CHIEF COMPLAINT: hyponatremia

PRESENT ILLNESS: Ms [**Known lastname 107395**] is an 83 yo F with a history of
hyperparathyroidism/hypothyroidism who presents with nausea and
vomiting x 3-4 days. She reports that she started feeling unwell
approximately 5 days ago with cough and shortness of breath. At
that time she went to see her PCP [**Last Name (NamePattern4) **] [**3-31**] who prescribed her with
a 5 day course of azithromycin. She reports that she started
taking the medication on friday [**3-31**] but with immediate
nausea and vomiting. She called her PCP who recommended that she
stop taking the azithromycin. She stopped the medication on [**4-1**] however the symptoms did not improve dramatically. She
reports that since Friday she has been persistently nauseated
with poor Po intake. She has vomited several times and gotten
progressively weaker. She fell the day prior to admission on her
left arm (location of the prior fracture) and has continued to
have pain in that left arm. She reports that the fall was
mechanical and a result of the weakness. She had not had syncope
and presyncope. She overall feels weak but denies any chest
pain, shortness of breath, fever, chills. She does persistently
have the cough that is approximately 1 week in duration.
.
In ED, vitals were 98.6 68 168/84 20 99% RA
Patient given IV fluids of approx 500 cc, 40 mEq potassium
chloride, levaquin 750 mg IV.

MEDICAL HISTORY: 1. Hyperparathyroidism: calcium was 10.8 [**5-26**], PTH 119 [**10-26**]
pre-op. S/p parathyroid adenomectomy/total thyroidectomy in
[**10/2113**]
2. Osteoporosis: Forearm T -3.2, Spine T -1.2 Hip T-1.9 [**5-26**], on

MEDICATION ON ADMISSION: ERGOCALCIFEROL (VITAMIN D2) [VITAMIN D] - 50,000 unit Capsule -
1
Capsule(s) by mouth once weekly
ESOMEPRAZOLE MAGNESIUM [NEXIUM] - (Prescribed by Other Provider)

ALLERGIES: Hydrochlorothiazide / Ssri &Antipsych,Atyp,Dop&Serotonin Antag

PHYSICAL EXAM: <b>PHYSICAL EXAMINATION:</b>
VITALS:  T:99.2 BP: 166/74 P: 66  RR 16 O2 SAT: 98% on 2L
GENERAL: Lying in ICU bed in no acute distress breathing
comfortably with O2 nasal canula in place.
HEENT: EOMI, PERRL, OP clear without lesions
NECK: No cervical lymphadenopathy, no JVD
CARD: RRR, normal S1/S2, no loud murmurs heard
RESP: CTA bilaterally, no wheezes/rales/rhonchi
ABD: Soft, nontender, nondistended, normoactive bowel sounds
EXT: No clubbing/cyanosis/edema, 2+ DP pulses
NEURO: CN II-XII, A&O x 3, Strength 5/5 in both upper and lower
extremities bilaterally, no sensory deficits, gait not tested
PSYCH: Appropriate, normal affect

FAMILY HISTORY: Noncontributory
No thyroid disease
No calcium disorders
Sister has Osteoporosis, [**Last Name **] problem

SOCIAL HISTORY: Married in [**Location (un) **]
Does Volunteer work
No tobacco
3 glasses wine/week
No coffee, does drink tea.
Other disorders of neurohypophysis,Pneumonia, organism unspecified,Other closed fractures of distal end of radius (alone),Osteoporosis, unspecified,Unspecified essential hypertension,Anemia, unspecified,Nausea with vomiting,Esophageal reflux,Other and unspecified hyperlipidemia,Hypoparathyroidism,Unspecified acquired hypothyroidism,Macular degeneration (senile), unspecified,Long-term (current) use of aspirin,Anxiety state, unspecified,Fall from other slipping, tripping, or stumbling
Neurohypophysis dis NEC,Pneumonia, organism NOS,Fx distal radius NEC-cl,Osteoporosis NOS,Hypertension NOS,Anemia NOS,Nausea with vomiting,Esophageal reflux,Hyperlipidemia NEC/NOS,Hypoparathyroidism,Hypothyroidism NOS,Macular degeneration NOS,Long-term use of aspirin,Anxiety state NOS,Fall from slipping NEC
Admission Date:  [**2119-4-5**]              Discharge Date:   [**2119-4-10**]

