CHIEF COMPLAINT: 

PRESENT ILLNESS: Mrs. [**Known lastname **] is a 62-year-old
female with a complicated medical history including
sarcoidosis, hepatic cirrhosis, Grade II esophageal varices,
hypertension, multiple orthopaedic procedures to her left
hip, right hip and right knee, who presented with left thigh
recently admitted to Surgery for ventral hernia repair, which
had caused an ileus and ascites, which required two
[**Location (un) 1661**]-[**Location (un) 1662**] drains.  These drains were recently removed.
The patient developed abdominal pain and diarrhea soon after.
The patient also developed left thigh pain.  The patient
reported that the pain worsened to the point where she was
unable to weight bear.  She denied any nausea, vomiting,
chills, feeling cold, and lightheadedness.  This prompted her
to present to the Emergency Department.

MEDICAL HISTORY: 1.  Sarcoidosis diagnosed in [**2137**], with pulmonary and hepatic
involvement, on chronic steroids
2.  Status post ventral hernia repair on [**2144-2-29**]
3.  History of cirrhosis diagnosed by CT in [**2143-10-31**]
with Grade II varices
4.  Status post right total hip replacement and right total
knee replacement
5.  Status post open reduction and internal fixation of her
left hip
6.  Osteoporosis
7.  Hypertension
8.  Choledocholithiasis
9.  Hypercholesterolemia
10. Aortic stenosis with ejection fraction of 55%
11. Status post total abdominal hysterectomy and bilateral
salpingo-oophorectomy

MEDICATION ON ADMISSION: Lasix 20 mg by mouth once daily,
Aldactone 15 mg twice a day, Actigall 300 mg three times a
day, Protonix 40 mg by mouth once daily, prednisone 10 mg by
mouth twice a day, Aleve 220 mg by mouth twice a day.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is divorced.  She lives with
her daughter.
Other postoperative infection,Cellulitis and abscess of leg, except foot,Acute kidney failure, unspecified,Methicillin susceptible Staphylococcus aureus septicemia,Urinary tract infection, site not specified,Pulmonary collapse,Mitral valve insufficiency and aortic valve insufficiency,Acidosis
Other postop infection,Cellulitis of leg,Acute kidney failure NOS,Meth susc Staph aur sept,Urin tract infection NOS,Pulmonary collapse,Mitral/aortic val insuff,Acidosis
Admission Date:  [**2144-4-19**]       Discharge Date:

Date of Birth:   [**2082-1-26**]       Sex:  F

Service:  MEDICINE
HISTORY OF PRESENT ILLNESS:   Mrs. [**Known lastname **] is a 62-year-old
female with a complicated medical history including
sarcoidosis, hepatic cirrhosis, Grade II esophageal varices,
hypertension, multiple orthopaedic procedures to her left
hip, right hip and right knee, who presented with left thigh
recently admitted to Surgery for ventral hernia repair, which
had caused an ileus and ascites, which required two
[**Location (un) 1661**]-[**Location (un) 1662**] drains.  These drains were recently removed.
The patient developed abdominal pain and diarrhea soon after.
The patient also developed left thigh pain.  The patient
reported that the pain worsened to the point where she was
unable to weight bear.  She denied any nausea, vomiting,
chills, feeling cold, and lightheadedness.  This prompted her
to present to the Emergency Department.

In the Emergency Department, the patient was found to be
hypotensive, with blood pressure 80/palpation, the heart rate
in the 160s.  Her white blood cell count was noted to be 30,
with 26% bandemia, and the patient was found to also be in
acute renal failure with a creatinine up to 3.0.  She was
also hyperkalemic, acidotic, with an anion gap of 14.  Per
the Emergency Department record, the patient appeared to have
received 1 gram of vancomycin, 100 mg of hydrocortisone, 10
units of regular insulin, 1 amp of dextrose, and 2 mg of
intravenous dilaudid.  She was transferred to the Medical
Intensive Care Unit on the [**Hospital Ward Name 516**].  On arrival to the
[**Hospital 516**] Medical Intensive Care Unit, the patient was
found to be lethargic, with pinpoint pupils secondary to
dilaudid.  An amp of Narcan was given, with improvement of
mental status.

On review of systems, the patient complains of exquisite pain
in her left thigh, with decreased range of motion of her
knee.

