CHIEF COMPLAINT: Respiratory distress

PRESENT ILLNESS: Patient intubated and history is per report and record review.
Ms. [**Known lastname **] is a 52-year-old female with ALL s/p chemo and single
cord blood transplantation complicated by CMV viremia,
streptococcal bacteremia, VRE UTI, and suspected GVHD-induced
hepatitis who presents with fever and productive cough. The
cough started 3 weeks ago and has been productive of green
sputum, and associated with mild shortness of breath,
nausea/vomiting (attributed to Gleevec), and fatigue. She saw
her oncologist on [**2114-11-6**] for a followup, was afebrile with O2
sat 91,RA, and was noted to have a WBC of 11.2. She was started
on azithromycin and advised to return to clinic in 3 days.
Today, she noted difficulty breathing and fevers/chills/night
sweats, as well as cough, with symptoms worse the past two days.
She also reports anorexia and [**7-1**]# wt loss. Her O2 sat was noted
to be 86 on RA, improving to 95 on 3L NC. Blood cultures and flu
swab were obtained and she was referred to the ED.
.
In the ED, her initial vitals were: 99.5 88 120/76 28 96% on 5L
NC. On exam, she was dry with diminished breath sounds and right
sided crackles, and tachycardia. A CT of the chest was ordered
looking for possible PCP and showed evidence of infection with
multifocal airspace opacities. She was started on vancomycin and
aztreonam, in addition to continuing her current azithromycin.
While in the ED, her respiratory status worsened, becoming more
tachypneic and hypoxic requiring intubation. Her recent vitals
(prior to intubation) show RR 32, HR 124, 127/83 and O2 sat of
76,RA -> 96,3L. She received 4L IVF in the ED. Cannot perform
ROS as pt is intubated and sedated.

MEDICAL HISTORY: ONCOLOGIC HISTORY
====================
Diagnosed with [**Location (un) 5622**] Chromosome positive pre-B cell ALL
in [**2113-11-25**]
- [**2113-12-13**]: Part A of hyperCVAD cycle 1 was started on  and
imantinib 600mg po qdaily was started on [**2113-12-21**] when the Ph
chromosome came back as positive.
- [**2113-12-22**]: First LP performed by IR and cytarabine was
administered. Fluid non-diagnostic but as high suspicion for CSF
disease started on twice weekly methotrexate
---[**2113-12-28**]: CSF sample from confirmed CNS involvement of ALL
---[**2115-1-1**] CSF sample from  was negative for ALL so IT MTX
discontinued
- [**2114-1-17**]: Part B hyperCVAD of cycle 1 was started (IT chemo
was
limited to D6 ara-C on [**2114-1-22**] to minimize neurotoxicity)
- [**2114-2-2**]: Cycle 2 (Part A) of hyperCVAD started
- [**2114-3-5**]: Cycle 2 (Part B) hyperCVAD chemotherapy started
- [**2114-4-5**]: IT MTX administered

MEDICATION ON ADMISSION: ACYCLOVIR - 400 mg TID
AMLODIPINE - 5 mg daily
Azithromycin 500mg, then 250mg daily x5 days total, started
[**2114-11-6**]
IMATINIB 100mg daily (on hold)
LAMIVUDINE - 100 mg daily
LORAZEPAM - 0.5 mg Tablet - [**1-26**] Tablet(s) by mouth every six (6)
hours
OMEPRAZOLE - 20 mg Capsule daily
PENTAMIDINE [NEBUPENT] - (received in IP) - 300 mg Recon Soln -

ALLERGIES: Cefepime

PHYSICAL EXAM: GENERAL: Intubated, initially responsive to verbal stimuli, but
sedation increased for agitation.
HEENT: Pupils are equal and minimally reactive to light. ETT in
place.
LUNGS: R lung fields with diffuse crackles. L side clear.
HEART: RRR no M/R/G
ABDOMEN: + BS. Soft, nontender, nondistended with no
hepatosplenomegaly. There are no palpable masses.
EXTREMITIES: There is no edema. 2+ peripheral pulses. Moves all
ext spontaneously.
SKIN: No rashes. The skin is warm and dry.

