CHIEF COMPLAINT: back pain, fever, SOB

PRESENT ILLNESS: Ms. [**Known lastname **] is a 46yo F admitted from the ED for likely urosepsis. 3
days PTA, the patient developed myalgias and generalized body
aches, worst in her L lower back. She went home from work 3 days
PTA for fevers (though no temp was documented). She says that
her sx had gotten progressively worse over the last 2 days, with
worsening pain, myalgia and a headache (ranging from [**2180-5-27**],
frontal, relieved w/ tylenol). Over the last 24 hrs, she
developed nausea and vomiting x5 and decided to come to the
hospital. She presented to the ED this AM with a fever to 101.5
for which she was immediately given tylenol. She then complained
of [**11-26**] left sided flank pain and was given 3mg of MSO4 x1. UA
was positive for UTI so she was given levaquin 500mg IV x1. A CT
scan with contrast was done to look for pyelonephritis (given
that she had a 10d hospitalization in the past for pyelo). On
return from CT scan, her husband noticed that she had a welt at
the site of the IV contrast injection and she felt like she was
developing a rash. Per the ED report, she then had rigors,
looked mottled, and developed SOB w/ chest tightness. BP rose to
168/82, HR 122-145, RR 36, O2 sats dropped to the 70s and only
improved to the 80s on a NRB. She was then put on CPAP with
improvement in her O2 sats to 100%. She was given MSO4,
solumedrol, pepcid, toradol, CTX and vancomycin. An ABG was
performed to monitor her oxygenation and ventilation and was
7/32/40/174/22. She was then transferred to the [**Hospital Unit Name 153**] on 15L NRB
for further monitoring.

MEDICAL HISTORY: pyelonephritis [**10-29**] yrs ago -> treated w/ gent
"corkscrew kidney"
h/o migraine headaches
R tympanoplasty
tubal ligation

MEDICATION ON ADMISSION: None

ALLERGIES: Erythromycin Base / Tetracyclines / Bactrim / Iodine; Iodine
Containing

PHYSICAL EXAM: VS - T 100.8, BP 117/67 (95-168/49-103), HR 100s (81-145), RR
22-38, sats 100% on 15L NRB -> 96% on 2L nc
Gen: WDWN middle aged Asian female in NAD. Lying in bed w/ eyes
closed.
HEENT: NCAT. Sclera anicteric, PERRL, 3 -> 2mm bilaterally,
EOMI. OP clear, no exudates or erythema. Neck supple, no
meningismus, no LAD.
CV: Tachy, reg, NL S1, S2. No m/r/g.
Lungs: Diminished BS at bases bilaterally, otherwise clear. No
crackles/wheezes/rhonchi.
Abd: Soft, ND, ttp in LUQ and LLQ, point tenderness in
midepigastric area as well. No rebound or guarding. NABS.
Ext: 2+ radial, PT pulses bilaterally. No c/c/e. No rashes.
Neuro: AAOx3, CN II-XII grossly intact, strength grossly intact
in all 4 extremities. Able to sit up on her own.

FAMILY HISTORY: Father died at 73 of renal failure, ? from PCKD. Mother has
hypertension and multiple CVAs. One brother and three sisters
all of whom are well. One brother died of cirrhosis. No family
history of any cancers. No family history of any early MIs or
diabetes.

SOCIAL HISTORY: She works full time at [**Hospital1 2025**] as a medical lab tech (also works
here part time). She is from [**Location (un) 41653**] originally then moved to
[**Country 6607**] for 20 years and now has been in the US for 5 years. Her
children are currently 10, 13, and 18. No tob or EtOH use. She
is currently married and her husband works here in the
microbiology lab.
Septicemia due to escherichia coli [E. coli],Pyelonephritis, unspecified,Anemia of other chronic disease,Other anaphylactic reaction,Other drugs and medicinal substances causing adverse effects in therapeutic use
E coli septicemia,Pyelonephritis NOS,Anemia-other chronic dis,Other anaphylactic react,Adv eff medicinal NEC
Admission Date:  [**2176-10-12**]              Discharge Date:   [**2176-10-15**]