PAST MEDICAL HISTORY:
1.  Sarcoidosis diagnosed in [**2137**], with pulmonary and hepatic
involvement, on chronic steroids
2.  Status post ventral hernia repair on [**2144-2-29**]
3.  History of cirrhosis diagnosed by CT in [**2143-10-31**]
with Grade II varices
4.  Status post right total hip replacement and right total
knee replacement
5.  Status post open reduction and internal fixation of her
left hip
6.  Osteoporosis
7.  Hypertension
8.  Choledocholithiasis
9.  Hypercholesterolemia
10. Aortic stenosis with ejection fraction of 55%
11. Status post total abdominal hysterectomy and bilateral
salpingo-oophorectomy

MEDICATIONS ON ADMISSION:  Lasix 20 mg by mouth once daily,
Aldactone 15 mg twice a day, Actigall 300 mg three times a
day, Protonix 40 mg by mouth once daily, prednisone 10 mg by
mouth twice a day, Aleve 220 mg by mouth twice a day.

SOCIAL HISTORY:   The patient is divorced.  She lives with
her daughter.

PHYSICAL EXAMINATION:   On arrival to the Medical Intensive
Care Unit, the patient's temperature was 99.2, blood pressure
120/84, heart rate 117, respiratory rate 12, oxygen
saturation 96% on room air, and her weight was 70 kg.
General examination revealed a lethargic patient, who became
alert and oriented x 3 after Narcan administration.  She was
not in any acute distress.  Head, eyes, ears, nose and throat
examination revealed cataracts, normal mucous membranes.
Pupils went from 1 mm to 3 mm after Narcan administration.
Neck examination revealed no jugular venous distention.
Cardiovascular examination revealed that the patient was
tachycardic, with normal S1 and S2, and III/VI systolic
ejection murmur at right upper sternal border.  This murmur
radiates to the carotids and apex.  She had no S3 and no S4.
Lung examination revealed lungs clear to auscultation
bilaterally, with no wheezes or crackles.  Abdominal
examination revealed a soft abdomen with decreased bowel
sounds.  The patient had a well-healed surgical scar with a
scab in the subumbilical abdominal area.  The patient was
mildly tender on palpation of the middle of her abdomen.
Extremity examination revealed trace bilateral lower
extremity edema, tenderness and warmth along her left lateral
thigh.  There was no induration or erythema. Neurologic
examination:  The patient was able to move all of her toes
and her ankles.  She was unable to bend her left knee to full
flexion secondary to pain.  She was otherwise alert and
oriented x 3.

LABORATORY DATA:   On admission, hematocrit 41.2, white count
29, and platelet count of 367.  Her serum chemistry revealed
a sodium of 137, potassium 4.9, chloride 107, bicarbonate 16,
BUN 83, creatinine 2.9, glucose 78.  Anion gap was 14.  On
her initial blood work, her white count differential revealed
69% neutrophils and 26% bands.  Coagulation studies revealed
an INR of 1.4.  Her ESR was 87.  Liver studies revealed an
ALT of 9, AST of 30, total bilirubin of 2.9, CK of 20,
calcium of 8.2, magnesium of 2.1, and phosphate of 5.6.  Her
electrocardiogram revealed sinus tachycardia.  Her chest
x-ray revealed no effusion, no pneumonia, and no
pneumothorax.  There was minimal increased interstitial
opacity, questionable atelectasis, in the lower lung bases.
Her ultrasound of her left thigh revealed a small fluid
collection in the left lateral thigh.

HOSPITAL COURSE:   After being found hypotensive with
hyperkalemia, the patient was treated with intravenous fluids
and insulin and D-50, as well as hydrocortisone for stress
dose steroids.  The patient's left thigh was evaluated by
ultrasound, which showed a fluid collection suspicious for
an abscess.  This fluid collection was aspirated by
Orthopaedic consultation team.  The patient received a total
of 12 liters of normal saline within 24 hours' time prior to
producing any urine output.  The patient was also started
empirically on clindamycin for antibiotic coverage.

Surgery was consulted to evaluate the possibility of fasciitis in
her left thigh. They recommended ultrasound-guided tap aspirate
of the left thigh fluid collection, which on Gram stain showed 4+
polymorhoneucleocytes.

