CHIEF COMPLAINT: Fever

PRESENT ILLNESS: 22 year-old Gravida 2 Para 0 at 21 weeks 2 days GA presented to
the ED with fever and flank pain. She reported bilateral flank
pain, mild nausea and denied any vaginal bleeding, contractions,
or leakage of fluid. She was feeling active
fetal movement.
.
Upon arrival to the ED she was found to have fever 101.1,
tachycardia to 120 and hypotension with blood pressure 80/50s.
Examination revealed CVA tenderness. Labs revealed a white blood
count of 18 and urinalysis had >50 WBC. The clinical picture was
consistent with pyelonephritis. Ceftriaxone was administered.
Given the persistent hypotension despite 4 Liters of IV fluid,
the decision was made to admit her to the [**Hospital Unit Name 153**].
.
Of note she has hyperthyroidism and had not be taking her PTU
for the last 2 weeks.

MEDICAL HISTORY: Prenatal Course:
1. Dating: estimated due date [**2104-4-19**]
2. Labs: A+/RI/HepB S Antigen -/RPRNR/HIV negative
3. Ultrasound: normal full fetal survey
4. Issues: Hyperthyroidism
.
Past Obstetric History: spontaneous abortion x 1
.
Past Gynecologic History:
-[**8-28**] Abnormal Pap->Colpo with normal biopsy
-h/o GC/chlamydia->negative [**12-30**]
.
Medical History: Hyperthyroidism ([**Doctor Last Name 933**])
.
Surgical History: Right eye surgery

MEDICATION ON ADMISSION: PNV
Propylthiouracil 100mg [**Hospital1 **] (has not taken for 2 weeks)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Presentation:

FAMILY HISTORY: Maternal Great Uncle had [**Name2 (NI) 933**] disease, mother has thyroid
dysfunction. No other family history of other autoimmune
diseases.

SOCIAL HISTORY: Patient denies any tobacco, alcohol or recreational drug use.
Prior to pregnancy, + alcohol
Other specified infectious and parasitic diseases of mother, antepartum condition or complication,Unspecified septicemia,Acute pyelonephritis without lesion of renal medullary necrosis,Sepsis,Acidosis,Hydronephrosis,Infections of genitourinary tract in pregnancy, antepartum condition or complication,Toxic diffuse goiter without mention of thyrotoxic crisis or storm,Thyroid dysfunction of mother, antepartum condition or complication,Iron deficiency anemia, unspecified,Hypocalcemia
Infect dis NEC-antepart,Septicemia NOS,Ac pyelonephritis NOS,Sepsis,Acidosis,Hydronephrosis,Gu infection-antepartum,Tox dif goiter no crisis,Thyroid dysfunc-antepart,Iron defic anemia NOS,Hypocalcemia
Admission Date:  [**2103-12-10**]              Discharge Date:   [**2103-12-16**]

Date of Birth:  [**2081-4-8**]             Sex:   F

Service: OBSTETRICS/GYNECOLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 8257**]
Chief Complaint:
Fever

Major Surgical or Invasive Procedure:
None

History of Present Illness:
22 year-old Gravida 2 Para 0 at 21 weeks 2 days GA presented to
the ED with fever and flank pain. She reported bilateral flank
pain, mild nausea and denied any vaginal bleeding, contractions,
or leakage of fluid. She was feeling active
fetal movement.
.
Upon arrival to the ED she was found to have fever 101.1,
tachycardia to 120 and hypotension with blood pressure 80/50s.
Examination revealed CVA tenderness. Labs revealed a white blood
count of 18 and urinalysis had >50 WBC. The clinical picture was
consistent with pyelonephritis. Ceftriaxone was administered.
Given the persistent hypotension despite 4 Liters of IV fluid,
the decision was made to admit her to the [**Hospital Unit Name 153**].
.
Of note she has hyperthyroidism and had not be taking her PTU
for the last 2 weeks.

Past Medical History:
Prenatal Course:
1. Dating: estimated due date [**2104-4-19**]
2. Labs: A+/RI/HepB S Antigen -/RPRNR/HIV negative
3. Ultrasound: normal full fetal survey
4. Issues: Hyperthyroidism
.
Past Obstetric History: spontaneous abortion x 1
.
Past Gynecologic History:
-[**8-28**] Abnormal Pap->Colpo with normal biopsy
-h/o GC/chlamydia->negative [**12-30**]
.
Medical History: Hyperthyroidism ([**Doctor Last Name 933**])
.
Surgical History: Right eye surgery

Social History:
Patient denies any tobacco, alcohol or recreational drug use.
Prior to pregnancy, + alcohol


Family History:
Maternal Great Uncle had [**Name2 (NI) 933**] disease, mother has thyroid
dysfunction. No other family history of other autoimmune
diseases.