Date of Birth:  [**2036-3-14**]             Sex:   F

Service: MEDICINE

Allergies:
Hydrochlorothiazide / Ssri &Antipsych,Atyp,Dop&Serotonin Antag

Attending:[**First Name3 (LF) 9853**]
Chief Complaint:
hyponatremia

Major Surgical or Invasive Procedure:
none

History of Present Illness:
Ms [**Known lastname 107395**] is an 83 yo F with a history of
hyperparathyroidism/hypothyroidism who presents with nausea and
vomiting x 3-4 days. She reports that she started feeling unwell
approximately 5 days ago with cough and shortness of breath. At
that time she went to see her PCP [**Last Name (NamePattern4) **] [**3-31**] who prescribed her with
a 5 day course of azithromycin. She reports that she started
taking the medication on friday [**3-31**] but with immediate
nausea and vomiting. She called her PCP who recommended that she
stop taking the azithromycin. She stopped the medication on [**4-1**] however the symptoms did not improve dramatically. She
reports that since Friday she has been persistently nauseated
with poor Po intake. She has vomited several times and gotten
progressively weaker. She fell the day prior to admission on her
left arm (location of the prior fracture) and has continued to
have pain in that left arm. She reports that the fall was
mechanical and a result of the weakness. She had not had syncope
and presyncope. She overall feels weak but denies any chest
pain, shortness of breath, fever, chills. She does persistently
have the cough that is approximately 1 week in duration.
.
In ED, vitals were 98.6 68 168/84 20 99% RA
Patient given IV fluids of approx 500 cc, 40 mEq potassium
chloride, levaquin 750 mg IV.

 [**Hospital Unit Name 153**] course:  Received 3% hypertonic IV fluids with good rise
in Na level over the last 36 hours to latest value of 126 on
afternoon of transfer. No longer receiving hypertonic IV fluids
as of 0300 on [**4-7**].  Had no seizures and minor confusion.

On transfer to 11 [**Hospital Ward Name 1827**], she was alert, afebrile with normal
exam except for elevated BP, and left wrist wrapped in brace.



Past Medical History:
1. Hyperparathyroidism: calcium was 10.8 [**5-26**], PTH 119 [**10-26**]
pre-op. S/p parathyroid adenomectomy/total thyroidectomy in
[**10/2113**]
2. Osteoporosis: Forearm T -3.2, Spine T -1.2 Hip T-1.9 [**5-26**], on

Fosamax from [**2110**] to [**1-/2118**]
3. HTN
4. Macular degeneration
5. Cystitis
6. Anxiety/ panic disorder
7. GERD
8. Arthritis
9. Hyperlipidemia
10. Left Wrist fx and ORIF [**12/2118**]


Social History:
Married in [**Location (un) **]
Does Volunteer work
No tobacco
3 glasses wine/week
No coffee, does drink tea.


Family History:
Noncontributory
No thyroid disease
No calcium disorders
Sister has Osteoporosis, [**Last Name **] problem


Physical Exam:
<b>PHYSICAL EXAMINATION:</b>
VITALS:  T:99.2 BP: 166/74 P: 66  RR 16 O2 SAT: 98% on 2L
GENERAL: Lying in ICU bed in no acute distress breathing
comfortably with O2 nasal canula in place.
HEENT: EOMI, PERRL, OP clear without lesions
NECK: No cervical lymphadenopathy, no JVD
CARD: RRR, normal S1/S2, no loud murmurs heard
RESP: CTA bilaterally, no wheezes/rales/rhonchi
ABD: Soft, nontender, nondistended, normoactive bowel sounds
EXT: No clubbing/cyanosis/edema, 2+ DP pulses
NEURO: CN II-XII, A&O x 3, Strength 5/5 in both upper and lower
extremities bilaterally, no sensory deficits, gait not tested
PSYCH: Appropriate, normal affect



Pertinent Results:
Admission labs:

[**2119-4-5**] 10:05AM   GLUCOSE-149* UREA N-9 CREAT-0.5 SODIUM-108*
POTASSIUM-2.6* CHLORIDE-69* TOTAL CO2-26 ANION GAP-16
[**2119-4-5**] 10:05AM   WBC-16.7*# HCT-42.0
[**2119-4-5**] 10:05AM   NEUTS-93* BANDS-0 LYMPHS-2* MONOS-5 EOS-0
BASOS-0 ATYPS-0 METAS-0 MYELOS-0

Chemistry panels:

[**2119-4-5**] 10:05AM BLOOD Glucose-149* UreaN-9 Creat-0.5 Na-108*
K-2.6* Cl-69* HCO3-26 AnGap-16
[**2119-4-5**] 05:06PM BLOOD Glucose-124* UreaN-7 Creat-0.5 Na-107*
K-2.7* Cl-70* HCO3-24 AnGap-16
[**2119-4-6**] 12:22PM BLOOD Na-118* K-3.7 Cl-86*
[**2119-4-6**] 10:39PM BLOOD Na-121* K-4.0
[**2119-4-7**] 07:54AM BLOOD Na-127* K-4.3

[**2119-4-9**] 06:40AM BLOOD WBC-11.2* RBC-4.08* Hgb-12.6 Hct-35.9*
MCV-88 MCH-30.9 MCHC-35.2* RDW-14.2 Plt Ct-295
[**2119-4-9**] 06:40AM BLOOD Plt Ct-295
[**2119-4-9**] 06:40AM BLOOD Glucose-100 UreaN-12 Creat-0.6 Na-129*
K-4.8 Cl-94* HCO3-23 AnGap-17

Brief Hospital Course:
83 yo F with history of hypothyroidism and hypoparathyroidism
who presents with nausea and vomiting with severe hyponatremia.

.
# Hyponatremia: The etiology of the patient's severe
hyponatremia was likely multifactorial given her recent paxil
reinitiation, HCTZ, possible pulmonary infection, macrolide use
and pain secondary to her left wrist fracture.  Most likely
cause is SIADH.  She did have a normal TSH. During her course in
the ICU, she was given hypertonic saline based on weight with
good effect and had her free water intake restricted to 1200cc
per day.  She was transferred to the regular floor after having
stable sodium of around 126 on her third hospital day. During
her hospital course for her hyponatremia, renal specialists
evaluated her and recommended the above treatment as well
discharging on her on a free water restriction of 1200 cc per
day.  She will need to follow up with her PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 2204**] 1 to
2 days after her discharge so that her serum sodium level may be
evaluated.

# Wrist fracture: History of wrist fracture with new deformation
of the volar plate. She was evaluated by plastic surgery,
received a wrist splint and has outpatient follow up scheduled
for this condition.

# Bronchitis/pneumonia: She initially presented to the hospital
with cough and rhonchorous breath sounds on exam and possible
radiological evidence suggestive of pulmonary infection.
Treated empirically with 5 day course of levofloxacin with
respiratory symptoms and signs negative on day of discharge.

# Benzodiazepine usage: There was initial concern for possible
excessive benzo use at home so pt was wrtitten for CIWA which
was not required.

# Hypertension: Patient's HCTZ was held during course and listed
as allergy.  She had her home [**Last Name (un) **] restarted to better control
her HTN, however her discharge blood pressure require her to be
evaluated for other anti hypertensives medication to be control
her BP.

# Hypothyroidism/hypoparathyroidism: she was continued on her
home dose of levothyroxine and given home dose of Vit D.


Medications on Admission:
ERGOCALCIFEROL (VITAMIN D2) [VITAMIN D] - 50,000 unit Capsule -
1
Capsule(s) by mouth once weekly
ESOMEPRAZOLE MAGNESIUM [NEXIUM] - (Prescribed by Other Provider)

- Dosage uncertain
LEVOTHYROXINE - 100 mcg Tablet - One Tablet(s) by mouth daily
except extra [**11-25**] pill every [**Month/Day (2) 766**]
LORAZEPAM - (Prescribed by Other Provider) - 1 mg Tablet -
Tablet(s) by mouth once a day (patient stopped on [**Month/Day (2) **]) (but
takes frequent doses)
RANIBIZUMAB [LUCENTIS] - (Prescribed by Other Provider: [**Name10 (NameIs) **] [**Name11 (NameIs) **]

and Ear) - Dosage uncertain
VALSARTAN-HYDROCHLOROTHIAZIDE [DIOVAN HCT] - (Prescribed by
Other Provider) - 160 mg-25 mg Tablet - 2 Tablet(s) by mouth
once
a day
ASCORBIC ACID - (Not Taking as Prescribed: Not effective - Dr.
[**Last Name (STitle) **] [**Last Name (STitle) 12309**].) - 500 mg Tablet - one Tablet(s) by mouth twice a day

