CHIEF COMPLAINT: transferred from OSH for Group A strep bacteremia and SIRS

PRESENT ILLNESS: 37 yo female w/ pmhx significant for tuberous sclerosis and
seizure disorder who was transferred to [**Hospital1 18**] for Group A strep
bacteremia and possible pneumonia, concern for impending ARDS.
The patient reports that she was feeling in her USH up until
Sunday ([**10-19**]) when she experienced fever, abdominal pain,
nausea and emesis. The pt continued to feel poorly and went to
the ED on Monday ([**10-20**]), where she was found to be febrile up
to 104 RR 24 and tachycardic HR 137. WBC with 10 K wbc and 11 %
bands. She had an abnormal UA c 5 wbc . CxR was nl. The pt was
admitted for IV antibiotics/ and hydration to treat possible
pneumonia/UTI .She was given Ceftriaxone and LEvofloxacin.
Patient remained persistently febrile and on [**10-21**] her
respiratory status worsened. She was subsequently transferred to
MICU for monitoring. Never intubated. Blood cultures from [**10-20**]
turned positive for Group A strep, and the patient was started
on Ceftriaxone/ Clinda/ and PCN G. Urine culture with gropu B
streptococcus. Non contrast abdominal CT revealed markedly
enlarged R kidney w/ numerous adipose tissue densities, no air
fluid levels/ gas present, enlarged spleen. ID consult was
obtained, and the etiology of strep A was undetermined. It was
recommended that she be started on IV Ig and possibly APC, and
an MRI be obtained to further characterize renal lesion.
.
On arrival the patient denies any difficulty breathing. Reports
some flank pain on the right. No N/V, no chest pain. + feeling
LH. Recent loose stools, denies blood in stool.
Denies hx of pharyngitis or skin infection, dysuria, no muscle
aches or joint pains, had a non productive cough, no headache,
n/v. No recent trauma, wounds, areas of skin breakdown
.

MEDICAL HISTORY: 1. tuberous sclerosis with involvement of left kidney resulting
in L nephrectomy due to hemorrhage at age 7.
2. seizure disorder
3. Gyne history- G1P1, LMP [**2127-10-13**].

MEDICATION ON ADMISSION: Ceftriaxone 1 gram IV BID
Clindamycin 900 mg IV q8
PCN 4 million units q 4h
tylenol 650 mg q 6h
Duo-Nebs
Lamictal 400 mg daily
Oxygen 4L NC

ALLERGIES: Tegretol

PHYSICAL EXAM: vitals: 100.4/ 137/84/ rr 35/ hr 98
GEN: awake, alert, sitting upright, mildly distressed
HEENT: anicteric, EOMI, dry mucosa, no pharyngeal exudate
NECK: no JVD, no LAD
CV: tachy, no murmurs, no rubs
LUNGS: rhonci B/L, decreased BS at bases, L>R
ABD: soft, mild distended, mild tenderness in RUQ, no rebound,
no organomegaly.  No flank tenderness
EXT: warm, dry.  Distal pulses full and equal B/L.  No obvious
rashes, areas of skin breakdown.  No LLE.
NEURO: A/O x3, no focal deficits, reflexes brisk and symmetric

FAMILY HISTORY: non contributory.

SOCIAL HISTORY: soc hx: Married, lives with husband and 6 year-old child. Works
as a secretary, no tobacco, rare ETOH, no illicits
.
Streptococcal septicemia,Pneumonia, organism unspecified,Urinary tract infection, site not specified,Acute respiratory failure,Acute kidney failure, unspecified,Tuberous sclerosis,Epilepsy, unspecified, without mention of intractable epilepsy,Severe sepsis
Streptococcal septicemia,Pneumonia, organism NOS,Urin tract infection NOS,Acute respiratry failure,Acute kidney failure NOS,Tuberous sclerosis,Epilep NOS w/o intr epil,Severe sepsis
Admission Date:  [**2127-10-22**]              Discharge Date:   [**2127-10-27**]

Date of Birth:  [**2090-4-22**]             Sex:   F

Service: MEDICINE

Allergies:
Tegretol

Attending:[**First Name3 (LF) 2159**]
Chief Complaint:
 transferred from OSH for Group A strep bacteremia and SIRS

Major Surgical or Invasive Procedure:
CVL placement [**10-24**]
PICC line placement