FAMILY HISTORY: There is no family history of cancer or blood disorders that she
is aware of.

SOCIAL HISTORY: She is Mandarin-speaking only and immigrated from [**Country 651**] in [**2100**].
She previously worked in customer service. She denies any
history of tobacco, alcohol, or illicit drugs. She's married.
Unspecified septicemia,Pneumonia, organism unspecified,Acute respiratory failure,Septic shock,Acute kidney failure with lesion of tubular necrosis,Severe sepsis,Acute lymphoid leukemia, without mention of having achieved remission,Graft-versus-host disease, unspecified,Mixed acid-base balance disorder,Cytomegaloviral disease,Thrombocytopenia, unspecified,Other specified organ or tissue replaced by transplant,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified vitamin B deficiency,Pulmonary tuberculosis, unspecified, unspecified,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Mechanical complication due to graft of other tissue, not elsewhere classified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other esophagitis,Contact dermatitis and other eczema, unspecified cause,Abdominal pain, unspecified site,Unspecified visual disturbance,Other abnormal blood chemistry,Other restorative surgery causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Conjunctival hemorrhage,Hypothermia not associated with low environmental temperature,Constipation, unspecified,Anemia, unspecified
Septicemia NOS,Pneumonia, organism NOS,Acute respiratry failure,Septic shock,Ac kidny fail, tubr necr,Severe sepsis,Ac lym leuk wo achv rmsn,Graft-versus-host NOS,Mixed acid-base bal dis,Cytomegaloviral disease,Thrombocytopenia NOS,Trnspl status organ NEC,DMII wo cmp nt st uncntr,Vitamin b deficiency NOS,Pulmonary TB NOS-unspec,Hpt B chrn wo cm wo dlta,Oth tissue graft malfunc,Hypertension NOS,Hyperlipidemia NEC/NOS,Other esophagitis,Dermatitis NOS,Abdmnal pain unspcf site,Visual disturbance NOS,Abn blood chemistry NEC,Abn react-plast surg NEC,Conjunctival hemorrhage,Hypothrm-wo low env tmp,Constipation NOS,Anemia NOS
Admission Date:  [**2114-11-9**]              Discharge Date:   [**2114-12-6**]

Date of Birth:  [**2061-11-17**]             Sex:   F

Service: MEDICINE

Allergies:
Cefepime

Attending:[**First Name3 (LF) 8487**]
Chief Complaint:
Respiratory distress

Major Surgical or Invasive Procedure:
Intubation
Bronchoscopy

History of Present Illness:
 Patient intubated and history is per report and record review.
Ms. [**Known lastname **] is a 52-year-old female with ALL s/p chemo and single
cord blood transplantation complicated by CMV viremia,
streptococcal bacteremia, VRE UTI, and suspected GVHD-induced
hepatitis who presents with fever and productive cough. The
cough started 3 weeks ago and has been productive of green
sputum, and associated with mild shortness of breath,
nausea/vomiting (attributed to Gleevec), and fatigue. She saw
her oncologist on [**2114-11-6**] for a followup, was afebrile with O2
sat 91,RA, and was noted to have a WBC of 11.2. She was started
on azithromycin and advised to return to clinic in 3 days.
Today, she noted difficulty breathing and fevers/chills/night
sweats, as well as cough, with symptoms worse the past two days.
She also reports anorexia and [**7-1**]# wt loss. Her O2 sat was noted
to be 86 on RA, improving to 95 on 3L NC. Blood cultures and flu
swab were obtained and she was referred to the ED.
.
In the ED, her initial vitals were: 99.5 88 120/76 28 96% on 5L
NC. On exam, she was dry with diminished breath sounds and right
sided crackles, and tachycardia. A CT of the chest was ordered
looking for possible PCP and showed evidence of infection with
multifocal airspace opacities. She was started on vancomycin and
aztreonam, in addition to continuing her current azithromycin.
While in the ED, her respiratory status worsened, becoming more
tachypneic and hypoxic requiring intubation. Her recent vitals
(prior to intubation) show RR 32, HR 124, 127/83 and O2 sat of
76,RA -> 96,3L. She received 4L IVF in the ED. Cannot perform
ROS as pt is intubated and sedated.