ASPIRIN - (Prescribed by Other Provider) (Not Taking as
Prescribed: last dose 1 week ago) - 81 mg Tablet, Chewable -
Tablet(s) by mouth
ERGOCALCIFEROL (VITAMIN D2) [VITAMIN D] - (OTC) (Not Taking as
Prescribed: Not taking.) - 400 unit Capsule - One Capsule(s) by

mouth daily
VIT C-VIT E-COPPER-ZNOX-LUTEIN [PRESERVISION] - (Prescribed by
Other Provider) - 226 mg-200 unit-[**Unit Number **] mg-0.8 mg-34.8 mg Capsule -

Capsule(s) by mouth
Paxil 10 mg daily


Discharge Medications:
1. Levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Ergocalciferol (Vitamin D2) 50,000 unit Capsule Sig: One (1)
Capsule PO QMONDAY ().
3. Valsartan 160 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

4. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed for sleep.
5. Aspirin 81 mg Tablet Sig: One (1) Tablet PO once a day.
6. Vit C-Vit E-Copper-ZnOx-Lutein 226-200-5 mg-unit-mg Capsule
Sig: One (1) Capsule PO once a day.


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 **] Family VNA

Discharge Diagnosis:
Primary:
Hyponatremia
Secondary:
Hypothyroidism and Hypoparathyroidism
Anxiety
Left wrist fracture


Discharge Condition:
Stable


Discharge Instructions:
You were admitted to the hospital for complaints of
nausea/vomitting, poor nutritional intake and very low sodium
level on your initial blood work.  You initially went th
Intensive Care Unit because of concern for this low sodium level
and were later transferred to less intensive care when your
sodium level started to normalize after receiving fluids that
gradually increased your sodium level.  This low sodium
condition was further treated by stopping two medications that
you were taking at home, hydrochlorothiazide and paxil, an
selective serotonin reuptake inhibitor, and by reducing the
amount of fluids your took in by your mouth and through an IV.
You were discharged to home after physical therapy assessed your
level of functioning to be safe for home.

It is important that you no longer take the above medications;
we have added these medications to your list of allergies so
please tell your PCP and other health care providers that you
should not receive these medications as they might cause you to
indirectly become hyponatremic (low sodium level).

Additionally, you should continue to limit the amount of fluid
you take in by mouth to 1200 cc per day so as to continue to
treat your hyponatremic state at home.  It is very important
that you keep the below appointment with your PCP so that he may
evaluate you and do blood work to see how your hyponatremia is
doing.

Should you have any of the symptoms that brought you to the
hospital or have other concerning symptoms such as confusion,
unsteadiness, chest pain, shortness of breath, please contact
your PCP or call 911 or go to the nearest emergency department.


Followup Instructions:
Please call your PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 97530**], on [**Last Name (LF) 766**], [**4-10**], to
schedule an outpatient visit with him on Tues or Wednesday ([**4-11**] or [**4-12**]).

Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] [**2119-5-5**]  09:00a   at [**Hospital Ward Name 23**] Clinical
center ([**Telephone/Fax (1) 1228**])  for follow up of your left wrist
fracture.

Provider:  [**Name10 (NameIs) **] DENSITY TESTING Phone:[**Telephone/Fax (1) 4586**]
Date/Time:[**2119-4-18**] 7:40
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2164**], MD Phone:[**Telephone/Fax (1) 1803**]
Date/Time:[**2119-4-18**] 8:45
Provider: [**Name10 (NameIs) 251**] [**Last Name (NamePattern4) 252**], M.D. Phone:[**Telephone/Fax (1) 253**]
Date/Time:[**2119-4-25**] 9:30



