CHIEF COMPLAINT: shortness of breath

PRESENT ILLNESS: 54F with history of decompensated hep c cirrhosis followed by
Dr. [**Last Name (STitle) **] presenting with progressive SOB over last 2-3 days
associated with pleuritic CP. She recently ran out of lasix 2
days ago and has noted progressive increase in abdominal girth.
She also notes cold symptoms x 2 weeks with cough productive of
white-yellow sputum and yellow post-tussive emesis. Denies
hemoptysis, LE edema or pain.  Reports chills but denies fevers
or sick contacts.  Denies diarrhea. Abdominal pain not worse
with PO intake. Denies trauma or recent falls. She called PCP
who recommended she call 911 since she was having difficulty
speaking in ful sentences. When EMS arrived, O2 sats high 80s to
low 90s so she was plaed on NRB and taken to [**Hospital1 18**].
.
In the ED, initial VS:98.2 82 132/61 22 100% 15L NRB, 87%RA. CXR
revealed large left pleural effusion with complete left lung
collapse. RUQ U/S was negative for ascites. Per liver fellow,
patient needs diagnostic and therapeutic [**Female First Name (un) 576**] tonight due to
respiratory distress so recommended admissionto MICU. She
received 80mg IV lasix and lactulose. Blood and urine cx sent.
VS prior to transfer: 98.1 86 132/60 18 100% 15L NRB.
.
ROS: + left elbow pain x weeks. Denies dysuria, diarrhea,
decrease PO intake, other joint pains, rash, headache,
palpitations, visual changes.

MEDICAL HISTORY: - HCV cirrhosis
- hypothyroidism
- depression/ anxiety
- MSSA spinal osteomyelitis/ discitis/ epidural abscess/
paravertebral abscess and cord compression s/p C2-C3 laminectomy

MEDICATION ON ADMISSION: Furosemide 40 mg Tablet 1 Tablet(s) by mouth daily
Lactulose 10 gram/15 mL Solution 30 ml by mouth three times a
day decrease to twice a day if having more than 3 bowel
movements a day  Spironolactone 100 mg Tablet 1.5 Tablet(s) by
mouth daily
Tramadol 50 mg Tablet 1 Tablet(s) by mouth qd prn for pain
Multivitamin Tablet 1 Tablet(s) by mouth daily
Omeprazole magnesium [Prilosec OTC] 20 mg Tablet, Delayed
Release (E.C.) 1 Tablet(s) by mouth twice a day

ALLERGIES: Penicillins

PHYSICAL EXAM: VS: 36.9 89 149/60 22 94%NRB, 92% RA
GEN: pleasant, tachypneic, speaking in partial sentences
HEENT: PERRL, EOMI, + scleral icterus, MMM, op without lesions,
no supraclavicular or cervical lymphadenopathy, no jvd, no
carotid bruits. + sublingual icterus
RESP: Crackles R base with expiratory wheezes. Left lung with
minimal air movement and breath sounds, dullness to percussion
3/4 up hemithorax
CV: RRR, S1 and S2 wnl, no m/r/g
ABD: nd, +b/s, soft, TTP epigastrum. No masses, + splenomegaly
EXT: no c/c. 1+ edema. Left elbow with slight effusion, no
erythema,h yperpigmented skin
SKIN: no rashes/no jaundice/no splinters
NEURO: AAOx3. Cn II-XII intact. 5/5 strength throughout
dorsiflexion, plantarflexion, [**Last Name (un) **] to lift legs off bed.
2+DTR's-patellar and biceps. No asterixis

FAMILY HISTORY: Mother with HTN and DM. Father unknown. Sister passed away from
pancreatic cancer. Grandmother with lung cancer.

