CHIEF COMPLAINT: Mastocytosis flare

PRESENT ILLNESS: 26yo F with mastocytosis with multiple flares in the past
without clear precipitating factor presented with few hours of
facial flushing, rash, generalized pruritis, nausea and
palpitations. Reports it's her typical symptoms consistent with
mastocytosis flares. She took zyrtec/doxipin/atarax at home
wtihout relief and cme fot ED for eval.
.
In [**Name (NI) **], pt received solumedrol, phenergan iv, benadryl iv.
.
Pt is currently too drowsy and sleepy to answer questions, but
her fiance denies her having f/c, cough/urinary sxs/diarrhea.
Currently, denies itching, nausea, flushing, palpitations.

MEDICAL HISTORY: Systemic mastocytosis
Thumb surgery
Tonsillectomy

MEDICATION ON ADMISSION: 1. Ranitidine HCl 150 mg PO BID
2. Montelukast 10 mg PO once a day.
3. Cromolyn 100 mg/5 mL Solution Sig: One Hundred (100) ML PO
q6h
4. Cetirizine 10 mg PO twice a day.
5. Doxepin 50 mg QAM and 100 mg QHS.
7. Hydroxyzine HCl 10 mg TID: Please increase dose to 30mg three
times a day as tolerated at home.

ALLERGIES: Aspirin / Iodine / Nsaids / Opioid Analgesics

PHYSICAL EXAM: VS: Tc 95.5, Tm 98.1, p66 (66-161), 128/67 (110-120s/50-70s),
rr22, 97%RA
Gen: NAD, appears comfortable
HEENT: PERRL, EOMI, clear OP
Neck: supple
CVS: RRR, nl s1 s2, no m/g/r
Lungs: CTAB, no c/w/r
Abd: soft, NT, ND, +BS
Ext: no edema
Skin: macular, erythematous rash on face, periorbital, neck

FAMILY HISTORY: Mother with MS. [**Name13 (STitle) **] family h/o allergic, rheumatologic, or
autoimmune diseases

SOCIAL HISTORY: Honorably discharged from air force due to her recurrent
mastocytosis flares and hospitalizations. Moved back to [**Location (un) 86**]
in [**2139-1-31**] to complete a 2 years Masters program in Library
Sciences. Is engaged. Doesn't smoke or use drugs, social
drinker.
Malignant mast cell tumors, unspecified site, extranodal and solid organ sites
Mlg mast unsp xtrndl org
Admission Date:  [**2140-10-28**]              Discharge Date:   [**2140-10-29**]

Date of Birth:  [**2114-5-11**]             Sex:   F

Service: MEDICINE

Allergies:
Aspirin / Iodine / Nsaids / Opioid Analgesics

Attending:[**First Name3 (LF) 8487**]
Chief Complaint:
Mastocytosis flare

Major Surgical or Invasive Procedure:
None

History of Present Illness:
26yo F with mastocytosis with multiple flares in the past
without clear precipitating factor presented with few hours of
facial flushing, rash, generalized pruritis, nausea and
palpitations. Reports it's her typical symptoms consistent with
mastocytosis flares. She took zyrtec/doxipin/atarax at home
wtihout relief and cme fot ED for eval.
.
In [**Name (NI) **], pt received solumedrol, phenergan iv, benadryl iv.
.
Pt is currently too drowsy and sleepy to answer questions, but
her fiance denies her having f/c, cough/urinary sxs/diarrhea.
Currently, denies itching, nausea, flushing, palpitations.


Past Medical History:
Systemic mastocytosis
Thumb surgery
Tonsillectomy


Social History:
Honorably discharged from air force due to her recurrent
mastocytosis flares and hospitalizations. Moved back to [**Location (un) 86**]
in [**2139-1-31**] to complete a 2 years Masters program in Library
Sciences. Is engaged. Doesn't smoke or use drugs, social
drinker.