Physical Exam:
On Presentation:

V/S Tm: 100.7, Tc: 98.8, BP 90/44 - 109/33, HR 81-122, RR 22-42,
O2 92-96% 2L
Gen: Young woman in NAD
HEENT: Slight bilateral proptosis with very slight soft tissue
swelling in area of epicanthal fold over left eye. OP clear
without erythema or exudate.
Neck: Thyroid gland small, firm, slightly irregular on left,
without tenderness to palpation.
Pulm: Good respiratory effort with no audible wheezes, rhonchi,
or rales
CV: Tachycardic, nl s1/s2
Abd: Gravid, soft, non-tender, +BS
Back: No significant CVA tenderness
Skin: No acanthosis nigricans, no rashes, left forearm tattoo
Ext: Warm and well perfused without lower extremity edema


Pertinent Results:
[**2103-12-10**] WBC-18.0*# RBC-3.42* Hgb-10.9* Hct-30.1* MCV-88 Plt
Ct-268
[**2103-12-10**] Neuts-93.3* Lymphs-4.5* Monos-1.6* Eos-0.5 Baso-0.1
[**2103-12-10**] WBC-14.4* RBC-2.92* Hgb-9.2* Hct-25.9* MCV-89 Plt
Ct-209
[**2103-12-11**] WBC-11.7* RBC-2.57* Hgb-8.2* Hct-22.7* MCV-88 Plt
Ct-187
[**2103-12-11**] Neuts-85.9* Lymphs-10.1* Monos-3.8 Eos-0.1 Baso-0.1
[**2103-12-11**] Hct-28.9*#
[**2103-12-12**] WBC-10.3 RBC-2.88* Hgb-9.3* Hct-25.4* MCV-88 Plt Ct-206
[**2103-12-13**] WBC-6.2 RBC-3.08* Hgb-9.6* Hct-27.3* MCV-89 Plt Ct-207
.
[**2103-12-10**] PT-13.3 PTT-30.2 INR(PT)-1.1
[**2103-12-11**] PT-14.0* PTT-36.0* INR(PT)-1.2*
.
[**2103-12-10**] Glucose-123* UreaN-7 Creat-1.1 Na-136 K-3.1* Cl-102
HCO3-21*
[**2103-12-10**] Glucose-96 UreaN-7 Creat-0.7 Na-139 K-3.5 Cl-112*
HCO3-15* [**2103-12-11**] Glucose-97 UreaN-6 Creat-0.7 Na-130* K-3.8
Cl-100 HCO3-17* [**2103-12-11**] Glucose-89 UreaN-6 Creat-0.8 Na-140
K-3.4 Cl-110* HCO3-19*
[**2103-12-12**] Glucose-76 UreaN-5* Creat-0.8 Na-136 K-4.1 Cl-108
HCO3-19*
.
[**2103-12-10**] ALT-14 AST-21 AlkPhos-57 TotBili-0.6
[**2103-12-10**] ALT-13 AST-25 LD(LDH)-200 AlkPhos-47 TotBili-0.4
.
[**2103-12-10**] Albumin-3.0* Calcium-6.7* Phos-1.6* Mg-1.4*
[**2103-12-11**] Calcium-6.4* Phos-2.1* Mg-2.2 Iron-10*
[**2103-12-11**] Mg-1.7
[**2103-12-12**] Albumin-2.9* Calcium-8.3* Mg-1.9
.
[**2103-12-11**] calTIBC-179* Ferritn-129 TRF-138*
.
[**2103-12-10**] 11:49AM BLOOD TSH-0.19*
[**2103-12-10**] 11:49AM BLOOD T3-146 Free T4-0.86*
[**2103-12-10**] 09:17PM BLOOD T4-9.4 calcTBG-1.28 TUptake-0.78
T4Index-7.3
[**2103-12-12**] 04:54AM BLOOD PTH-16
[**2103-12-13**] 07:45AM BLOOD TSH-1.0
[**2103-12-13**] 07:45AM BLOOD T3-129 Free T4-0.96
.
[**2103-12-10**] Type-[**Last Name (un) **] Temp-39.1 pH-7.34* Comment-GREEN TOP
[**2103-12-12**] Type-[**Last Name (un) **] pH-7.43
.
[**2103-12-10**] URINE Blood-NEG Nitrite-POS Protein-30 Glucose-100
Ketone-TR Bilirub-NEG Urobiln-1 pH-5.0 Leuks-MOD
[**2103-12-10**] URINE RBC-0-2 WBC->50 Bacteri-MANY Yeast-NONE Epi-[**1-24**]
[**2103-12-11**] URINE Blood-NEG Nitrite-NEG Protein-NEG Glucose-NEG
Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG
.
URINE CULTURE (Final [**2103-12-13**]): ESCHERICHIA COLI. >100,000
ORGANISMS/ML..
SENSITIVITIES: MIC expressed in MCG/ML
AMPICILLIN------------   <=2 S
AMPICILLIN/SULBACTAM--   <=2 S
CEFAZOLIN-------------   <=4 S
CEFEPIME--------------   <=1 S
CEFTAZIDIME-----------   <=1 S
CEFTRIAXONE-----------   <=1 S
CEFUROXIME------------     2 S
CIPROFLOXACIN---------<=0.25 S
GENTAMICIN------------   <=1 S
MEROPENEM-------------<=0.25 S
NITROFURANTOIN--------  <=16 S
PIPERACILLIN----------   <=4 S
PIPERACILLIN/TAZO-----   <=4 S
TOBRAMYCIN------------   <=1 S
TRIMETHOPRIM/SULFA----   <=1 S
.
URINE CULTURE (Final [**2103-12-12**]):    <10,000 organisms/ml.
.
Blood cultures 1/19, [**12-11**]: no growth
.
Echocardiogram [**12-11**]:
IMPRESSION: Normal LV cavity size with normal global and
regional biventricular systolic function. No diastolic
dysfunction or significant valvular disease seen. Small
pericardial effusion located posterior to inferolateral wall
without evidence of tamponade.
.
Chest X-Ray [**12-11**]:
Final Report
INDICATION: 22-year-old female who is pregnant with
pyelonephritis and
shortness of breath after fluid.
PA AND LATERAL CHEST RADIOGRAPHS: There is bilateral
predominantly lower lobe air space opacity with air
bronchograms. There is prominent azygos vein. The heart size is
normal. There are no pleural effusions on this frontal
radiograph. Findings are consistent with pulmonary edema.
.
Bilateral Lower Extremity Venous Doppler [**12-11**]:
CLINICAL HISTORY: Acute onset of shortness of breath, 21 weeks
pregnant.
Evaluate for deep vein thrombosis.
Normal flow and compressibility was present in the common
femoral, superficial femoral, and popliteal veins in both the
right and left side. No evidence of thrombus in either calf was
seen.
IMPRESSION: No evidence of deep vein thrombosis.
.
Renal Ultrasound [**12-11**]:
INDICATION: 21 weeks pregnant with pyelonephritis. Please assess
for
hydronephrosis or perinephric abscesses.
FINDINGS: The right kidney measures 11.7 cm. The left kidney
measures 10.6
cm. There is moderate bilateral hydronephrosis. No definite
stones are
identified in either kidney. Renal parenchymal abnormalities are
identified to suggest abscess. An intrauterine pregnancy is
present with fetal heart rate of 167 beats per minute.
IMPRESSION: Moderate bilateral hydronephrosis and small amount
of right
perinephric fluid with no son[**Name (NI) 493**] evidence for renal
abscesses. As no
renal stones are identified and the entire course of the ureters
is not
visualized, it is not possible to determine whether the
hydronephrosis present relates to pregnancy or other causes.

