CHIEF COMPLAINT: delta MS, lethargy, ?sepsis
.

PRESENT ILLNESS: Hx obtained per ED notes and sister
.
HPI: 35F with [**Location (un) 6988**] disease who presented today from
daycare after her healthcare providers noted that she was
lethargic.  They were initially unable to obtain a blood
pressure.  The patient was noted to have a very rapid heart
rate. Vitals were finally obtained and were as follows: BP 70/50
(baseline SBPs 80-90), HR 113, O2 sat 99% on 3L NC.
.
The patient was transferred to [**Hospital1 18**] where she was noted to have
a temp of 101.4, HR 200 and SBP 80s. EKG was noteworthy for a
wide complex tachycardia. The patient received adenosine 6mg and
then 12mg with no improvement. She was cardioverted into sinus
rhythm.  Her D-dimer was elevated at 3590, lactate was 2.5 and
trop T 0.39 in the setting of renal insufficiency.  A CT-A was
negative for a PE.  The patient was transferred to the MICU for
further mgmt.
.

MEDICAL HISTORY: [**Location (un) 6988**] Disease
Anemia
Nonverbal at baseline

MEDICATION ON ADMISSION: none

ALLERGIES: Haldol

PHYSICAL EXAM: T 97.7, HR 65-68, BP 91-97/61-63, R 14-21, O2 sat 100%2l
GEN: thin appearing female lying in fetal position in NAD
HEENT: MM dry, OP clear
HEART: nl rate, S1S2, no gmr
LUNGS: CTA b/l
ABD: flat, soft, NT, ND, +BS, negative guardin, negative rebound
tenderness
EXT: wwp, +dp b/l
NEURO: unable to assess
.

FAMILY HISTORY: father who passed away of [**Name (NI) **] dz

SOCIAL HISTORY: MEDS:
Tylenol
Ensure
.
SocHX: Patient lives at home with sister and brother.  She also
goes to daycare.  She is non-verbal at baseline.
.
Pneumonitis due to inhalation of food or vomitus,Unspecified septicemia,Dehydration,Unspecified pleural effusion,Other primary cardiomyopathies,Atrial fibrillation,Acute kidney failure, unspecified,Sepsis,Huntington's chorea,Anemia, unspecified,Other abnormal blood chemistry
Food/vomit pneumonitis,Septicemia NOS,Dehydration,Pleural effusion NOS,Prim cardiomyopathy NEC,Atrial fibrillation,Acute kidney failure NOS,Sepsis,Huntington's chorea,Anemia NOS,Abn blood chemistry NEC
Admission Date:  [**2189-1-28**]              Discharge Date:   [**2189-2-2**]

Date of Birth:  [**2153-9-26**]             Sex:   F

Service: MEDICINE

Allergies:
Haldol

Attending:[**First Name3 (LF) 2297**]
Chief Complaint:
 delta MS, lethargy, ?sepsis
.


Major Surgical or Invasive Procedure:
none

History of Present Illness:
Hx obtained per ED notes and sister
.
HPI: 35F with [**Location (un) 6988**] disease who presented today from
daycare after her healthcare providers noted that she was
lethargic.  They were initially unable to obtain a blood
pressure.  The patient was noted to have a very rapid heart
rate. Vitals were finally obtained and were as follows: BP 70/50
(baseline SBPs 80-90), HR 113, O2 sat 99% on 3L NC.
.
The patient was transferred to [**Hospital1 18**] where she was noted to have
a temp of 101.4, HR 200 and SBP 80s. EKG was noteworthy for a
wide complex tachycardia. The patient received adenosine 6mg and
then 12mg with no improvement. She was cardioverted into sinus
rhythm.  Her D-dimer was elevated at 3590, lactate was 2.5 and
trop T 0.39 in the setting of renal insufficiency.  A CT-A was
negative for a PE.  The patient was transferred to the MICU for
further mgmt.
.


Past Medical History:
[**Location (un) 6988**] Disease
Anemia
Nonverbal at baseline

.


Social History:
MEDS:
Tylenol
Ensure
.
SocHX: Patient lives at home with sister and brother.  She also
goes to daycare.  She is non-verbal at baseline.
.


Family History:
father who passed away of [**Name (NI) **] dz

Physical Exam:
T 97.7, HR 65-68, BP 91-97/61-63, R 14-21, O2 sat 100%2l
GEN: thin appearing female lying in fetal position in NAD
HEENT: MM dry, OP clear
HEART: nl rate, S1S2, no gmr
LUNGS: CTA b/l
ABD: flat, soft, NT, ND, +BS, negative guardin, negative rebound
tenderness
EXT: wwp, +dp b/l
NEURO: unable to assess
.