SOCIAL HISTORY: On disability since her epidural abscess s/p laminectomy in
[**2107**]. Prior to that was a nurses aid, teacher, crossing guard.A
mbulates minimally with a rolling walker, but mostly confined to
wheelchair. Lives at home with her children, 19 and 21 years
old. Quit smoking in [**2110**]. Formerly smoked [**1-4**] ppd x 5 years.
Denies current ETOH or IVDA. Used to use cocaine. Denies contact
with homeless or incarcerated persons.
Other specified forms of effusion, except tuberculous,Pulmonary collapse,Chronic hepatitis C without mention of hepatic coma,Cirrhosis of liver without mention of alcohol,Unspecified acquired hypothyroidism,Esophageal reflux,Thrombocytopenia, unspecified
Effusion NEC exc tb,Pulmonary collapse,Chrnc hpt C wo hpat coma,Cirrhosis of liver NOS,Hypothyroidism NOS,Esophageal reflux,Thrombocytopenia NOS
Admission Date:  [**2111-2-11**]              Discharge Date:   [**2111-2-14**]

Date of Birth:  [**2056-9-29**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 12174**]
Chief Complaint:
shortness of breath

Major Surgical or Invasive Procedure:
thoracentesis [**2-12**]

History of Present Illness:
54F with history of decompensated hep c cirrhosis followed by
Dr. [**Last Name (STitle) **] presenting with progressive SOB over last 2-3 days
associated with pleuritic CP. She recently ran out of lasix 2
days ago and has noted progressive increase in abdominal girth.
She also notes cold symptoms x 2 weeks with cough productive of
white-yellow sputum and yellow post-tussive emesis. Denies
hemoptysis, LE edema or pain.  Reports chills but denies fevers
or sick contacts.  Denies diarrhea. Abdominal pain not worse
with PO intake. Denies trauma or recent falls. She called PCP
who recommended she call 911 since she was having difficulty
speaking in ful sentences. When EMS arrived, O2 sats high 80s to
low 90s so she was plaed on NRB and taken to [**Hospital1 18**].
.
In the ED, initial VS:98.2 82 132/61 22 100% 15L NRB, 87%RA. CXR
revealed large left pleural effusion with complete left lung
collapse. RUQ U/S was negative for ascites. Per liver fellow,
patient needs diagnostic and therapeutic [**Female First Name (un) 576**] tonight due to
respiratory distress so recommended admissionto MICU. She
received 80mg IV lasix and lactulose. Blood and urine cx sent.
VS prior to transfer: 98.1 86 132/60 18 100% 15L NRB.
.
ROS: + left elbow pain x weeks. Denies dysuria, diarrhea,
decrease PO intake, other joint pains, rash, headache,
palpitations, visual changes.


Past Medical History:
- HCV cirrhosis
- hypothyroidism
- depression/ anxiety
- MSSA spinal osteomyelitis/ discitis/ epidural abscess/
paravertebral abscess and cord compression s/p C2-C3 laminectomy

in [**2107**] with resultant disability and "paralysis"
- prior IV cocaine use of short duration
- negative PPD several years ago


Social History:
On disability since her epidural abscess s/p laminectomy in
[**2107**]. Prior to that was a nurses aid, teacher, crossing guard.A
mbulates minimally with a rolling walker, but mostly confined to
wheelchair. Lives at home with her children, 19 and 21 years
old. Quit smoking in [**2110**]. Formerly smoked [**1-4**] ppd x 5 years.
Denies current ETOH or IVDA. Used to use cocaine. Denies contact
with homeless or incarcerated persons.

Family History:
Mother with HTN and DM. Father unknown. Sister passed away from
pancreatic cancer. Grandmother with lung cancer.