The patient's hypotension resolved with aggressive
intravenous fluid hydration and a brief course of pressors.  Her
acute renal failure also appeared to improve after she was
aggressively hydrated.  The nephrolog was consulted.  Her
hyperkalemia began to resolved after insulin and D-50 treatments.
The patient's initial tachycardia on admission resolved after
intravenous fluid hydration.  In terms of the patient's
leukocytosis, the suspicion was that this is a
reaction to the abscess in her left thigh.  An MRI of her
left thigh was obtained on [**2144-4-20**].  On this MRI, the
patient was found to have a discrete fluid collection in the
subcutaneous tissue of the anterior abdominal wall measuring
16 x 20 x 3 cm.  It extends from above the umbilicus to the
pubic symphysis, and is predominantly on the left side of the
abdomen.  The source of this fluid was not entirely clear on
this MRI.  Orthopedics thought this unlikely to involve her hip
prosthesis.  The patient was also found to have extensive
subcutaneous edema and small fluid collections in her left
thigh.  She was found to not have any significant fluid
within her left hip joint.  At this time, the patient was on
clindamycin and vancomycin as her antibiotic coverage.

The patient also received a right internal jugular
centrally-placed catheter on [**2144-4-20**], for access.  On
this date, the patient had continual hypotension requiring
aggressive fluid hydration, and also low-dose dopamine to be
added via her central catheter.  Her blood culture on this
date was found to have staphylococcus bacteremia.  She
underwent a transthoracic echocardiogram, which did not show
any vegetations.  On this date, the initial fluid aspirate
from her left thigh also grew out coagulase positive
staphylococcus aureus.

The patient's hypotension was improved and was able to be
weaned off dopamine on [**2144-4-21**].  On this date, she was
also started on Fluconazole for yeast in her urine.

Infectious Diseases was consulted on [**4-21**].  They
recommended tapping of the patient's abdominal fluid
collection, which was found on the MRI study of her left
thigh and abdomen.  However, at the same time, the Surgical
consultants felt strongly that this fluid should not be
tapped due to potential for infecting it, and a potential
connection with the patient's abdominal cavity, especially in
the setting of known ascites.  This fluid collection
therefore was not tapped on this date.

The patient continued to improve.  On [**2144-4-22**], the
patient was no longer requiring pressor support, and her
creatinine had decreased to 2.0.  She was no longer febrile.

The patient's final cultures came back as
methicillin-sensitive staphylococcus aureus in her blood
obtained on [**2144-4-19**].  She also grew
methicillin-sensitive staphylococcus aureus at the aspirate
of one fluid collection in her left thigh.  In the same
culture, she also grew some bacillus species.

On [**2144-4-23**], the patient was found to have a positive
urine culture growing Klebsiella pneumoniae.  She was started
on levofloxacin by mouth for this infection.  Her Foley
catheter was removed on this date.  She was also started on
prednisone for her sarcoidosis.  By this time, the patient's
white blood cell count had decreased to 19.4.  Her serum
creatinine had decreased to 1.9.  As the patient has had
stable blood pressure up until now, and has had peripheral
edema due to saline resuscitation, the patient received a
low-dose diuretic, and her urine output increased.

On the early morning of [**2144-4-24**], the patient was
called out of the Intensive Care Unit and transferred to the
floor.  By this time, her serum creatinine was down at 1.4.
Her blood pressure has been stable.  She is no longer
tachycardic.  Her methicillin-sensitive staphylococcus aureus
bacteremia and left thigh abscess have been treated by
continuing dosages of vancomycin, and the left thigh
aspiration.  Her left thigh pain was much improved at this
time, with no requirement of narcotics for pain control.

After arrival to the floor, the patient received a PICC line
placement in the morning of [**2144-4-24**].  Her right
internal jugular vein central catheter was therefore removed.
The patient was continued on her levofloxacin and vancomycin.
The plan at this time was to further treat the patient's
infections, stabilize her, diurese her, and have
physiotherapist screen her, with eventual plans to discharge
her to a [**Hospital 3058**] rehabilitation center.

With regards to the patient's methicillin-sensitive
staphylococcus aureus bacteremia, the patient was determined
to be too high risk to receive a transesophageal
echocardiogram for further evaluation of her valves.  This is
because she has known Grade II varices in her esophagus.
After much discussion with the Infectious Disease team and
the patient's primary doctor, Dr.  [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], it was
determined that the patient should be treated for a total
course of eight weeks with vancomycin.  This is because she
is thought to be high risk for seeding her known stenosed
aortic valve.