Past Medical History:
ONCOLOGIC HISTORY
====================
Diagnosed with [**Location (un) 5622**] Chromosome positive pre-B cell ALL
in [**2113-11-25**]
- [**2113-12-13**]: Part A of hyperCVAD cycle 1 was started on  and
imantinib 600mg po qdaily was started on [**2113-12-21**] when the Ph
chromosome came back as positive.
- [**2113-12-22**]: First LP performed by IR and cytarabine was
administered. Fluid non-diagnostic but as high suspicion for CSF
disease started on twice weekly methotrexate
---[**2113-12-28**]: CSF sample from confirmed CNS involvement of ALL
---[**2115-1-1**] CSF sample from  was negative for ALL so IT MTX
discontinued
- [**2114-1-17**]: Part B hyperCVAD of cycle 1 was started (IT chemo
was
limited to D6 ara-C on [**2114-1-22**] to minimize neurotoxicity)
- [**2114-2-2**]: Cycle 2 (Part A) of hyperCVAD started
- [**2114-3-5**]: Cycle 2 (Part B) hyperCVAD chemotherapy started
- [**2114-4-5**]: IT MTX administered

OTHER PAST MEDICAL HISTORY
============================
- Latent tuberculosis: PPD with 12mm of induration in [**2111**] at
[**Hospital1 2177**] after which received [**1-26**] mos of INH discontinued due to
transaminitis, she has been on moxifloxacin suppression since
starting chemotherapy
-Hypertension
-Hyperlipidemia
-Diabetes Mellitus (not on medications)
-Vitamin D deficiency
- Hepatitis B Ab positive (core +), maintained on lamuvidine


Social History:
She is Mandarin-speaking only and immigrated from [**Country 651**] in [**2100**].
She previously worked in customer service. She denies any
history of tobacco, alcohol, or illicit drugs. She's married.

Family History:
There is no family history of cancer or blood disorders that she
is aware of.

Physical Exam:
GENERAL: Intubated, initially responsive to verbal stimuli, but
sedation increased for agitation.
HEENT: Pupils are equal and minimally reactive to light. ETT in
place.
LUNGS: R lung fields with diffuse crackles. L side clear.
HEART: RRR no M/R/G
ABDOMEN: + BS. Soft, nontender, nondistended with no
hepatosplenomegaly. There are no palpable masses.
EXTREMITIES: There is no edema. 2+ peripheral pulses. Moves all
ext spontaneously.
SKIN: No rashes. The skin is warm and dry.


Pertinent Results:
Admission Labs:

[**2114-11-9**] 01:37PM   LACTATE-1.5
[**2114-11-9**] 09:15AM   GLUCOSE-156* UREA N-17 CREAT-0.9 SODIUM-137
POTASSIUM-3.8 CHLORIDE-102 TOTAL CO2-22 ANION GAP-17
[**2114-11-9**] 09:15AM   ALT(SGPT)-24 AST(SGOT)-27 LD(LDH)-349* ALK
PHOS-189* TOT BILI-0.8
[**2114-11-9**] 09:15AM   WBC-13.5* RBC-2.96* HGB-10.0* HCT-29.7*
MCV-101* MCH-33.8* MCHC-33.6 RDW-13.9
[**2114-11-9**] 09:15AM   NEUTS-68.1 LYMPHS-17.8* MONOS-13.3* EOS-0.5
BASOS-0.3

