife, and one of children, worked as a [**Company 22957**]
technician now retired.
Tob: previously smoked 1ppd for many years but quit 3 years ago
Influenza with pneumonia,Acute respiratory failure,Acute kidney failure, unspecified,Complications of transplanted bone marrow,Chronic graft-versus-host disease,Acute myeloid leukemia, without mention of having achieved remission,Aseptic necrosis of head and neck of femur,Glucocorticoid deficiency,Secondary diabetes mellitus without mention of complication, not stated as uncontrolled, or unspecified,Adrenal cortical steroids causing adverse effects in therapeutic use,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Personal history of venous thrombosis and embolism,Long-term (current) use of steroids,Thrombocytopenia, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Obstructive sleep apnea (adult)(pediatric),Dermatitis due to drugs and medicines taken internally,Other specified antibiotics causing adverse effects in therapeutic use,Nonspecific abnormal electrocardiogram [ECG] [EKG]
Influenza with pneumonia,Acute respiratry failure,Acute kidney failure NOS,Compl marrow transplant,Chronc graft-vs-host dis,Ac myl leuk wo achv rmsn,Aseptic necrosis femur,Glucocorticoid deficient,Sec DM wo cmp nt st uncn,Adv eff corticosteroids,Abn react-org transplant,Hx-ven thrombosis/embols,Long-term use steroids,Thrombocytopenia NOS,Hypertension NOS,Hyperlipidemia NEC/NOS,Obstructive sleep apnea,Drug dermatitis NOS,Adv eff antibiotics NEC,Abnorm electrocardiogram
Admission Date:  [**2146-2-14**]              Discharge Date:   [**2146-2-24**]

Date of Birth:  [**2090-7-16**]             Sex:   M

Service: MEDICINE

Allergies:
Cefepime / Cipro

Attending:[**First Name3 (LF) 3913**]
Chief Complaint:
Hypoxic Respiratory Failure

Major Surgical or Invasive Procedure:
None


History of Present Illness:
55 year h/o AML, s/p BMT w/ chronic GVHD of the liver, skin, and
eye, reporting 3 days of productive cough, malaise, nausea,
non-bilious, non-bloody vomiting x1 and weakness who was seen in
[**Hospital 3242**] clinic today with fever to 101, hypotension 90's/50's, tachy
120's, hypoxia 91% on RA, 93-94% on 2 L via NC. An EKG was
obtained with showed V4-V6 Twave inversions prompting further
evaluation in the ED. Prior to leaving the clinic he received 1
Liter NS, 60 mg Solumedrol (stress dose as pt on chronic
steroids), vancomycin 1gm IV with blood cultures sent from
clinic.
.
In the ED, initial vs were: T 101.9 HR 117 BP 107/73 RR 24 POX
89% on RA. Improved to 95% on a NRB, then on ventimask 50%.
Repeat blood cultures and urine culture were sent. Patient was
given dilaudid, aztreonam 2gm IV, benadryl and prochloperazine
for headache/belly ache. IV access 2 18g PIVs. CTA negative for
PE, but did show scatteredtree in [**Male First Name (un) 239**] opacities. EKG was not far
from baseline and plan established to trend CEs per BMT team, no
aspirin given [**1-18**] low platelets. VS 90 126/78 16 97% on 50%
ventimask prior to transfer.
.
On the floor, patient denied shortness of breath but did report
vague diffuse chest discomfort, headache, and nausea. Wife
reported recent course of azithromycin.
.
Review of sytems:
(+) Per HPI, has baseline rhinorrhea that is unchanged,
(-) Denies chills, night sweats, recent weight loss or gain.
Denies sinus tenderness or congestion. Denied palpitations.
Denied diarrhea, constipation or abdominal pain. No recent
change in bowel or bladder habits. No dysuria. Denied
arthralgias or myalgias.