The patient did very well on the floor between [**4-24**] and
29.  She was diuresed with initially 20 mg of lasix by mouth,
with minimal effects.  She received intravenous lasix after
that, with better responses.  The patient was still generally
edematous, especially in her legs.  She had not been able to
ambulate because of her gross lower extremity edema.  Her
renal failure was completely resolved by this time.  Her
baseline creatinine of 0.7 was reached on [**2144-4-26**].
Her white blood cell count was also noted to be decreasing.

Into the morning of [**4-27**], the patient was noted to be
tachycardic up to 118 to 120s.  This was thought to be from
intravascular volume depletion due to aggressive diuresis.
The patient received a trial of 250 cc of saline bolus, and
her heart rate decreased from 120 to 108.  This was thought
to be a positive test result for her intravascular volume
status.  Her lasix was therefore discontinued.

By the next morning, the patient's tachycardia had resolved,
and her heart rate ranged between 80s to 100s.  However, on
the same day, the patient noted new onset left thigh
tenderness.  This was concerning for reaccumulation of fluids
or reappearance of her left thigh abscess.  The patient was
afebrile on this date.  Given the concerning symptoms,
another ultrasound of her left lower extremity was obtained.
On this ultrasound, the patient was again found to have
hypoechoic fluid collection tracking along her left lateral
thigh.  This collection measures 3.2 cm in the largest AP
diameter, and was thought to be more than 10 cm in length.

After discussion with Surgery and Orthopaedics, it was
determined that this fluid collection needed to be drained,
with the placement of a pigtail catheter.  This was done on
the morning of [**2144-4-28**], without complications.  The
patient had purulent fluids drained from her left thigh fluid
collection.  This fluid was sent for cell count and culture.
The patient also received a chest x-ray on this date for
crackles noted on physical examination.  On the chest x-ray,
the patient had no evidence of pneumonia.  The patient was
thought to have low-grade atelectasis, and was encouraged to
take deeper breaths in.  The patient has been using an
incentive spirometer ever since admission to the Intensive
Care Unit.

On the morning of [**2144-4-28**], the patient experienced an
episode of spontaneous drainage of most likely the
subcutaneous fluid collection seen on MRI in her abdomen.
Per patient's report, she stood up to go to the commode, and
all of a sudden she felt gushing fluid coming from her
abdomen.  The scab in her subumbilical region apparently
lifted and clear fluid drained out in copious amounts.  The
scab was later on covered with dry dressing.  The patient did
require frequent dressing change, and had persistent leakage
of clear-looking fluid from this site.  The Surgery service
was notified of this event.  They recommended dry dressings
frequently.  They were not concerned that this fluid could be
infected fluid.  Due to the physical characteristics of the
fluid drained from the patient's left thigh fluid collection,
she was started on levofloxacin by mouth for broadening
antibiotic coverage until this fluid culture returns.  The
concern here is multiorganism infection which was not covered
by vancomycin.


                            [**First Name11 (Name Pattern1) 4283**] [**Last Name (NamePattern4) 4284**], M.D.  [**MD Number(1) 7551**]

Dictated By:[**Name8 (MD) 9921**]
MEDQUIST36

D:  [**2144-5-1**]  17:39
T:  [**2144-5-2**]  00:00
JOB#:  [**Job Number 12570**]


Name:  [**Known lastname **], [**Known firstname 1873**]                       Unit No:  [**Numeric Identifier 1874**]

Admission Date:  [**2144-4-19**]     Discharge Date:

Date of Birth:   [**2082-1-26**]     Sex:  F


ADDENDUM:
HOSPITAL COURSE:
1.  Left thigh abscess:  The patient's left thigh abscess
grew Methicillin sensitive staph aureus with similar
receive Vancomycin.  Her pigtail drain that was placed in her
left thigh continued to drain serosanguineous drainage but
with decreased amounts every day.  It was flushed three times
per day and she was placed in a left knee immobilizer.  The
plan was to re-image her left thigh probably with MRI to look
at the fluid collection seen previously and if still present,
to reinvolve orthopedics so that it can be decided whether
point tenderness along her old scar area of her thigh.
However, the patient continued to refuse MRI or any other
imaging given her severe diarrhea which developed in the last
few days.