Discharge Labs:

Radiology:
CT Chest w/o contrast:
IMPRESSION: New-onset airspace opacification with air
bronchograms of the
right upper lobes, lower lobes and middle portion of the right
middle lobe
with patchy diffusely distributed opacification in the left lung
with an
associated right pleural effusion, suggests the possibility of
an infectious process, such as multifocal bacterial pneumonia.
However, considering the patient's clinical history of recent
bone marrow transplantation, an atypical pneumonia must be
included in the differential diagnosis (fungal, mycobacterial,
viral organisms). Pulmonary edema and pulmonary hemorrhage are
less likely, as the patient's history does not have
corroborating symptoms for the same.

TTE:The left atrium is normal in size. No atrial septal defect
is seen by 2D or color Doppler. Left ventricular wall thickness,
cavity size and regional/global systolic function are normal
(LVEF >55%). There is no ventricular septal defect. Right
ventricular chamber size and free wall motion are normal. The
aortic valve leaflets (3) appear structurally normal with good
leaflet excursion. There is no valvular aortic stenosis. The
increased transaortic velocity is likely related to high cardiac
output. No aortic regurgitation is seen. The mitral valve
appears structurally normal with trivial mitral regurgitation.
There is no mitral valve prolapse. There is mild pulmonary
artery systolic hypertension. There is a small pericardial
effusion. There are no echocardiographic signs of tamponade.


Brief Hospital Course:
ASSESSMENT AND PLAN: 52-year-old female with ALL s/p chemo and
single cord blood transplantation complicated by CMV viremia,
streptococcal bacteremia, VRE UTI, and suspected GVHD-induced
hepatitis who presents with pneumonia/sepsis and respiratory
failure.
.
# Respiratory failure:
Consistent with ARDS in setting on severe PNA. Very large A-a
gradient on admission. Placed on ARDS-NET protocol.
Nasopharyngeal aspirate for influenza was negative, and flu
cultures were negative. TB was ruled out with negative BAL,
despite patient's history of latent TB. Sputum cultures did not
show any bacteria. On Bronchoscopy, nothing significant was
visualized in the airways. BAL was negative for PCP; there was
some concern that inhaled pentamidine could make a BAL appear
falsely negative and diagnosis could require a tissue biopsy,
but the beta-glucan was also negative, which was reassuring for
rule out of PCP.  [**Name10 (NameIs) **] patient had been started empirically on
treatment doses of bactrim for PCP until the first beta-glucan
returned negative.  She was restarted on prophylactic doses of
bactrim, per BMT recommendations. Since her LFTs were beginning
to rise, bactrim was discontinued, as she has a history of
elevated LFTs in the setting of this medication.
.
Cardiac causes of respiratory failure were considered, but a TTE
showed hyperdynamic function with LVEF> 55%, mild pulm htn,
trivial pericardial effusion, and no valvular disease, so this
was not likely to cause a compromise in respiratory function.
.

The patient was very difficult to oxygenate for much of her ICU
stay.  She was often desynchronous with the ventilator, often
over-breathing the ventilator on volume control but not able to
tolerate pressure control or pressure support ventilation
modalities intitially. Eventually, she was able to tolerate AC
settings with increased sedation, and only brief trials on
pressure support with less sedation.  She would often desaturate
with positional changes, likely also had some mucus plugging.
Multiple attempts to wean down PEEP were unsuccessful as she
would desaturate. Muscle paralytics had to be emploted to assure
syncronized ventilation.

On [**11-25**], the patient was switched to Airway Pressure Release
Ventilation (APRV). This resulted in increased sats to ~93%, but
unable to wean FiO2 down from 100%.  The patient was placed on a
RotaProne bed.  Pronation resulted in some shortterm improvement
in saturation with the ability to wean oxygen to FiO2 of 80%.
On [**11-28**], the patient was switched to Triadyne II bed and was
continued on APRV.  Nitric oxide was used as well with some
modest improvement in oxygenation.