Date of Birth:  [**2130-9-14**]             Sex:   F

Service: MEDICINE

Allergies:
Erythromycin Base / Tetracyclines / Bactrim / Iodine; Iodine
Containing

Attending:[**First Name3 (LF) 1148**]
Chief Complaint:
back pain, fever, SOB

Major Surgical or Invasive Procedure:
None


History of Present Illness:
Ms. [**Known lastname **] is a 46yo F admitted from the ED for likely urosepsis. 3
days PTA, the patient developed myalgias and generalized body
aches, worst in her L lower back. She went home from work 3 days
PTA for fevers (though no temp was documented). She says that
her sx had gotten progressively worse over the last 2 days, with
worsening pain, myalgia and a headache (ranging from [**2180-5-27**],
frontal, relieved w/ tylenol). Over the last 24 hrs, she
developed nausea and vomiting x5 and decided to come to the
hospital. She presented to the ED this AM with a fever to 101.5
for which she was immediately given tylenol. She then complained
of [**11-26**] left sided flank pain and was given 3mg of MSO4 x1. UA
was positive for UTI so she was given levaquin 500mg IV x1. A CT
scan with contrast was done to look for pyelonephritis (given
that she had a 10d hospitalization in the past for pyelo). On
return from CT scan, her husband noticed that she had a welt at
the site of the IV contrast injection and she felt like she was
developing a rash. Per the ED report, she then had rigors,
looked mottled, and developed SOB w/ chest tightness. BP rose to
168/82, HR 122-145, RR 36, O2 sats dropped to the 70s and only
improved to the 80s on a NRB. She was then put on CPAP with
improvement in her O2 sats to 100%. She was given MSO4,
solumedrol, pepcid, toradol, CTX and vancomycin. An ABG was
performed to monitor her oxygenation and ventilation and was
7/32/40/174/22. She was then transferred to the [**Hospital Unit Name 153**] on 15L NRB
for further monitoring.


Past Medical History:
pyelonephritis [**10-29**] yrs ago -> treated w/ gent
"corkscrew kidney"
h/o migraine headaches
R tympanoplasty
tubal ligation

Social History:
She works full time at [**Hospital1 2025**] as a medical lab tech (also works
here part time). She is from [**Location (un) 41653**] originally then moved to
[**Country 6607**] for 20 years and now has been in the US for 5 years. Her
children are currently 10, 13, and 18. No tob or EtOH use. She
is currently married and her husband works here in the
microbiology lab.

Family History:
Father died at 73 of renal failure, ? from PCKD. Mother has
hypertension and multiple CVAs. One brother and three sisters
all of whom are well. One brother died of cirrhosis. No family
history of any cancers. No family history of any early MIs or
diabetes.

Physical Exam:
VS - T 100.8, BP 117/67 (95-168/49-103), HR 100s (81-145), RR
22-38, sats 100% on 15L NRB -> 96% on 2L nc
Gen: WDWN middle aged Asian female in NAD. Lying in bed w/ eyes
closed.
HEENT: NCAT. Sclera anicteric, PERRL, 3 -> 2mm bilaterally,
EOMI. OP clear, no exudates or erythema. Neck supple, no
meningismus, no LAD.
CV: Tachy, reg, NL S1, S2. No m/r/g.
Lungs: Diminished BS at bases bilaterally, otherwise clear. No
crackles/wheezes/rhonchi.
Abd: Soft, ND, ttp in LUQ and LLQ, point tenderness in
midepigastric area as well. No rebound or guarding. NABS.
Ext: 2+ radial, PT pulses bilaterally. No c/c/e. No rashes.
Neuro: AAOx3, CN II-XII grossly intact, strength grossly intact
in all 4 extremities. Able to sit up on her own.