Pertinent Results:
CT-A [**2189-1-28**]
IMPRESSION: No evidence of pulmonary embolism. Poorly defined
opacities within the lungs bilaterally, possibly representing
combination of atelectasis and consolidation. Air bronchograms
in the right middle lobe suggests possible infection.
.
CXR [**2189-1-28**]
IMPRESSION: Left lower lobe process suggesting pneumonia.
.
ECHO [**2189-1-28**]
The left atrium is normal in size. Left ventricular wall
thicknesses are normal. The left ventricular cavity is
moderately dilated. There is severe global left ventricular
hypokinesis. No masses or thrombi are seen in the left
ventricle. Right ventricular systolic function is borderline
normal. The aortic valve leaflets (3) appear structurally normal
with good leaflet excursion and no aortic regurgitation. The
mitral valve leaflets are structurally normal. Moderate (2+)
mitral regurgitation is seen. The mitral regurgitation jet is
eccentric. The tricuspid regurgitation jet is eccentric and may
be underestimated. There is a small pericardial effusion.
.
IMPRESSION: Dilated cardiomyopathy with severely depressed LVEF.
EF 10%.
.
EKG ventricular tacchycardia at 200bpm
.

[**2189-1-28**] 10:30PM URINE  bnzodzpn-POS barbitrt-NEG opiates-NEG
cocaine-NEG amphetmn-NEG mthdone-NEG
[**2189-1-28**] 08:30PM   GLUCOSE-100 SODIUM-141 POTASSIUM-4.8
CHLORIDE-111* TOTAL CO2-20* ANION GAP-15
[**2189-1-28**] 08:30PM   LD(LDH)-493*
[**2189-1-28**] 08:30PM   CALCIUM-8.2* PHOSPHATE-3.8 MAGNESIUM-2.1
[**2189-1-28**] 08:30PM   OSMOLAL-308
[**2189-1-28**] 08:30PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2189-1-28**] 08:30PM   WBC-7.8 RBC-4.09* HGB-10.5* HCT-32.2* MCV-79*
MCH-25.8* MCHC-32.7 RDW-16.2*
[**2189-1-28**] 08:30PM   PLT COUNT-140*
[**2189-1-28**] 04:00PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.022
[**2189-1-28**] 04:00PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-TR
GLUCOSE-NEG KETONE-TR BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2189-1-28**] 04:00PM URINE  RBC-0-2 WBC-[**3-2**] BACTERIA-RARE YEAST-FEW
EPI-[**3-2**]
[**2189-1-28**] 04:00PM URINE  MUCOUS-MOD
[**2189-1-28**] 03:33PM   LACTATE-2.5*
[**2189-1-28**] 02:53PM   GLUCOSE-116* UREA N-51* CREAT-1.7* SODIUM-140
POTASSIUM-5.4* CHLORIDE-104 TOTAL CO2-23 ANION GAP-18

Brief Hospital Course:
A/P: 35F w/HD who presents with lethary course complicated by
tachycardia and possible sepsis.
.
1. Hypotension- probably [**1-30**] AVNRT vs. ventricular tachycardia
in a pt w/baseline EF 10%- cardiology was consulted in the ED
where it was thought that pt should be managed medically.  She
received Adenosine x 2 w/o effect and then was cardioverted.
This was in the setting of infection and deyhdration. Since
arrival she is +9L. CT-A was negative for a PE; random cortisol
33.
- trending cardiac enzymes: 0.39, most likely elevated [**1-30**]
cardioversion
- EP following, plan for medical management of tachycardia
w/Amiodarone: on drip yesterday for 24 hours, started po 200 q
daily [**2189-1-31**].
- cardiology and EP satisfied with patients stability, may
recommend lisinopril low dose as an outpatient, follow up in 1
month with cardiology
.
2. PNA- Patient received levaquin, vanc, flagyl and ceftriaxone
in the ED. Imaging concerning for pneumonia.
- trend leukocytosis and fever curve
- change Unasyn for coverage of aspiration PNA to Augmentin
500mg PO TID today([**3-7**])
- blood cultures: pending
- urine cultures: NGTD final
.
3. Delta MS: Per patient's PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **], and pt's sister-
patient is at baseline.  Lethargy may have been [**1-30**] infection.
Will continue infectious w/u and treatment. tox screen negative
except for benzos.
.
4. Elevated liver enzymes: most likely [**1-30**] shock liver,
hypotension during v-tach and cardioversion; KUB was normal
[**2189-1-31**].
- trend LFT's: improving over time
- RUQ ultrasound: liver and gallbladder normal with right
pleural effusion and ascites;
.
5. Anemia: stable over hospital course
- Will monitor daily
- Patient has a hx of anemia.
.
6. Elevated D-dimer
CTA-negative, may be acute phase reactant.
.
7. FEN
-Replete lytes, aspiration precautions.
.
8. PPX: pneumoboots, heparin SC and PPI
.
9. FC confirmed with sister
.
Brother:
[**Name (NI) 6989**] [**Telephone/Fax (1) 6990**](c), [**Telephone/Fax (1) 6991**] (h)
Francetta [**Telephone/Fax (1) 6992**]