Past Medical History:
- Type 2 DM, steroid induced
- Hyperlipidemia
- H/o AVN bilateral hips
- HTN
- H/o nephrolithiasis, lithotripsy and previous nephrostomy tube
and emergent surgery to repair ureteral damage
- h/o left interpolar renal lesion, followed with MRs
- h/o BCC s/p excision
- h/o SCC left cheek, s/p Mohs' [**5-/2144**]
- h/o multiple back surgeries: Lumbar L5-S1 surgery x 3, and
cervical spine fusion (bone graft, no hardware)
- h/o anterior cervical diskectomy and instrument arthrodesis at
C5-C6 and C6-C7 for degenerative cervical spondylitic disease
with spinal cord compression and foraminal stenosis at C5-C6 and
C6-C7 [**2-/2144**]- Dr. [**Last Name (STitle) 548**]
- Chronic numbness, neuropathic pain in left upper extremity.
- Multilevel compression fractures T11, T12, L1 and mild
compression L3 and L4.
- h/o pulmonary embolism [**11-23**] on anticoagulated from
[**Date range (1) 72256**]
- h/o RSV [**11/2144**] requiring ICU admission
- h/o OSA, on BIPAP followed by [**Location (un) 4507**]


Social History:
Lives with his wife, and one of children, worked as a [**Company 22957**]
technician now retired.
Tob: previously smoked 1ppd for many years but quit 3 years ago

EtOH: h/o social use; none recently


Family History:
Mother died suddenly in her 70s. Father died of unknown cancer
with tumors visible across body. One sister has thyroid cancer.
One brother has diabetes and kidney stones. One sister has
[**Name (NI) 5895**].


Physical Exam:
General: Sleepy but easily arousable, oriented x3, no acute
distress, speaking in full sentences w/out accessory muscle use

HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Scatter crackles, rhonchi at left base, no wheezes, good
air movement, no stridor
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: Obese, distended, soft, non-tender, bowel sounds
present, no rebound tenderness or guarding, no organomegaly
GU:no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema, strength intact throughout


Pertinent Results:
[**2146-2-14**] 10:00AM   WBC-6.5 RBC-4.46*# HGB-16.3# HCT-48.7
MCV-109* MCH-36.5* MCHC-33.4 RDW-13.6
[**2146-2-14**] 10:00AM   NEUTS-86* BANDS-3 LYMPHS-5* MONOS-6 EOS-0
BASOS-0 ATYPS-0 METAS-0 MYELOS-0
[**2146-2-14**] 10:00AM   HYPOCHROM-NORMAL ANISOCYT-NORMAL
POIKILOCY-NORMAL MACROCYT-3+ MICROCYT-NORMAL POLYCHROM-NORMAL
[**2146-2-14**] 10:00AM   UREA N-17 CREAT-1.5* SODIUM-133 POTASSIUM-3.8
CHLORIDE-93* TOTAL CO2-25 ANION GAP-19
[**2146-2-14**] 10:00AM   CALCIUM-9.0 PHOSPHATE-1.6* MAGNESIUM-1.8
[**2146-2-14**] 10:00AM   ALT(SGPT)-52* AST(SGOT)-46* LD(LDH)-227
CK(CPK)-43* ALK PHOS-125 TOT BILI-0.3
[**2146-2-14**] 10:00AM   cTropnT-0.02* proBNP-364*
[**2146-2-14**] 01:48PM   LACTATE-1.7
[**2146-2-14**] 03:10PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.013
[**2146-2-14**] 03:10PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-25
GLUCOSE-TR KETONE-TR BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG
[**2146-2-14**] 03:10PM URINE  RBC-[**2-18**]* WBC-[**5-26**]* BACTERIA-FEW
YEAST-NONE EPI-0-2
[**2146-2-14**] 03:10PM URINE  GRANULAR-0-2 HYALINE-[**11-5**]*
[**2146-2-14**] 05:10PM   CK(CPK)-51
[**2146-2-14**] 05:10PM   CK-MB-NotDone cTropnT-<0.01
[**2146-2-14**] 08:26PM   PT-11.7 PTT-31.7 INR(PT)-1.0

Brief Hospital Course:
55 year h/o AML, s/p BMT w/ chronic GVHD to skin and liver, on
steroids, presenting with hypoxic respiratory failure secondary
to parainfluenza infection.