Pertinent Results:
[**2176-10-12**] 08:08PM   GLUCOSE-199* UREA N-9 CREAT-0.8 SODIUM-139
POTASSIUM-4.3 CHLORIDE-108 TOTAL CO2-21* ANION GAP-14
[**2176-10-12**] 08:08PM   CALCIUM-7.7* PHOSPHATE-2.3* MAGNESIUM-1.7
[**2176-10-12**] 08:08PM   WBC-24.4* RBC-3.63* HGB-10.7* HCT-32.1*
MCV-89 MCH-29.5 MCHC-33.3 RDW-13.2
[**2176-10-12**] 08:08PM   NEUTS-80* BANDS-14* LYMPHS-5* MONOS-1* EOS-0
BASOS-0 ATYPS-0 METAS-0 MYELOS-0
[**2176-10-12**] 08:08PM   PLT COUNT-174
[**2176-10-12**] 01:48PM   PO2-174* PCO2-40 PH-7.32* TOTAL CO2-22 BASE
XS--5
[**2176-10-12**] 01:48PM   LACTATE-2.1*
[**2176-10-12**] 12:50PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.035
[**2176-10-12**] 12:50PM URINE  BLOOD-MOD NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG

urine culture: no growth
blood culture: 2/4 bottles e coli, pan sensitive

AP UPRIGHT CHEST RADIOGRAPH:
The heart size is normal. Mediastinal and hilar contours are
unremarkable. The lungs are clear. No pleural effusions. No
evidence for pneumothorax. Surrounding osseous and soft tissue
structures are unremarkable.

CT ABDOMEN WITH IV CONTRAST: There is bibasilar atelectasis. The
liver, adrenal glands, spleen, pancreas, right kidney, stomach
and abdominal loops of small and large bowel are unremarkable.
There are multiple gallstones without evidence of cholecystitis.
Subtle wedge-shaped cortical perfusion defects within the left
kidney are consistent pyelonephritis. There is no significant
perinephric stranding or fluid collections. There are no
pathologically enlarged mesenteric or retroperitoneal lymph
nodes. There is no free air or free fluid within the abdomen.

CT PELVIS WITH IV CONTRAST: The rectum, uterus, bladder and
sigmoid colon are unremarkable. The appendix is clearly
visualized, and there is no evidence of appendicitis. There are
no pathologically enlarged pelvic or inguinal lymph nodes. There
is no free air or free fluid within the pelvis.

Osseous structures reveal no suspicious lytic or sclerotic foci.


Brief Hospital Course:
# SEPSIS: Was started on levaquin, CTX, and vanco in ER while
cultures are pending. Most likely etiology is urosepsis (UA was
questionable, as first one looks positive but had epis, second
UA had no epis, some WBC and moderate blood, but no bacteria).
[**3-23**] Blood cultures grew e coli, so patient switched to just
levaquin and then cipro po.  D/w urology and plan to follow up
with her as outpatient in [**3-22**] weeks to look at anatomy.  Patient
to finish 14 days of antibiotics total.
.
# SOB/HYPOXIA: Likely due to IV contrast allergy. Upon return to
ER from CT scan, pt developed rash, hives, SOB, chest tightness,
temp to 104 and rigors. She was treated with tylenol,
solumedrol, and pepcid. She dropped her O2 sats transiently and
required CPAP briefly, but now is back to 2L nc with sats in the
high 90s. Will now list IV contrast as an allergy in pt's file.
Patient to avoid further contrast exposure in future.
.
#ANEMIA: Patient's Hct drifted down to low 30s.  Fe studies,
folate, b12 all normal.  Most likely combination diluational
with anemia of chronic disease in face of inflammation.
-patient should get repeat Hct as outpatient in [**3-22**] weeks
.
#HYPERGLYCEMIA: Patient transiently had elevated glucoses after
receiving high dose steroids that then resolved.

Medications on Admission:
None

Discharge Medications:
1. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours) for 10 days.
Disp:*20 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Pyelonephritis from e. coli
anaphylactic reaction to IV dye


Discharge Condition:
Good


Discharge Instructions:
Take your antibiotics until they are finished.  Call your doctor
if you develop fevers, chills, discomfort urinating.

Followup Instructions:
Please make a follow up appointment with your regular doctor,
Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] ([**Telephone/Fax (1) 1247**]) in the next 2-3 weeks.