Medications on Admission:
none

Discharge Medications:
1. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
2. Amoxicillin-Pot Clavulanate 250-62.5 mg/5 mL Suspension for
Reconstitution Sig: Ten (10) ml PO TID (3 times a day) for 7
days.
Disp:*210 ml* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**First Name9 (NamePattern2) 269**] [**Location (un) **]

Discharge Diagnosis:
supraventricular tachycardia requiring cardioversion
pneumonia


Discharge Condition:
stable and improving


Discharge Instructions:
You will be discharged home today after being in the hospital
for both a fast heart rate and a pneumonia.  Both of these were
controlled in the hospital, and you will be sent home with two
new medications.

The antibiotic Augmentin is to help treat your pneumonia.  You
will take this for the next 7 days.

You are also prescribed Amiodarone.  This medicatoin is to help
control your heart rate.  You must take this everyday.

If you should develop any chest pain, shortness of breath,
nausea, vomiting, difficulty eating, cough, fever or any other
concerns, please call Dr [**Last Name (STitle) 6993**] or return to the emergency
department

Followup Instructions:
Please follow up with Dr [**Last Name (STitle) 6993**] within the next week.  Dr
[**Last Name (STitle) 6993**] should set up a follow up with Cardiology within the
next month.
{"Pneumonitis due to inhalation of food or vomitus,Unspecified septicemia,Dehydration,Unspecified pleural effusion,Other primary cardiomyopathies,Atrial fibrillation,Acute kidney failure, unspecified,Sepsis,Huntington's chorea,Anemia, unspecified,Other abnormal blood chemistry"}


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: delta MS, lethargy, ?sepsis
.

PRESENT ILLNESS: Hx obtained per ED notes and sister
.
HPI: 35F with [**Location (un) 6988**] disease who presented today from
daycare after her healthcare providers noted that she was
lethargic.  They were initially unable to obtain a blood
pressure.  The patient was noted to have a very rapid heart
rate. Vitals were finally obtained and were as follows: BP 70/50
(baseline SBPs 80-90), HR 113, O2 sat 99% on 3L NC.
.
The patient was transferred to [**Hospital1 18**] where she was noted to have
a temp of 101.4, HR 200 and SBP 80s. EKG was noteworthy for a
wide complex tachycardia. The patient received adenosine 6mg and
then 12mg with no improvement. She was cardioverted into sinus
rhythm.  Her D-dimer was elevated at 3590, lactate was 2.5 and
trop T 0.39 in the setting of renal insufficiency.  A CT-A was
negative for a PE.  The patient was transferred to the MICU for
further mgmt.
.

MEDICAL HISTORY: [**Location (un) 6988**] Disease
Anemia
Nonverbal at baseline

MEDICATION ON ADMISSION: none

ALLERGIES: Haldol

PHYSICAL EXAM: T 97.7, HR 65-68, BP 91-97/61-63, R 14-21, O2 sat 100%2l
GEN: thin appearing female lying in fetal position in NAD
HEENT: MM dry, OP clear
HEART: nl rate, S1S2, no gmr
LUNGS: CTA b/l
ABD: flat, soft, NT, ND, +BS, negative guardin, negative rebound
tenderness
EXT: wwp, +dp b/l
NEURO: unable to assess
.

FAMILY HISTORY: father who passed away of [**Name (NI) **] dz

SOCIAL HISTORY: MEDS:
Tylenol
Ensure
.
SocHX: Patient lives at home with sister and brother.  She also
goes to daycare.  She is non-verbal at baseline.
. 

### Response:
{"Pneumonitis due to inhalation of food or vomitus,Unspecified septicemia,Dehydration,Unspecified pleural effusion,Other primary cardiomyopathies,Atrial fibrillation,Acute kidney failure, unspecified,Sepsis,Huntington's chorea,Anemia, unspecified,Other abnormal blood chemistry"}