# Hypoxic Respiratory Failure - Pt admitted to the ICU with
fever, SOB, productive cough, and O2 sat of 86% on RA, improving
to 94% on non-rebreather. CTA negative for PE, hypoxia out of
proportion to imaging findings of scattered tree-in-[**Male First Name (un) 239**]
opacities. Rapid viral screen returned positive for
parainfluenza. Sputum gram stain demonstrated GPCs and GNRs.
Sputum culture (prelim) demonstrated commensal flora, yeast,
negative PCP. [**Name10 (NameIs) 72257**] only mildly elevated. No evidence of
meningismus.  Started on vancomycin/aztreonam empirically for
pneumonia as allergic to cipro and cefepime.  Doxycycline also
added for mycoplasma coverage but this was D/Ced after
parainfluenza diagnosis. Patient was gradually weaned from a non
rebreather to NC supp O2. He was able to ambulate and maintain
O2 sat >90% on RA though still required 2-3L NC O2 to maintain
sat >90% while seated in bed. Baseline O2 sat is around 94% RA.
He was transferred to the floor for furhter management.  Oxygen
was continued on a prn basis.  Scheduled nebulizers were
continued.  Mr. [**Known lastname 47367**] developed a rash and vancomycin and
aztreonam were discontinued.  Oxygen requirement was
intermittant.  Due to continued malaise and oxygen requirement,
Ig levels were drawn and Mr. [**Known lastname 47367**] was determined to be IgG
deficient.  He recieved IVIG and prednisone was increased to 15
mg daily.  His oxygen status improved within 48 hours of these
changes.  On day of discharge, ambulatory oxygen saturation was
90% and oxygen saturation at rest was 94-96%.  He was discharged
home to follow-up with Dr. [**Last Name (STitle) **] on Monday, [**2-28**].

# Abnormal EKG/Lateral ST-depressions and T-wave inversions -
Has had similar EKG changes in setting of physiologic stress.
ECHO [**8-25**] showed EF >55%, borderline pulm HTN, could not rule
out WMA due to poor quality of study. Patient was ruled out for
MI with negative cardiac enzymes, no further symptoms or EKG
changes.
.
# Hypotension - Responded to IVF and has since remained
normotensive. Received stress dose steroids in clinic and on ICU
Day 1, given diagnosis of steroid-induced adrenal insufficieny
on last hospital admission, but decreased to his home dose the
following morning.

# Acute Renal Failure - Baseline 0.9-1, 1.5 on presentation.
Likely prerenal in etiology given poor po, nausea/vomiting, and
hypotension. Rapidly resolved with IV hydration.

# Steroid-induced DMII: Covered with 12 units NPH in AM (per
home regimen) and SS. Daytime fingerstick BS were 200-300, down
to 100s at bedtime and in AM. Erratic BS expected, given
administration of stress-dose steroids and resumption of full
diet following reduced PO intake prior to admission.  Blood
sugars were well controlled prior to discharge.

# AML s/p BMT w/ GVHD. Patient continued on home doses of
prednisone 10mg daily and acyclovir/bactrim prophylaxis, also
folic acid and vitamin D.  Prednisone increased to 15mg prior to
discharge and should be re-evaluated at follow-up appointment
with Dr. [**Last Name (STitle) **].

# Thrombocytopenia - Baseline 160-220, down to 140s on
admission, likely [**1-18**] hemoconcentration. Platelets were trended
and noted to be stable.


Medications on Admission:
Acyclovir 400 mg PO Q8H
Folic Acid 1 mg PO DAILY
Prednisone 10 mg PO DAILY
Pantoprazole 40 mg Tablet PO Q12H
Trimethoprim-Sulfamethoxazole 80-400 mg PO DAILY
Oxycodone SR (60 mg)QAM , (20 mg) Q2PM, and 60mg QPM
Ranitidine HCl 150 mg PO HS
Budesonide 3 mg SR PO three times a day.
Cholecalciferol (Vitamin D3) 400 unit PO DAILY
Humulin N Twelve (12) units Subcutaneous twice a day.
Insulin Lispro QACHS Per sliding scale.