History of Present Illness:
37 yo female w/ pmhx significant for tuberous sclerosis and
seizure disorder who was transferred to [**Hospital1 18**] for Group A strep
bacteremia and possible pneumonia, concern for impending ARDS.
The patient reports that she was feeling in her USH up until
Sunday ([**10-19**]) when she experienced fever, abdominal pain,
nausea and emesis. The pt continued to feel poorly and went to
the ED on Monday ([**10-20**]), where she was found to be febrile up
to 104 RR 24 and tachycardic HR 137. WBC with 10 K wbc and 11 %
bands. She had an abnormal UA c 5 wbc . CxR was nl. The pt was
admitted for IV antibiotics/ and hydration to treat possible
pneumonia/UTI .She was given Ceftriaxone and LEvofloxacin.
Patient remained persistently febrile and on [**10-21**] her
respiratory status worsened. She was subsequently transferred to
MICU for monitoring. Never intubated. Blood cultures from [**10-20**]
turned positive for Group A strep, and the patient was started
on Ceftriaxone/ Clinda/ and PCN G. Urine culture with gropu B
streptococcus. Non contrast abdominal CT revealed markedly
enlarged R kidney w/ numerous adipose tissue densities, no air
fluid levels/ gas present, enlarged spleen. ID consult was
obtained, and the etiology of strep A was undetermined. It was
recommended that she be started on IV Ig and possibly APC, and
an MRI be obtained to further characterize renal lesion.
.
On arrival the patient denies any difficulty breathing. Reports
some flank pain on the right. No N/V, no chest pain. + feeling
LH. Recent loose stools, denies blood in stool.
Denies hx of pharyngitis or skin infection, dysuria, no muscle
aches or joint pains, had a non productive cough, no headache,
n/v. No recent trauma, wounds, areas of skin breakdown
.


Past Medical History:
1. tuberous sclerosis with involvement of left kidney resulting
in L nephrectomy due to hemorrhage at age 7.
2. seizure disorder
3. Gyne history- G1P1, LMP [**2127-10-13**].


Social History:
soc hx: Married, lives with husband and 6 year-old child. Works
as a secretary, no tobacco, rare ETOH, no illicits
.


Family History:
non contributory.

Physical Exam:
vitals: 100.4/ 137/84/ rr 35/ hr 98
GEN: awake, alert, sitting upright, mildly distressed
HEENT: anicteric, EOMI, dry mucosa, no pharyngeal exudate
NECK: no JVD, no LAD
CV: tachy, no murmurs, no rubs
LUNGS: rhonci B/L, decreased BS at bases, L>R
ABD: soft, mild distended, mild tenderness in RUQ, no rebound,
no organomegaly.  No flank tenderness
EXT: warm, dry.  Distal pulses full and equal B/L.  No obvious
rashes, areas of skin breakdown.  No LLE.
NEURO: A/O x3, no focal deficits, reflexes brisk and symmetric


Pertinent Results:
[**2127-10-22**] 09:58PM   WBC-6.2 RBC-3.48* HGB-9.9* HCT-28.6* MCV-82
MCH-28.6 MCHC-34.8 RDW-15.2
[**2127-10-22**] 09:58PM   GLUCOSE-113* UREA N-13 CREAT-1.2* SODIUM-135
POTASSIUM-4.1 CHLORIDE-107 TOTAL CO2-18* ANION GAP-14
[**2127-10-22**] 11:52PM URINE  RBC-0-2 WBC-<1 BACTERIA-NONE YEAST-NONE
EPI-0-2
[**2127-10-22**] 11:52PM URINE  UCG-NEGATIVE
[**2127-10-22**] 09:58PM   PT-11.9 PTT-25.8 INR(PT)-1.0
[**2127-10-22**] 09:58PM   RET AUT-0.7*
[**2127-10-22**] 09:58PM   PT-11.9 PTT-25.8 INR(PT)-1.0
[**2127-10-22**] 09:58PM   PLT SMR-NORMAL PLT COUNT-180
[**2127-10-22**] 09:58PM   HYPOCHROM-NORMAL ANISOCYT-1+ POIKILOCY-1+
MACROCYT-OCCASIONAL MICROCYT-1+ POLYCHROM-OCCASIONAL BURR-1+
[**2127-10-22**] 09:58PM   NEUTS-81.4* BANDS-0 LYMPHS-15.6* MONOS-2.0
EOS-0.4 BASOS-0.6
[**2127-10-22**] 09:58PM   WBC-6.2 RBC-3.48* HGB-9.9* HCT-28.6* MCV-82
MCH-28.6 MCHC-34.8 RDW-15.2
[**2127-10-22**] 09:58PM   ALBUMIN-2.5* CALCIUM-7.7* PHOSPHATE-2.1*
MAGNESIUM-1.5* URIC ACID-5.2
[**2127-10-22**] 09:58PM   LIPASE-18
[**2127-10-22**] 09:58PM   ALT(SGPT)-87* AST(SGOT)-45* LD(LDH)-341*
CK(CPK)-71 ALK PHOS-114 AMYLASE-38 TOT BILI-0.5
[**2127-10-22**] 09:58PM   GLUCOSE-113* UREA N-13 CREAT-1.2* SODIUM-135
POTASSIUM-4.1 CHLORIDE-107 TOTAL CO2-18* ANION GAP-14
[**2127-10-22**] 11:52PM URINE  RBC-0-2 WBC-<1 BACTERIA-NONE YEAST-NONE
EPI-0-2
[**2127-10-22**] 11:52PM URINE  BLOOD-MOD NITRITE-NEG PROTEIN-100
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2127-10-22**] 11:52PM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.014
[**2127-10-22**] 11:52PM URINE  UCG-NEGATIVE
[**2127-10-22**] 11:52PM URINE  HOURS-RANDOM CREAT-56 SODIUM-91
[**2127-10-22**] 11:52PM URINE  HOURS-RANDOM