Brief Hospital Course:
MICU COURSE:
# Acute pyelonephritis: Treated with ampicillin and gentamicin
per OB recommendations.  Renal ultrasound did not show
perinephric abscess. Continued to have intermittent low grade
fevers while in the ICU
.
# Hypotension: Patient met the criteria for sepsis, howevere per
prior OMR notes, blood pressures had been running in 90's, so
patient not hypotensive per her parameters.
.
# Tachycardia: Differential diagnosis includes hyperthyroidism
though per endocrine consult, felt that based on her labs, she
was likely hypothroid.  However, may be a sign of early dilated
cardiomyopathy. Echocardiogram was normal. Was minimally fluid
responsive. Ruled out deep vein thrombosis with lower extremity
venous Dopplers.
.
# Oxygen desaturation: Oxygen saturation in the mid 80s% on
hospital day #2.  Patient was approximately 9 liters positive.
Chest x-ray was consistent with pulmonary edema
.
# Pregnancy at 21 weeks: Fetal heart rate was reassuring on
admission. Continued prenatal vitamins.  Had daily fetal heart
rate spot checks that were reassuring.
.
# [**Doctor Last Name 933**] Disease status post eye surgery: TSH is low at 0.19.
Free T4 is also low at 0.86. This may be a result of increased
thyroid binding globulin induced by hyper-estrogen state. Also,
patient had not been taking PTU for 2 weeks. The importance of
taking this medication for fetal well-being was explained to the
patient and she understood this conversation.  Endocrinology
consult placed for recommendations regarding thyroid hormone
level normalization.
.
# Hypokalemia: Etiology unclear, was 3.1 on admission.  Resolved
with repletion.  Only 1 episode of diarrhea ~2 weeks ago. Kidney
function normal. Oral intake had been good until 3 days ago.
.
# Anemia: Likely dilutional and secondary to pregnancy, appears
to also have iron deficiency component. Recevied 1 unit packed
red blood cells for hematocrit of 22.
.
# Hypocarbia: Likely a hyperchloremic metabolic alkalosis
secondary to fluid resuscitation. [**Month (only) 116**] also be a consequence of
tachypnea.
.
.
The patient was called out of the ICU on hospital day #3.
Clinically she was stable with no oxygen requirement and stable
blood pressure.  She continued on IV ampicillin and gentamicin
until she was afebrile for 48 hours on the evening of hospital
day #5.  Her initial urine culture grew pan-sensitive E. Coli
and she was transitioned to oral Nitrofuantoin.  She remained
afebrile and was discharged home on hospital day #6.  She will
remain on suppression for the remainder of her pregnancy.
.
While hopsitalized, she was followed by the endocrine service.
Her thyroid function tests were normal off medication and they
believed her [**Doctor Last Name 933**] to be in remission and that she should
remain off the propylthiouracil that she had been taking.  She
will follow up with endocrine as an outpatient.