Completed by:[**2119-4-10**]
{'Other disorders of neurohypophysis,Pneumonia, organism unspecified,Other closed fractures of distal end of radius (alone),Osteoporosis, unspecified,Unspecified essential hypertension,Anemia, unspecified,Nausea with vomiting,Esophageal reflux,Other and unspecified hyperlipidemia,Hypoparathyroidism,Unspecified acquired hypothyroidism,Macular degeneration (senile), unspecified,Long-term (current) use of aspirin,Anxiety state, unspecified,Fall from other slipping, tripping, or stumbling'}


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: hyponatremia

PRESENT ILLNESS: Ms [**Known lastname 107395**] is an 83 yo F with a history of
hyperparathyroidism/hypothyroidism who presents with nausea and
vomiting x 3-4 days. She reports that she started feeling unwell
approximately 5 days ago with cough and shortness of breath. At
that time she went to see her PCP [**Last Name (NamePattern4) **] [**3-31**] who prescribed her with
a 5 day course of azithromycin. She reports that she started
taking the medication on friday [**3-31**] but with immediate
nausea and vomiting. She called her PCP who recommended that she
stop taking the azithromycin. She stopped the medication on [**4-1**] however the symptoms did not improve dramatically. She
reports that since Friday she has been persistently nauseated
with poor Po intake. She has vomited several times and gotten
progressively weaker. She fell the day prior to admission on her
left arm (location of the prior fracture) and has continued to
have pain in that left arm. She reports that the fall was
mechanical and a result of the weakness. She had not had syncope
and presyncope. She overall feels weak but denies any chest
pain, shortness of breath, fever, chills. She does persistently
have the cough that is approximately 1 week in duration.
.
In ED, vitals were 98.6 68 168/84 20 99% RA
Patient given IV fluids of approx 500 cc, 40 mEq potassium
chloride, levaquin 750 mg IV.

MEDICAL HISTORY: 1. Hyperparathyroidism: calcium was 10.8 [**5-26**], PTH 119 [**10-26**]
pre-op. S/p parathyroid adenomectomy/total thyroidectomy in
[**10/2113**]
2. Osteoporosis: Forearm T -3.2, Spine T -1.2 Hip T-1.9 [**5-26**], on

MEDICATION ON ADMISSION: ERGOCALCIFEROL (VITAMIN D2) [VITAMIN D] - 50,000 unit Capsule -
1
Capsule(s) by mouth once weekly
ESOMEPRAZOLE MAGNESIUM [NEXIUM] - (Prescribed by Other Provider)

ALLERGIES: Hydrochlorothiazide / Ssri &Antipsych,Atyp,Dop&Serotonin Antag

PHYSICAL EXAM: <b>PHYSICAL EXAMINATION:</b>
VITALS:  T:99.2 BP: 166/74 P: 66  RR 16 O2 SAT: 98% on 2L
GENERAL: Lying in ICU bed in no acute distress breathing
comfortably with O2 nasal canula in place.
HEENT: EOMI, PERRL, OP clear without lesions
NECK: No cervical lymphadenopathy, no JVD
CARD: RRR, normal S1/S2, no loud murmurs heard
RESP: CTA bilaterally, no wheezes/rales/rhonchi
ABD: Soft, nontender, nondistended, normoactive bowel sounds
EXT: No clubbing/cyanosis/edema, 2+ DP pulses
NEURO: CN II-XII, A&O x 3, Strength 5/5 in both upper and lower
extremities bilaterally, no sensory deficits, gait not tested
PSYCH: Appropriate, normal affect

FAMILY HISTORY: Noncontributory
No thyroid disease
No calcium disorders
Sister has Osteoporosis, [**Last Name **] problem

SOCIAL HISTORY: Married in [**Location (un) **]
Does Volunteer work
No tobacco
3 glasses wine/week
No coffee, does drink tea. 

### Response:
{'Other disorders of neurohypophysis,Pneumonia, organism unspecified,Other closed fractures of distal end of radius (alone),Osteoporosis, unspecified,Unspecified essential hypertension,Anemia, unspecified,Nausea with vomiting,Esophageal reflux,Other and unspecified hyperlipidemia,Hypoparathyroidism,Unspecified acquired hypothyroidism,Macular degeneration (senile), unspecified,Long-term (current) use of aspirin,Anxiety state, unspecified,Fall from other slipping, tripping, or stumbling'}