2.  Abdominal wound:  Patient had spontaneous abdominal
drainage from her lower abdomen, thought to be not infected
but also upon culture grew staph aureus.  On [**5-2**] the patient
was taken to the OR by Dr. [**Last Name (STitle) 1180**] and closure was done of her
abdominal layers with two JP drains placed draining
serosanguineous fluid.  This also decreased over the next two
days and are ready for removal.  The patient had no abdominal
pain after surgery.  The patient was placed on Levofloxacin
on Thursday, [**4-30**], for coverage of her abdominal wound until
growth of the fluid culture, however, this was discontinued
on [**Last Name (LF) 228**], [**5-4**] because it was not necessary anymore and her
cultures grew Vancomycin sensitive organisms.

3.  GI:  The patient developed severe diarrhea on [**First Name3 (LF) 228**],
[**5-4**].  She was also complaining of chills.  White blood cell
count increased at that point to 15 and she had a low grade
temperature.  It was thought that her diarrhea may be
secondary to Clostridium difficile infection despite three
negative toxin assays, so she was started empirically on Flagyl
500 mg po tid and given Kaopectate.  Her diarrhea continued for
the next three days  until she received a dose of immodium
following a KUB study at the bedside that showed no evidence of
toxic megacolon. Her Levofloxacin was discontinued on
[**5-4**], and thought possibly to be related to the diarrhea.
Nutrition consult was requested and TPN may be
initiated.  The patient made npo.

3.  Anemia:  Patient with guaiac positive stools.  Hematocrit
was followed closely, at times [**Hospital1 **] and she did receive two
units of packed red blood cells on [**5-1**] as well as on [**5-6**].

4.  Decreased urine output:  Was reported to have decreased
output on the night between [**5-5**] and [**5-6**], likely prerenal
secondary to her severe diarrhea.  Urinalysis and urine
culture were checked and she was continued on IV fluids with
potassium repletion.




                          [**First Name11 (Name Pattern1) 970**] [**Last Name (NamePattern4) 971**], M.D.  [**MD Number(1) 972**]

Dictated By:[**Last Name (NamePattern1) 1875**]

MEDQUIST36

D:  [**2144-5-6**]  20:12
T:  [**2144-5-6**]  20:29
JOB#:  [**Job Number 1876**]


Admission Date:  [**2144-4-19**]       Discharge Date:

Date of Birth:                    Sex:  F

Service:  MEDICINE
ADDENDUM

HOSPITAL COURSE:

1.  INFECTIOUS DISEASE:  The patient continued on vancomycin
for treatment of Staphylococcus bacteremia, abscess and possible
 endocarditis.  The patient was also suffering from
diarrhea which appeared to resolve with loperamide after
three Clostridium difficile toxin ELISAs were obtained which
were negative.  In terms of the patient's left lateral thigh,
which appeared to be the source seen in the patient's
bloodstream with Staphylococcus aureus.  A pigtail catheter
placed on [**2144-4-28**] was discontinued after repeat ultrasound
interventional radiology.  Though the patient continues to
have some mild tenderness over the left lateral thigh and
continues to have demonstration of subcutaneous fluid, this
is felt to be non infectious and representative of edema.

2.  NUTRITION:  The patient received four days of TPN.  She
appeared to get mildly hypervolemic on TPN as she was also
taking her own.  She was also taking good po's.  This was
discontinued on [**2144-5-13**].

3.  PHYSICAL THERAPY:  The patient was seen again by PT and
OT on [**2144-5-12**].  She required maximal assists just to get out
of bed.  The determination was made that she was severely
deconditioned and would benefit from a stay in
rehabilitation.  Screening is ongoing.

4.  RHEUMATOLOGIC:  The patient continues on low dose of
maintenance prednisone for sarcoidosis.

DISCHARGE CONDITION:  Rehabilitation

DISCHARGE STATUS:  Stable

DISCHARGE DIAGNOSES:
1.  MSSA bacteremia secondary to left lateral thigh fluid
abscess, status post drainage.
2.  Cirrhosis complicated by esophageal varices.
3.  Sarcoidosis
4.  Multiple valvular disease, including moderate aortic
stenosis and 2+ mitral regurgitation.