On [**11-29**], the patient became hypotensive with SBP in 70s.  The
patient desatted to low 70s/high 60s with IV bolus. The patient
was repositioned patient on left side and noticed decreased
breath sounds on left in new position. Adjusted ventilator
settings and started nitric oxide with no improvement in
oxygenation. Got stat CXR which showed large left pneumothorax.
Chest tube was immediately placed with vital signs improved
immediately upon chest tube placement. FiO2 was weaned to 90%.

On [**12-3**], the patient developed massive upper GI bleed.  EGD was
performed at bedside which revealed massive amounts of clotted
blood in the fundus of the stomach, but no clear eveidence of
active bleed.  The patient was started on IV PPI and was given
multiple blood products including pRBCs and FFP.  The patient's
oxygenation worsened, and she continued to desat on FIO2 of 100%
and maximum nitric oxide.   Given clinical deterioration,
extensive discussion was held with the patient's husband and
family about goals of care and a decision was made about no
further escalation in care, including no blood products or lab
draws.  The patient expired the following day.
.
# Septic shock:
The patient was hypotensive requiring levophed and vasopressin
initially, likely due to septic shock secondary to multifocal
PNA, as seen on CT chest.  Levophed was weaned down [**11-11**] and
vasopressin was stopped [**11-13**]. There was a wide differential
given her immunosuppression which included usual pathogens
(Strep, etc), viral (flu, CMV), PCP (esp with elev LDH),
atypicals.  She was started empirically on broad antibiotic
coverage with vancomycin, aztreonam, and azithromycin. The
aztreonam was broadened to meropenem on [**11-12**] per ID
recommendations.

On admission, she was empirically started on PCP treatment doses
of bactrim and stress dose steroids with IV hydrocortisone. She
was also empirically started on oseltamivir for flu coverage
which was discontinued on the fifth day of treatment due to a
negative flu culture. The urine legionella antigen was negative,
and the patient did not grow any bacteria from her urine or
blood cultures.  Once the beta-glucan was negative, the
treatment doses of bactrim for PCP were discontinued;
prophylactic doses re-started on [**11-18**] per BMT recommendations.
Serum beta-glucan and beta-galactomannan were negative on
multple occasions.

Patient was fluid overloaded after initial fluid resusciation.
Her urine output at times was low likely due to hypotension and
a component of ATN. She was given IVFs and albumin
intermittently. Urine output picked up successfully with fluids
and increases in blood pressure. After vasopressin was stopped,
she was diuresed on a lasix drip with successful output.

On [**11-24**], an inverse correlation between fever curves and
Bactrim use was found and Bactrim was re-started again.  IVIG
was administered.   On [**11-29**], mild CMV viremia  (VL 1000) was
detected.  Metropenem was discontinued on [**11-29**] per ID recs.

#Non-gap acidosis: Related to normal saline and a component of
renal failure. As renal failure improved and normal saline was
stopped, her acidosis stabilized. During her lasix drip
administration, the patient developed a metabolic contraction
alkalosis. She was started on acetazolamide.

#Ileus: Due to the high dose of fentanyl patient received, it
appeared she developed an ileus. An extensive bowel regimen plus
PO narcan alleviated her symptoms.
.
# ALL: On chronic immunosuppression s/p single cord blood
transplantation. Was not neutropenic.  She was continued on
acyclovir for prophylaxis, and her tacrolimus was discontinued.
She was started on stress dose steroids of hydrocortisone 100mg
IV Q8hours; when the stress dose steroids were tapered down
slowly, the patient seemed to make less progress with her
respiratory status, so her steroid dose was increased back.
.
# Anemia: The patient intermittently needed blood transfusions
due to low Hematocrits. She received 2 units prbcs from
admission to the ICU to [**2114-11-16**]. Her anemia is likely due to
her CA, anemia of chronic inflammation and the daily blood draws
that were needed during her ICU course.
.
# Hep B: The patient was continued on lamivudine. A hep B viral
load was sent [**11-15**] and no DNA could be detected.