Physical Exam:
VS: 36.9 89 149/60 22 94%NRB, 92% RA
GEN: pleasant, tachypneic, speaking in partial sentences
HEENT: PERRL, EOMI, + scleral icterus, MMM, op without lesions,
no supraclavicular or cervical lymphadenopathy, no jvd, no
carotid bruits. + sublingual icterus
RESP: Crackles R base with expiratory wheezes. Left lung with
minimal air movement and breath sounds, dullness to percussion
3/4 up hemithorax
CV: RRR, S1 and S2 wnl, no m/r/g
ABD: nd, +b/s, soft, TTP epigastrum. No masses, + splenomegaly
EXT: no c/c. 1+ edema. Left elbow with slight effusion, no
erythema,h yperpigmented skin
SKIN: no rashes/no jaundice/no splinters
NEURO: AAOx3. Cn II-XII intact. 5/5 strength throughout
dorsiflexion, plantarflexion, [**Last Name (un) **] to lift legs off bed.
2+DTR's-patellar and biceps. No asterixis


Pertinent Results:
ADMISSION LABS:
[**2111-2-11**] 05:20PM BLOOD WBC-3.7* RBC-4.11* Hgb-12.9 Hct-36.9
MCV-90 MCH-31.3 MCHC-34.9 RDW-16.5* Plt Ct-62*
[**2111-2-11**] 05:20PM BLOOD Neuts-58.6 Lymphs-30.1 Monos-5.0 Eos-5.1*
Baso-1.1
[**2111-2-11**] 05:20PM BLOOD PT-17.5* PTT-34.6 INR(PT)-1.6*
[**2111-2-11**] 05:20PM BLOOD Glucose-114* UreaN-12 Creat-0.8 Na-142
K-3.6 Cl-111* HCO3-22 AnGap-13
[**2111-2-11**] 05:20PM BLOOD ALT-291* AST-547* LD(LDH)-338*
AlkPhos-187* TotBili-2.2*
[**2111-2-11**] 05:20PM BLOOD Lipase-79*
[**2111-2-11**] 05:20PM BLOOD TotProt-5.9* Albumin-3.3* Globuln-2.6
Calcium-8.9 Phos-3.4 Mg-2.0
[**2111-2-11**] 05:20PM BLOOD TSH-4.7*
[**2111-2-11**] 05:20PM BLOOD Free T4-1.2
[**2111-2-12**] 12:48AM BLOOD HBsAg-NEGATIVE HBsAb-BORDERLINE
HBcAb-NEGATIVE
[**2111-2-12**] 12:48AM BLOOD ASA-NEG Acetmnp-NEG Bnzodzp-NEG
Barbitr-NEG Tricycl-NEG
[**2111-2-11**] 07:10PM URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-1.005
[**2111-2-11**] 07:10PM URINE Blood-NEG Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG
[**2111-2-12**] 12:48AM PLEURAL WBC-115* RBC-225* Polys-10* Lymphs-64*
Monos-17* Meso-9*
[**2111-2-12**] 12:48AM PLEURAL TotProt-0.7 Glucose-110 LD(LDH)-60
Amylase-51 Albumin-LESS THAN
.
DISCHARGE LABS:
[**2111-2-14**] 05:00AM BLOOD WBC-5.5 RBC-3.82* Hgb-11.6* Hct-34.1*
MCV-89 MCH-30.5 MCHC-34.1 RDW-16.3* Plt Ct-48*
[**2111-2-14**] 05:00AM BLOOD PT-17.6* PTT-38.1* INR(PT)-1.6*
[**2111-2-14**] 05:00AM BLOOD Glucose-102* UreaN-15 Creat-1.0 Na-139
K-3.8 Cl-106 HCO3-26 AnGap-11
[**2111-2-14**] 05:00AM BLOOD ALT-228* AST-393* AlkPhos-156*
TotBili-2.1*
[**2111-2-14**] 05:00AM BLOOD Albumin-2.9* Calcium-8.7 Phos-3.1 Mg-2.0
.
MICROBIOLOGY:
   URINE CULTURE (Final [**2111-2-14**]):
      ESCHERICHIA COLI.    10,000-100,000 ORGANISMS/ML..
         PRESUMPTIVE IDENTIFICATION OF TWO COLONIAL
MORPHOLOGIES.
         Piperacillin/tazobactam sensitivity testing available
on request.