DISCHARGE MEDICATIONS:
1.  Vancomycin 1 gm q 12 hours [**5-13**] represents day 24 of a 4
to 6 week course of vancomycin
2.  Colace 100 mg po bid
3.  Lopressor 12.5 mg po bid
4.  Prednisone 10 mg po qd
5.  Spironolactone 50 mg po bid
6.  Furosemide 10 mg po qd
7.  Betamethasone 0.1% topical [**Hospital1 **] prn
8.  Evista 60mg po qd
9.  Actigall 300 mg po tid

DISCHARGE FOLLOW UP:  The patient will follow up with her
primary care physician, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], in two weeks time and
with Dr. [**Last Name (STitle) 519**], her surgeon, on [**5-21**] for abdominal suture
removal.

                     DR.[**Last Name (STitle) **],[**First Name3 (LF) 4283**] 12-740


Dictated By:[**Name8 (MD) 2653**]
MEDQUIST36

D:  [**2144-5-13**]  08:18
T:  [**2144-5-13**]  08:45
JOB#:  [**Job Number 12571**]
1
1
1
R



Admission Date:  [**2144-5-14**]       Discharge Date:  [**2144-5-18**]

Date of Birth:                    Sex:  F

Service:  GENERAL SURGERY

ADDENDUM:

The patient was medically stable over this period of time
with no further medical events.  The patient was waiting for
a rehabilitation bed while insurance issues were worked out.
The plan for discharge is [**2144-5-18**] to rehabilitation.




                            [**First Name11 (Name Pattern1) 4283**] [**Last Name (NamePattern4) 4284**], M.D.  [**MD Number(1) 7551**]

Dictated By:[**Name8 (MD) 4575**]
MEDQUIST36

D:  [**2144-5-18**]  07:54
T:  [**2144-5-18**]  08:01
JOB#:  [**Job Number 14353**]
{'Other postoperative infection,Cellulitis and abscess of leg, except foot,Acute kidney failure, unspecified,Methicillin susceptible Staphylococcus aureus septicemia,Urinary tract infection, site not specified,Pulmonary collapse,Mitral valve insufficiency and aortic valve insufficiency,Acidosis'}


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: 

PRESENT ILLNESS: Mrs. [**Known lastname **] is a 62-year-old
female with a complicated medical history including
sarcoidosis, hepatic cirrhosis, Grade II esophageal varices,
hypertension, multiple orthopaedic procedures to her left
hip, right hip and right knee, who presented with left thigh
recently admitted to Surgery for ventral hernia repair, which
had caused an ileus and ascites, which required two
[**Location (un) 1661**]-[**Location (un) 1662**] drains.  These drains were recently removed.
The patient developed abdominal pain and diarrhea soon after.
The patient also developed left thigh pain.  The patient
reported that the pain worsened to the point where she was
unable to weight bear.  She denied any nausea, vomiting,
chills, feeling cold, and lightheadedness.  This prompted her
to present to the Emergency Department.

MEDICAL HISTORY: 1.  Sarcoidosis diagnosed in [**2137**], with pulmonary and hepatic
involvement, on chronic steroids
2.  Status post ventral hernia repair on [**2144-2-29**]
3.  History of cirrhosis diagnosed by CT in [**2143-10-31**]
with Grade II varices
4.  Status post right total hip replacement and right total
knee replacement
5.  Status post open reduction and internal fixation of her
left hip
6.  Osteoporosis
7.  Hypertension
8.  Choledocholithiasis
9.  Hypercholesterolemia
10. Aortic stenosis with ejection fraction of 55%
11. Status post total abdominal hysterectomy and bilateral
salpingo-oophorectomy

MEDICATION ON ADMISSION: Lasix 20 mg by mouth once daily,
Aldactone 15 mg twice a day, Actigall 300 mg three times a
day, Protonix 40 mg by mouth once daily, prednisone 10 mg by
mouth twice a day, Aleve 220 mg by mouth twice a day.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is divorced.  She lives with
her daughter. 

### Response:
{'Other postoperative infection,Cellulitis and abscess of leg, except foot,Acute kidney failure, unspecified,Methicillin susceptible Staphylococcus aureus septicemia,Urinary tract infection, site not specified,Pulmonary collapse,Mitral valve insufficiency and aortic valve insufficiency,Acidosis'}