.



Medications on Admission:
ACYCLOVIR - 400 mg TID
AMLODIPINE - 5 mg daily
Azithromycin 500mg, then 250mg daily x5 days total, started
[**2114-11-6**]
IMATINIB 100mg daily (on hold)
LAMIVUDINE - 100 mg daily
LORAZEPAM - 0.5 mg Tablet - [**1-26**] Tablet(s) by mouth every six (6)
hours
OMEPRAZOLE - 20 mg Capsule daily
PENTAMIDINE [NEBUPENT] - (received in IP) - 300 mg Recon Soln -

1 ihnalation(s) po monthly received on [**11-6**]
PREDNISONE - 5 mg tablet daily
TACROLIMUS [PROGRAF] - 0.5 mg qAM (decreased from [**Hospital1 **] on
[**2114-11-6**])
CALCIUM CARBONATE-VITAMIN D3 [CALCIUM 500 WITH D] - 500 mg
(1,250
mg)-400 unit Tablet - 2 tabs daily
PYRIDOXINE - 100 mg Tablet two times per week
SENNA - 8.6 mg Tablet - [**1-26**] Tablet prn constipation


Discharge Medications:
EXPIRED

Discharge Disposition:
Expired

Discharge Diagnosis:
EXPIRED

Discharge Condition:
EXPIRED

Discharge Instructions:
EXPIRED

Followup Instructions:
EXPIRED


Completed by:[**2115-8-5**]
{'Unspecified septicemia,Pneumonia, organism unspecified,Acute respiratory failure,Septic shock,Acute kidney failure with lesion of tubular necrosis,Severe sepsis,Acute lymphoid leukemia, without mention of having achieved remission,Graft-versus-host disease, unspecified,Mixed acid-base balance disorder,Cytomegaloviral disease,Thrombocytopenia, unspecified,Other specified organ or tissue replaced by transplant,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified vitamin B deficiency,Pulmonary tuberculosis, unspecified, unspecified,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Mechanical complication due to graft of other tissue, not elsewhere classified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other esophagitis,Contact dermatitis and other eczema, unspecified cause,Abdominal pain, unspecified site,Unspecified visual disturbance,Other abnormal blood chemistry,Other restorative surgery causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Conjunctival hemorrhage,Hypothermia not associated with low environmental temperature,Constipation, unspecified,Anemia, 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: Respiratory distress

PRESENT ILLNESS: Patient intubated and history is per report and record review.
Ms. [**Known lastname **] is a 52-year-old female with ALL s/p chemo and single
cord blood transplantation complicated by CMV viremia,
streptococcal bacteremia, VRE UTI, and suspected GVHD-induced
hepatitis who presents with fever and productive cough. The
cough started 3 weeks ago and has been productive of green
sputum, and associated with mild shortness of breath,
nausea/vomiting (attributed to Gleevec), and fatigue. She saw
her oncologist on [**2114-11-6**] for a followup, was afebrile with O2
sat 91,RA, and was noted to have a WBC of 11.2. She was started
on azithromycin and advised to return to clinic in 3 days.
Today, she noted difficulty breathing and fevers/chills/night
sweats, as well as cough, with symptoms worse the past two days.
She also reports anorexia and [**7-1**]# wt loss. Her O2 sat was noted
to be 86 on RA, improving to 95 on 3L NC. Blood cultures and flu
swab were obtained and she was referred to the ED.
.
In the ED, her initial vitals were: 99.5 88 120/76 28 96% on 5L
NC. On exam, she was dry with diminished breath sounds and right
sided crackles, and tachycardia. A CT of the chest was ordered
looking for possible PCP and showed evidence of infection with
multifocal airspace opacities. She was started on vancomycin and
aztreonam, in addition to continuing her current azithromycin.
While in the ED, her respiratory status worsened, becoming more
tachypneic and hypoxic requiring intubation. Her recent vitals
(prior to intubation) show RR 32, HR 124, 127/83 and O2 sat of
76,RA -> 96,3L. She received 4L IVF in the ED. Cannot perform
ROS as pt is intubated and sedated.