Family History:
Mother with MS. [**Name13 (STitle) **] family h/o allergic, rheumatologic, or
autoimmune diseases

Physical Exam:
VS: Tc 95.5, Tm 98.1, p66 (66-161), 128/67 (110-120s/50-70s),
rr22, 97%RA
Gen: NAD, appears comfortable
HEENT: PERRL, EOMI, clear OP
Neck: supple
CVS: RRR, nl s1 s2, no m/g/r
Lungs: CTAB, no c/w/r
Abd: soft, NT, ND, +BS
Ext: no edema
Skin: macular, erythematous rash on face, periorbital, neck


Pertinent Results:
LABS (on admission):
WBC 13.7, Hct 33.6, MCV 81, Plt 361
(DIFF: 61.8N, 35.7L, 2.2M, 0.2E, 0.1B)
Na 139, K 3.6, Cl 103, HCO3 22, BUN 8, Cr 0.8, Glu 120, Mg 1.9
.
UA: yellow, clear, USG <1.005, neg blood/nitrite/prot/glu, trace
ketones, neg bili, urobili 0.2, pH 5, trace LE, 0 RBC, 0-2 WBC,
occ bacteria, no yeast, 0-2 epi
.
LABS (on discharge):
WBC 15.3, Hct 28.4, MCV 82, Plt 284
(DIFF: 92N, 6.3L, 1.6M, 0.1E)
Na 142, K 3.9, Cl 109, HCO3 23, BUN 10, Cr 0.8, Glu 137, Ca 9.1,
Ph 3.3, Mg 2.1
.
MICRO:
[**2140-10-28**] - blood cx NO GROWTH TO DATE
.
EKG [**10-28**] - sinus tach


Brief Hospital Course:
26yo F with mastocytosis a/w mastocytosis flare up.
.
# MASTOCYTOSIS: Ms. [**Known lastname 2696**] is followed by Dr. [**Last Name (STitle) 2603**] of
allergy for her mastocytosis. Her usual flare-up treatment
regimen include IV solumedrol, hydroxyzine in lieu of IV
benadryl, IV anzamet for nausea, and continuation of her home
meds including Cromolyn, Zantac, and Singulair. She was admitted
to the floor and continued on all of the above medications, but
continued to have flares, with tachycardia to the 160s and
severe nausea, vomiting, and abdominal pain. She never had any
symptoms of respiratory compromise. She was transferred to the
ICU for closer monitoring and nursing care. She was given IV
solumedrol, IV famotidine, and IV benadryl in the ICU and
continued on her PO medications including montelukast, cromolyn,
zyrtec, doxepin (instead of benadryl), and hydroxyzine. She had
no further episodes of mastocytosis flare in the unit. She
remained hemodynamically stable, was able to tolerate POs and
was ambulating on her own to the bathroom. She was changed to PO
prednisone and PO H2 blocker/benadryl and continued to remain
asymptomatic, so she was discharged to home on a prednisone
taper with instructions to follow-up with Dr. [**Last Name (STitle) 2603**] and Dr.
[**Last Name (STitle) **] as an outpatient.
.
# LEUKOCYTOSIS: She has a chronic leukocytosis and her WBC
during this admission is within her normal range. It was felt to
be a stress-response induced by mastocytosis flare-up. She
remained afebrile and had no localizaing signs or symptoms of
infection.
.
# FEN: She was given a regular diet. She received IVF while she
was nauseated and vomiting. Her electrolytes were checked daily
and were repleted prn.
.
# PPX: Pneumoboots, H2 blocker, no bowel regimen indicated.
.
# COMM: with patient and her fiancee
.
# CODE: FULL
.
# Dispo: To home
.


Medications on Admission:
1. Ranitidine HCl 150 mg PO BID
2. Montelukast 10 mg PO once a day.
3. Cromolyn 100 mg/5 mL Solution Sig: One Hundred (100) ML PO
q6h
4. Cetirizine 10 mg PO twice a day.
5. Doxepin 50 mg QAM and 100 mg QHS.
7. Hydroxyzine HCl 10 mg TID: Please increase dose to 30mg three
times a day as tolerated at home.


Discharge Medications:
1. Prednisone 10 mg Tablet Sig: Variable Tablet PO DAILY
(Daily): Please taper as follows: 60mg (6 tablets) on [**10-30**]; 50mg
(5 tablets) on [**10-31**]; 40mg (4 tablets) on [**11-1**]; 20mg (2 tablets)
on [**11-2**]; 10mg (1 tablet) on [**11-3**]; 5 mg ([**2-1**] tablet) on [**11-4**].
Disp:*19 Tablet(s)* Refills:*0*
2. Doxepin 25 mg Capsule Sig: Two (2) Capsule PO QAM (once a day
(in the morning)). Capsule(s)
3. Doxepin 25 mg Capsule Sig: Four (4) Capsule PO HS (at
bedtime).
4. Hydroxyzine HCl 25 mg Tablet Sig: One (1) Tablet PO Q6H
(every 6 hours).
5. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Cromolyn 100 mg/5 mL Solution Sig: Five (5) mL PO Q6H (every
6 hours).
7. Cetirizine 10 mg Tablet Sig: One (1) Tablet PO twice a day.
8. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO twice a
day.
9. Benadryl 25 mg Tablet Sig: 1-2 Tablets PO every six (6) hours
as needed.