Discharge Medications:
1. Bactrim 400-80 mg Tablet Sig: One (1) Tablet PO once a day.
2. Acyclovir 200 mg Capsule Sig: Two (2) Capsule PO Q8H (every 8
hours).
3. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Compazine 5 mg Tablet Sig: 1-2 Tablets PO every six (6) hours
as needed for nausea.
Disp:*30 Tablet(s)* Refills:*0*
5. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
6. Prednisone 5 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
7. Oxycodone 20 mg Tablet Sustained Release 12 hr Sig: Three (3)
Tablet Sustained Release 12 hr PO BID (2 times a day).
8. Oxycodone 20 mg Tablet Sustained Release 12 hr Sig: One (1)
Tablet Sustained Release 12 hr PO Q2PM ().
9. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO at
bedtime.
10. Budesonide 3 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO TID (3 times a day).
11. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
12. NPH Insulin Human Recomb 100 unit/mL Suspension Sig: [**5-28**]
units Subcutaneous twice a day: Take as previously prescribed.
13. Humalog 100 unit/mL Solution Sig: 1-12 units Subcutaneous
before meals and at bedtime: Take as previously prescribed.
14. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO every four (4)
hours as needed for pain.


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
- Parainfluenza infection
- Acute Renal Failure
- Hypotension, responsive to fluids

Secondary:
- Diabetes, type II
- Chronic GVHD


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


Discharge Instructions:
You were admitted for shortness of breath.  You initially went
to the ICU for monitoring because you required oxygen and you
had low blood pressure.  Your low blood pressure improved with
fluids.  You were transferred to the BMT unit once you were
stable.  You tested positive for parainfluenza, which causes
symptoms similar to a common cold.  You were treated with
antibiotics to help avoid getting another infection.   You were
given antibodies and your prednisone was increased to help you
breathe easier.  You are being discharged home to follow up with
Dr. [**Last Name (STitle) **].

Changes in Medication:
Increase Prednisone to 15 mg by mouth daily
Please take all other medications as previously prescribed

Followup Instructions:
Please follow up with Dr. [**Last Name (STitle) **] after discharge.  An
appointment has been made for you and is listed below.  Please
call and reschedule if you are unable to make this appointment.

Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 7779**], MD Phone:[**Telephone/Fax (1) 3241**]
Date/Time:[**2146-2-28**] 3:00
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 9574**], [**MD Number(3) 1240**]:[**Telephone/Fax (1) 3241**]
Date/Time:[**2146-2-28**] 3:00
{'Influenza with pneumonia,Acute respiratory failure,Acute kidney failure, unspecified,Complications of transplanted bone marrow,Chronic graft-versus-host disease,Acute myeloid leukemia, without mention of having achieved remission,Aseptic necrosis of head and neck of femur,Glucocorticoid deficiency,Secondary diabetes mellitus without mention of complication, not stated as uncontrolled, or unspecified,Adrenal cortical steroids causing adverse effects in therapeutic use,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Personal history of venous thrombosis and embolism,Long-term (current) use of steroids,Thrombocytopenia, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Obstructive sleep apnea (adult)(pediatric),Dermatitis due to drugs and medicines taken internally,Other specified antibiotics causing adverse effects in therapeutic use,Nonspecific abnormal electrocardiogram [ECG] [EKG]'}


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: Hypoxic Respiratory Failure

PRESENT ILLNESS: 55 year h/o AML, s/p BMT w/ chronic GVHD of the liver, skin, and
eye, reporting 3 days of productive cough, malaise, nausea,
non-bilious, non-bloody vomiting x1 and weakness who was seen in
[**Hospital 3242**] clinic today with fever to 101, hypotension 90's/50's, tachy
120's, hypoxia 91% on RA, 93-94% on 2 L via NC. An EKG was
obtained with showed V4-V6 Twave inversions prompting further
evaluation in the ED. Prior to leaving the clinic he received 1
Liter NS, 60 mg Solumedrol (stress dose as pt on chronic
steroids), vancomycin 1gm IV with blood cultures sent from
clinic.
.
In the ED, initial vs were: T 101.9 HR 117 BP 107/73 RR 24 POX
89% on RA. Improved to 95% on a NRB, then on ventimask 50%.
Repeat blood cultures and urine culture were sent. Patient was
given dilaudid, aztreonam 2gm IV, benadryl and prochloperazine
for headache/belly ache. IV access 2 18g PIVs. CTA negative for
PE, but did show scatteredtree in [**Male First Name (un) 239**] opacities. EKG was not far
from baseline and plan established to trend CEs per BMT team, no
aspirin given [**1-18**] low platelets. VS 90 126/78 16 97% on 50%
ventimask prior to transfer.
.
On the floor, patient denied shortness of breath but did report
vague diffuse chest discomfort, headache, and nausea. Wife
reported recent course of azithromycin.
.
Review of sytems:
(+) Per HPI, has baseline rhinorrhea that is unchanged,
(-) Denies chills, night sweats, recent weight loss or gain.
Denies sinus tenderness or congestion. Denied palpitations.
Denied diarrhea, constipation or abdominal pain. No recent
change in bowel or bladder habits. No dysuria. Denied
arthralgias or myalgias.