MEDICAL HISTORY: ONCOLOGIC HISTORY
====================
Diagnosed with [**Location (un) 5622**] Chromosome positive pre-B cell ALL
in [**2113-11-25**]
- [**2113-12-13**]: Part A of hyperCVAD cycle 1 was started on  and
imantinib 600mg po qdaily was started on [**2113-12-21**] when the Ph
chromosome came back as positive.
- [**2113-12-22**]: First LP performed by IR and cytarabine was
administered. Fluid non-diagnostic but as high suspicion for CSF
disease started on twice weekly methotrexate
---[**2113-12-28**]: CSF sample from confirmed CNS involvement of ALL
---[**2115-1-1**] CSF sample from  was negative for ALL so IT MTX
discontinued
- [**2114-1-17**]: Part B hyperCVAD of cycle 1 was started (IT chemo
was
limited to D6 ara-C on [**2114-1-22**] to minimize neurotoxicity)
- [**2114-2-2**]: Cycle 2 (Part A) of hyperCVAD started
- [**2114-3-5**]: Cycle 2 (Part B) hyperCVAD chemotherapy started
- [**2114-4-5**]: IT MTX administered

MEDICATION ON ADMISSION: ACYCLOVIR - 400 mg TID
AMLODIPINE - 5 mg daily
Azithromycin 500mg, then 250mg daily x5 days total, started
[**2114-11-6**]
IMATINIB 100mg daily (on hold)
LAMIVUDINE - 100 mg daily
LORAZEPAM - 0.5 mg Tablet - [**1-26**] Tablet(s) by mouth every six (6)
hours
OMEPRAZOLE - 20 mg Capsule daily
PENTAMIDINE [NEBUPENT] - (received in IP) - 300 mg Recon Soln -

ALLERGIES: Cefepime

PHYSICAL EXAM: GENERAL: Intubated, initially responsive to verbal stimuli, but
sedation increased for agitation.
HEENT: Pupils are equal and minimally reactive to light. ETT in
place.
LUNGS: R lung fields with diffuse crackles. L side clear.
HEART: RRR no M/R/G
ABDOMEN: + BS. Soft, nontender, nondistended with no
hepatosplenomegaly. There are no palpable masses.
EXTREMITIES: There is no edema. 2+ peripheral pulses. Moves all
ext spontaneously.
SKIN: No rashes. The skin is warm and dry.

FAMILY HISTORY: There is no family history of cancer or blood disorders that she
is aware of.

SOCIAL HISTORY: She is Mandarin-speaking only and immigrated from [**Country 651**] in [**2100**].
She previously worked in customer service. She denies any
history of tobacco, alcohol, or illicit drugs. She's married. 

### Response:
{'Unspecified septicemia,Pneumonia, organism unspecified,Acute respiratory failure,Septic shock,Acute kidney failure with lesion of tubular necrosis,Severe sepsis,Acute lymphoid leukemia, without mention of having achieved remission,Graft-versus-host disease, unspecified,Mixed acid-base balance disorder,Cytomegaloviral disease,Thrombocytopenia, unspecified,Other specified organ or tissue replaced by transplant,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified vitamin B deficiency,Pulmonary tuberculosis, unspecified, unspecified,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Mechanical complication due to graft of other tissue, not elsewhere classified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other esophagitis,Contact dermatitis and other eczema, unspecified cause,Abdominal pain, unspecified site,Unspecified visual disturbance,Other abnormal blood chemistry,Other restorative surgery causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Conjunctival hemorrhage,Hypothermia not associated with low environmental temperature,Constipation, unspecified,Anemia, unspecified'}