Discharge Disposition:
Home

Discharge Diagnosis:
Mastocytosis flare


Discharge Condition:
Good. Afebrile, vital signs stable. No symptoms of mastocytosis
in the last 24 hrs.


Discharge Instructions:
Please call your PCP or go to the nearest ER if you develop any
of the following symptoms: fever >101, chills, chest pain,
shortness of breath, difficulty breathing, rapid heart rate,
nausea, vomiting, abdominal pain, or any other worrisome
symptoms.
.
Please take all your medications as prescribed, including the
prednisone taper.
.
Please make a follow up appointment with your PCP within the
next 1-2 weeks.

Followup Instructions:
Please call your PCP and make an appointment with her in the
next 1-2 weeks.
.
Please keep the following appointments:
Provider: [**First Name11 (Name Pattern1) 18169**] [**Initial (NamePattern1) **]. [**Last Name (NamePattern1) **], OD Phone:[**Telephone/Fax (1) 253**]
Date/Time:[**2140-12-13**] 4:00
Provider: [**First Name8 (NamePattern2) **] [**Name11 (NameIs) **], MD Phone:[**Telephone/Fax (1) 1723**] Date/Time:[**2141-1-4**]
8:00
{'Malignant mast cell tumors, unspecified site, extranodal and solid organ sites'}


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: Mastocytosis flare

PRESENT ILLNESS: 26yo F with mastocytosis with multiple flares in the past
without clear precipitating factor presented with few hours of
facial flushing, rash, generalized pruritis, nausea and
palpitations. Reports it's her typical symptoms consistent with
mastocytosis flares. She took zyrtec/doxipin/atarax at home
wtihout relief and cme fot ED for eval.
.
In [**Name (NI) **], pt received solumedrol, phenergan iv, benadryl iv.
.
Pt is currently too drowsy and sleepy to answer questions, but
her fiance denies her having f/c, cough/urinary sxs/diarrhea.
Currently, denies itching, nausea, flushing, palpitations.

MEDICAL HISTORY: Systemic mastocytosis
Thumb surgery
Tonsillectomy

MEDICATION ON ADMISSION: 1. Ranitidine HCl 150 mg PO BID
2. Montelukast 10 mg PO once a day.
3. Cromolyn 100 mg/5 mL Solution Sig: One Hundred (100) ML PO
q6h
4. Cetirizine 10 mg PO twice a day.
5. Doxepin 50 mg QAM and 100 mg QHS.
7. Hydroxyzine HCl 10 mg TID: Please increase dose to 30mg three
times a day as tolerated at home.

ALLERGIES: Aspirin / Iodine / Nsaids / Opioid Analgesics

PHYSICAL EXAM: VS: Tc 95.5, Tm 98.1, p66 (66-161), 128/67 (110-120s/50-70s),
rr22, 97%RA
Gen: NAD, appears comfortable
HEENT: PERRL, EOMI, clear OP
Neck: supple
CVS: RRR, nl s1 s2, no m/g/r
Lungs: CTAB, no c/w/r
Abd: soft, NT, ND, +BS
Ext: no edema
Skin: macular, erythematous rash on face, periorbital, neck

FAMILY HISTORY: Mother with MS. [**Name13 (STitle) **] family h/o allergic, rheumatologic, or
autoimmune diseases

SOCIAL HISTORY: Honorably discharged from air force due to her recurrent
mastocytosis flares and hospitalizations. Moved back to [**Location (un) 86**]
in [**2139-1-31**] to complete a 2 years Masters program in Library
Sciences. Is engaged. Doesn't smoke or use drugs, social
drinker. 

### Response:
{'Malignant mast cell tumors, unspecified site, extranodal and solid organ sites'}