MEDICAL HISTORY: - Type 2 DM, steroid induced
- Hyperlipidemia
- H/o AVN bilateral hips
- HTN
- H/o nephrolithiasis, lithotripsy and previous nephrostomy tube
and emergent surgery to repair ureteral damage
- h/o left interpolar renal lesion, followed with MRs
- h/o BCC s/p excision
- h/o SCC left cheek, s/p Mohs' [**5-/2144**]
- h/o multiple back surgeries: Lumbar L5-S1 surgery x 3, and
cervical spine fusion (bone graft, no hardware)
- h/o anterior cervical diskectomy and instrument arthrodesis at
C5-C6 and C6-C7 for degenerative cervical spondylitic disease
with spinal cord compression and foraminal stenosis at C5-C6 and
C6-C7 [**2-/2144**]- Dr. [**Last Name (STitle) 548**]
- Chronic numbness, neuropathic pain in left upper extremity.
- Multilevel compression fractures T11, T12, L1 and mild
compression L3 and L4.
- h/o pulmonary embolism [**11-23**] on anticoagulated from
[**Date range (1) 72256**]
- h/o RSV [**11/2144**] requiring ICU admission
- h/o OSA, on BIPAP followed by [**Location (un) 4507**]

MEDICATION ON ADMISSION: Acyclovir 400 mg PO Q8H
Folic Acid 1 mg PO DAILY
Prednisone 10 mg PO DAILY
Pantoprazole 40 mg Tablet PO Q12H
Trimethoprim-Sulfamethoxazole 80-400 mg PO DAILY
Oxycodone SR (60 mg)QAM , (20 mg) Q2PM, and 60mg QPM
Ranitidine HCl 150 mg PO HS
Budesonide 3 mg SR PO three times a day.
Cholecalciferol (Vitamin D3) 400 unit PO DAILY
Humulin N Twelve (12) units Subcutaneous twice a day.
Insulin Lispro QACHS Per sliding scale.

ALLERGIES: Cefepime / Cipro

PHYSICAL EXAM: General: Sleepy but easily arousable, oriented x3, no acute
distress, speaking in full sentences w/out accessory muscle use

FAMILY HISTORY: Mother died suddenly in her 70s. Father died of unknown cancer
with tumors visible across body. One sister has thyroid cancer.
One brother has diabetes and kidney stones. One sister has
[**Name (NI) 5895**].

SOCIAL HISTORY: Lives with his wife, and one of children, worked as a [**Company 22957**]
technician now retired.
Tob: previously smoked 1ppd for many years but quit 3 years ago 

### Response:
{'Influenza with pneumonia,Acute respiratory failure,Acute kidney failure, unspecified,Complications of transplanted bone marrow,Chronic graft-versus-host disease,Acute myeloid leukemia, without mention of having achieved remission,Aseptic necrosis of head and neck of femur,Glucocorticoid deficiency,Secondary diabetes mellitus without mention of complication, not stated as uncontrolled, or unspecified,Adrenal cortical steroids causing adverse effects in therapeutic use,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Personal history of venous thrombosis and embolism,Long-term (current) use of steroids,Thrombocytopenia, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Obstructive sleep apnea (adult)(pediatric),Dermatitis due to drugs and medicines taken internally,Other specified antibiotics causing adverse effects in therapeutic use,Nonspecific abnormal electrocardiogram [ECG] [EKG]'}