Please call the urology office at [**Telephone/Fax (1) 18197**] for 2-3 weeks
after discharge from the hospital.
{'Septicemia due to escherichia coli [E. coli],Pyelonephritis, unspecified,Anemia of other chronic disease,Other anaphylactic reaction,Other drugs and medicinal substances causing adverse effects in therapeutic use'}


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: back pain, fever, SOB

PRESENT ILLNESS: Ms. [**Known lastname **] is a 46yo F admitted from the ED for likely urosepsis. 3
days PTA, the patient developed myalgias and generalized body
aches, worst in her L lower back. She went home from work 3 days
PTA for fevers (though no temp was documented). She says that
her sx had gotten progressively worse over the last 2 days, with
worsening pain, myalgia and a headache (ranging from [**2180-5-27**],
frontal, relieved w/ tylenol). Over the last 24 hrs, she
developed nausea and vomiting x5 and decided to come to the
hospital. She presented to the ED this AM with a fever to 101.5
for which she was immediately given tylenol. She then complained
of [**11-26**] left sided flank pain and was given 3mg of MSO4 x1. UA
was positive for UTI so she was given levaquin 500mg IV x1. A CT
scan with contrast was done to look for pyelonephritis (given
that she had a 10d hospitalization in the past for pyelo). On
return from CT scan, her husband noticed that she had a welt at
the site of the IV contrast injection and she felt like she was
developing a rash. Per the ED report, she then had rigors,
looked mottled, and developed SOB w/ chest tightness. BP rose to
168/82, HR 122-145, RR 36, O2 sats dropped to the 70s and only
improved to the 80s on a NRB. She was then put on CPAP with
improvement in her O2 sats to 100%. She was given MSO4,
solumedrol, pepcid, toradol, CTX and vancomycin. An ABG was
performed to monitor her oxygenation and ventilation and was
7/32/40/174/22. She was then transferred to the [**Hospital Unit Name 153**] on 15L NRB
for further monitoring.

MEDICAL HISTORY: pyelonephritis [**10-29**] yrs ago -> treated w/ gent
"corkscrew kidney"
h/o migraine headaches
R tympanoplasty
tubal ligation

MEDICATION ON ADMISSION: None

ALLERGIES: Erythromycin Base / Tetracyclines / Bactrim / Iodine; Iodine
Containing

PHYSICAL EXAM: VS - T 100.8, BP 117/67 (95-168/49-103), HR 100s (81-145), RR
22-38, sats 100% on 15L NRB -> 96% on 2L nc
Gen: WDWN middle aged Asian female in NAD. Lying in bed w/ eyes
closed.
HEENT: NCAT. Sclera anicteric, PERRL, 3 -> 2mm bilaterally,
EOMI. OP clear, no exudates or erythema. Neck supple, no
meningismus, no LAD.
CV: Tachy, reg, NL S1, S2. No m/r/g.
Lungs: Diminished BS at bases bilaterally, otherwise clear. No
crackles/wheezes/rhonchi.
Abd: Soft, ND, ttp in LUQ and LLQ, point tenderness in
midepigastric area as well. No rebound or guarding. NABS.
Ext: 2+ radial, PT pulses bilaterally. No c/c/e. No rashes.
Neuro: AAOx3, CN II-XII grossly intact, strength grossly intact
in all 4 extremities. Able to sit up on her own.

FAMILY HISTORY: Father died at 73 of renal failure, ? from PCKD. Mother has
hypertension and multiple CVAs. One brother and three sisters
all of whom are well. One brother died of cirrhosis. No family
history of any cancers. No family history of any early MIs or
diabetes.

SOCIAL HISTORY: She works full time at [**Hospital1 2025**] as a medical lab tech (also works
here part time). She is from [**Location (un) 41653**] originally then moved to
[**Country 6607**] for 20 years and now has been in the US for 5 years. Her
children are currently 10, 13, and 18. No tob or EtOH use. She
is currently married and her husband works here in the
microbiology lab. 

### Response:
{'Septicemia due to escherichia coli [E. coli],Pyelonephritis, unspecified,Anemia of other chronic disease,Other anaphylactic reaction,Other drugs and medicinal substances causing adverse effects in therapeutic use'}