Medications on Admission:
PNV
Propylthiouracil 100mg [**Hospital1 **] (has not taken for 2 weeks)


Discharge Medications:
1. Nitrofurantoin (Macrocryst25%) 100 mg Capsule Sig: One (1)
Capsule PO BID (2 times a day): for 10 days, then once daily for
rest of pregnancy.
Disp:*50 Capsule(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Pyelonephritis


Discharge Condition:
Good


Discharge Instructions:
Take Antibiotics as prescribed - twice a day for 10 days, then
once a day for rest of pregnancy.
Call with abdominal pain, pain or burning with urination,
vaginal bleeding, or any other problems.

Followup Instructions:
Dr. [**Last Name (STitle) **] at [**Hospital1 **] on [**12-27**] as scheduled.

Endocrine: [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 13645**], M.D. Phone:[**Telephone/Fax (1) 1803**]
Date/Time:[**2103-12-31**] 2:30
{'Other specified infectious and parasitic diseases of mother, antepartum condition or complication,Unspecified septicemia,Acute pyelonephritis without lesion of renal medullary necrosis,Sepsis,Acidosis,Hydronephrosis,Infections of genitourinary tract in pregnancy, antepartum condition or complication,Toxic diffuse goiter without mention of thyrotoxic crisis or storm,Thyroid dysfunction of mother, antepartum condition or complication,Iron deficiency anemia, unspecified,Hypocalcemia'}


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: Fever

PRESENT ILLNESS: 22 year-old Gravida 2 Para 0 at 21 weeks 2 days GA presented to
the ED with fever and flank pain. She reported bilateral flank
pain, mild nausea and denied any vaginal bleeding, contractions,
or leakage of fluid. She was feeling active
fetal movement.
.
Upon arrival to the ED she was found to have fever 101.1,
tachycardia to 120 and hypotension with blood pressure 80/50s.
Examination revealed CVA tenderness. Labs revealed a white blood
count of 18 and urinalysis had >50 WBC. The clinical picture was
consistent with pyelonephritis. Ceftriaxone was administered.
Given the persistent hypotension despite 4 Liters of IV fluid,
the decision was made to admit her to the [**Hospital Unit Name 153**].
.
Of note she has hyperthyroidism and had not be taking her PTU
for the last 2 weeks.

MEDICAL HISTORY: Prenatal Course:
1. Dating: estimated due date [**2104-4-19**]
2. Labs: A+/RI/HepB S Antigen -/RPRNR/HIV negative
3. Ultrasound: normal full fetal survey
4. Issues: Hyperthyroidism
.
Past Obstetric History: spontaneous abortion x 1
.
Past Gynecologic History:
-[**8-28**] Abnormal Pap->Colpo with normal biopsy
-h/o GC/chlamydia->negative [**12-30**]
.
Medical History: Hyperthyroidism ([**Doctor Last Name 933**])
.
Surgical History: Right eye surgery

MEDICATION ON ADMISSION: PNV
Propylthiouracil 100mg [**Hospital1 **] (has not taken for 2 weeks)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Presentation:

FAMILY HISTORY: Maternal Great Uncle had [**Name2 (NI) 933**] disease, mother has thyroid
dysfunction. No other family history of other autoimmune
diseases.

SOCIAL HISTORY: Patient denies any tobacco, alcohol or recreational drug use.
Prior to pregnancy, + alcohol 

### Response:
{'Other specified infectious and parasitic diseases of mother, antepartum condition or complication,Unspecified septicemia,Acute pyelonephritis without lesion of renal medullary necrosis,Sepsis,Acidosis,Hydronephrosis,Infections of genitourinary tract in pregnancy, antepartum condition or complication,Toxic diffuse goiter without mention of thyrotoxic crisis or storm,Thyroid dysfunction of mother, antepartum condition or complication,Iron deficiency anemia, unspecified,Hypocalcemia'}