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             ESCHERICHIA COLI
                             |
AMPICILLIN------------  =>32 R
AMPICILLIN/SULBACTAM--  =>32 R
CEFAZOLIN-------------   <=4 S
CEFEPIME--------------   <=1 S
CEFTAZIDIME-----------   <=1 S
CEFTRIAXONE-----------   <=1 S
CIPROFLOXACIN---------   =>4 R
GENTAMICIN------------   <=1 S
MEROPENEM-------------<=0.25 S
NITROFURANTOIN--------  <=16 S
TOBRAMYCIN------------   <=1 S
TRIMETHOPRIM/SULFA----   <=1 S
.
Blood Culture x2 [**2111-2-11**]: No Growth To Date (Pending)
.
[**2111-2-12**] 12:48 am PLEURAL FLUID

   GRAM STAIN (Final [**2111-2-12**]):
      2+   (1-5 per 1000X FIELD):   POLYMORPHONUCLEAR
LEUKOCYTES.
      NO MICROORGANISMS SEEN.

   FLUID CULTURE (Preliminary):    NO GROWTH.

   ANAEROBIC CULTURE (Preliminary):    NO GROWTH.

   FUNGAL CULTURE (Preliminary):    NO FUNGUS ISOLATED.
.
IMAGING:
CXR [**2111-2-11**]: Complete opacification of the left hemithorax likely
secondary to large effusion and left lung collapse.
.
RUQ U/S [**2111-2-11**]:
1. Large left-sided pleural effusion.
2. Echogenic and nodular liver, consistent with known cirrhosis.
 No focal hepatic lesions are identified. Patent portal venous
system with appropriate direction of flow.
3. Trace amount of ascites around the liver.
.
CXR [**2111-2-12**]: There is interval decrease in pleural effusion with
reexpansion of the upper portion of the left lung. No definitive
pneumothorax is demonstrated. The mediastinal position is more
central. Right lung is essentially clear.
.
CXR [**2111-2-13**]: In comparison with study of [**2-12**], there has been
removal of large amount of fluid from the left pleural space.
Little residual persists. No evidence of pneumothorax.

Brief Hospital Course:
The patient is a 54 yo F with a decompensated Hep C cirrhosis
who was admitted to the MICU on [**2111-2-12**] with respiratory
distress secondary to hydrothorax who is called out to the
hepatology service following clinical improvement after
thoracentesis.
.
Left-sided hepatic hydrothorax: The patient initially developed
SOB 2-3 days prior to admission coinciding with running out of
lasix and increased abdominal girth. On the day of admission
oxygen saturation was in the high 80s.  In the ED initial labs
notable for absence of leukocytosis, ALT 291, AST 547, LDH 338,
Alk Phos 187, Tbili 2.2. CXR revealed L hydrothorax with
complete L lung collapse. A RUQ U/S was negative for ascites.
She was given 80 mg IV lasix and lactulose and transferred to
the MICU.  In the MICU, she underwent thoracentesis with 1.1 L
drained which was terminated early due to coughing, resulting in
symptomatic improvement, increased oxygen saturation, and
decreased respiratory rate. She was diuresed with IV lasix and
spironolactone.  She was able to be weaned to oxygen by nasal
cannula. Pleural fluid was consistent with a transudate with
culture pending.  She was then transferred to the hepatology
service.  She underwent a second thoracentesis, draining 800
cc's of fluid, after which chest x-ray showed almost no residual
pleural fluid.  She is discharged home on increased lasix (40 mg
[**Hospital1 **] instead of daily) and spironolactone 150 mg daily.  She will
have electrolytes drawn next week and sent to her hepatologist
and follow-up in hepatology clinic in [**10-16**] days.
.
Hep C cirrhosis/Transaminitis:  The patient's LFTs were up from
baseline on admission.  Serum tox screen was negative.  She
underwent RUQ U/S which showed patent portal veins.  She was
continued on lactulose.  Her LFTs trended down during her
admission and she will follow-up in hepatology clinic.
.
GERD: The patient has a history of GERD.  She was maintained on
her home dose PPI.  Prior to discharge she had one episode of
emesis.  She was not orthostatic.  She was treated with zofran
and tolerated a regular dinner prior to discharge.
.
Hypothyroidism: The patient's TSH was checked and mildly
elevated at 4.7 with a normal T4 of 1.2  She should have a
follow-up TSH in 3 months.
.
Code:  Full Code

Medications on Admission:
Furosemide 40 mg Tablet 1 Tablet(s) by mouth daily
Lactulose 10 gram/15 mL Solution 30 ml by mouth three times a
day decrease to twice a day if having more than 3 bowel
movements a day  Spironolactone 100 mg Tablet 1.5 Tablet(s) by
mouth daily
Tramadol 50 mg Tablet 1 Tablet(s) by mouth qd prn for pain
Multivitamin Tablet 1 Tablet(s) by mouth daily
Omeprazole magnesium [Prilosec OTC] 20 mg Tablet, Delayed
Release (E.C.) 1 Tablet(s) by mouth twice a day

Discharge Medications:
1. furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
2. lactulose 10 gram/15 mL Syrup Sig: Thirty (30) ML PO TID (3
times a day).
3. spironolactone 100 mg Tablet Sig: 1.5 Tablets PO DAILY
(Daily).
4. tramadol 50 mg Tablet Sig: One (1) Tablet PO twice a day as
needed for pain.
5. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO BID (2 times a day).
6. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

7. Outpatient Lab Work
Please have blood drawn for chem 7 on Wednesday [**2-18**].
Fax results to [**First Name11 (Name Pattern1) 2808**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 805**], NP and [**Name6 (MD) **] [**Name8 (MD) **], MD at
([**Telephone/Fax (1) 4409**].


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis: Hepatic Hydrothorax
Secondary Diagnosis: Hepatitis C Cirrhosis, Hypothyroidism,


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
You were admitted to the hospital due to shortness of breath
caused by fluid around your lung.  This fluid accumulated
because of your scarred liver.  You had fluid drained twice from
the lung and felt better.  Your lasix dose was increased to help
keep the fluid from re-accumulating around your lung.  You will
need to have your blood drawn next week for labs that should be
sent to your liver doctor.  You should also follow-up with your
liver doctor in 2 weeks.
.
The following change was made to your medications:
INCREASE your lasix dose from once per day to twice per day.

Followup Instructions:
Please have blood drawn sometime between Wednesday [**2-18**]
and Friday [**2-20**].
.
It is imporant that you call [**First Name8 (NamePattern2) 2808**] [**Last Name (NamePattern1) 805**] at the Liver Center
(phone number [**Telephone/Fax (1) 2422**]) on Monday to schedule an appointment
for sometime in the next 10-14 days.
.
Department: LIVER CENTER
When: FRIDAY [**2111-3-20**] at 10:40 AM
With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] [**Telephone/Fax (1) 2422**]
Building: LM [**Hospital Unit Name **] [**Location (un) 858**]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage
{'Other specified forms of effusion, except tuberculous,Pulmonary collapse,Chronic hepatitis C without mention of hepatic coma,Cirrhosis of liver without mention of alcohol,Unspecified acquired hypothyroidism,Esophageal reflux,Thrombocytopenia, 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: shortness of breath

PRESENT ILLNESS: 54F with history of decompensated hep c cirrhosis followed by
Dr. [**Last Name (STitle) **] presenting with progressive SOB over last 2-3 days
associated with pleuritic CP. She recently ran out of lasix 2
days ago and has noted progressive increase in abdominal girth.
She also notes cold symptoms x 2 weeks with cough productive of
white-yellow sputum and yellow post-tussive emesis. Denies
hemoptysis, LE edema or pain.  Reports chills but denies fevers
or sick contacts.  Denies diarrhea. Abdominal pain not worse
with PO intake. Denies trauma or recent falls. She called PCP
who recommended she call 911 since she was having difficulty
speaking in ful sentences. When EMS arrived, O2 sats high 80s to
low 90s so she was plaed on NRB and taken to [**Hospital1 18**].
.
In the ED, initial VS:98.2 82 132/61 22 100% 15L NRB, 87%RA. CXR
revealed large left pleural effusion with complete left lung
collapse. RUQ U/S was negative for ascites. Per liver fellow,
patient needs diagnostic and therapeutic [**Female First Name (un) 576**] tonight due to
respiratory distress so recommended admissionto MICU. She
received 80mg IV lasix and lactulose. Blood and urine cx sent.
VS prior to transfer: 98.1 86 132/60 18 100% 15L NRB.
.
ROS: + left elbow pain x weeks. Denies dysuria, diarrhea,
decrease PO intake, other joint pains, rash, headache,
palpitations, visual changes.

MEDICAL HISTORY: - HCV cirrhosis
- hypothyroidism
- depression/ anxiety
- MSSA spinal osteomyelitis/ discitis/ epidural abscess/
paravertebral abscess and cord compression s/p C2-C3 laminectomy

MEDICATION ON ADMISSION: Furosemide 40 mg Tablet 1 Tablet(s) by mouth daily
Lactulose 10 gram/15 mL Solution 30 ml by mouth three times a
day decrease to twice a day if having more than 3 bowel
movements a day  Spironolactone 100 mg Tablet 1.5 Tablet(s) by
mouth daily
Tramadol 50 mg Tablet 1 Tablet(s) by mouth qd prn for pain
Multivitamin Tablet 1 Tablet(s) by mouth daily
Omeprazole magnesium [Prilosec OTC] 20 mg Tablet, Delayed
Release (E.C.) 1 Tablet(s) by mouth twice a day

ALLERGIES: Penicillins

PHYSICAL EXAM: VS: 36.9 89 149/60 22 94%NRB, 92% RA
GEN: pleasant, tachypneic, speaking in partial sentences
HEENT: PERRL, EOMI, + scleral icterus, MMM, op without lesions,
no supraclavicular or cervical lymphadenopathy, no jvd, no
carotid bruits. + sublingual icterus
RESP: Crackles R base with expiratory wheezes. Left lung with
minimal air movement and breath sounds, dullness to percussion
3/4 up hemithorax
CV: RRR, S1 and S2 wnl, no m/r/g
ABD: nd, +b/s, soft, TTP epigastrum. No masses, + splenomegaly
EXT: no c/c. 1+ edema. Left elbow with slight effusion, no
erythema,h yperpigmented skin
SKIN: no rashes/no jaundice/no splinters
NEURO: AAOx3. Cn II-XII intact. 5/5 strength throughout
dorsiflexion, plantarflexion, [**Last Name (un) **] to lift legs off bed.
2+DTR's-patellar and biceps. No asterixis

FAMILY HISTORY: Mother with HTN and DM. Father unknown. Sister passed away from
pancreatic cancer. Grandmother with lung cancer.

SOCIAL HISTORY: On disability since her epidural abscess s/p laminectomy in
[**2107**]. Prior to that was a nurses aid, teacher, crossing guard.A
mbulates minimally with a rolling walker, but mostly confined to
wheelchair. Lives at home with her children, 19 and 21 years
old. Quit smoking in [**2110**]. Formerly smoked [**1-4**] ppd x 5 years.
Denies current ETOH or IVDA. Used to use cocaine. Denies contact
with homeless or incarcerated persons. 

### Response:
{'Other specified forms of effusion, except tuberculous,Pulmonary collapse,Chronic hepatitis C without mention of hepatic coma,Cirrhosis of liver without mention of alcohol,Unspecified acquired hypothyroidism,Esophageal reflux,Thrombocytopenia, unspecified'}