CXR:
 Bilateral pulmonary infiltrates consistent with pneumonia.
Interval improvement on the right.  Persistent left effusion.

US kidneys:
1.  Grossly deformed and enlarged right kidney due to the
presence of multiple
AMLs. The largest is at the upper pole measuring over 11 cm but
showing no
signs of hemorrhage.  In the middle third of the right kidney,
there is an
indeterminate lesion measuring 4.3 cm.  This may be a somewhat
lipid poor AML
but further evaluation is recommended with MRI to exclude
possible renal cell
carcinoma, since we have no other studies for comparison.

Small bilateral effusions and status post left nephrectomy.

ECHO:
The left atrium is mildly dilated. The interatrial septum is
aneurysmal, and  there is right-to-left flow of saline contrast,
indicating a patent foramen  ovale. Left ventricular wall
thickness, cavity size, and systolic function are  normal
(LVEF>55%). Regional left ventricular wall motion is normal.
Right  ventricular chamber size and free wall motion are normal.
The aortic valve  leaflets (3) appear structurally normal with
good leaflet excursion and no  aortic regurgitation. No masses
or vegetations are seen on the aortic valve.  The mitral valve
leaflets are structurally normal. There is no mitral valve
prolapse. No mass or vegetation is seen on the mitral valve.
Mild (1+) mitral regurgitation is seen. The estimated pulmonary
artery systolic pressure is  normal. There is a
trivial/physiologic pericardial effusion.

IMPRESSION: No evidence of endocarditis. Normal global and
regional
biventricular systolic function. Patent foramen ovale.


Brief Hospital Course:
Assessment/Plan:
36 yo F with tuberous sclerosis presents with Group A Strep
bacteremia, sepsis now resolved.
.
# Bacteremia: Unclear the source of her Strep A group
bacteremia, echo without vegatations. Pt will need to continue
Pen G. Has PICC line placed. will continue PCN 4 MU IV Q4H for
coverage for 14 days total.
.
# Hypoxia: Patient hypoxic on admission, requiring NRB to
maintain O2 sats. Likely due to paneumonia or early ARDS. was
put on albuterol/ atrovent nebs. was weaned off O2. was satting
well on RA at discharge
.
# Renal CT scan findings: pt w/ fatty infiltrate on CT scan
(w/out contrast) from OSH. Reviewed w/ our radiologists, who
believed the fatty infiltrate likely represents angiomyolipoma,
c/w her h/o tuberous sclerosis. Could get MRI for further
imaging as outpatient
.
# H/o Seizure d/o: continued home lamotrigine
.
# Proph: pneumoboots, SC Heparin
.
# F/E/N: ADAT, moniter and replete lytes PRN


Medications on Admission:
Ceftriaxone 1 gram IV BID
Clindamycin 900 mg IV q8
PCN 4 million units q 4h
tylenol 650 mg q 6h
Duo-Nebs
Lamictal 400 mg daily
Oxygen 4L NC


Discharge Medications:
1. Heparin Lock Flush (Porcine) 100 unit/mL Syringe Sig: One (1)
ML Intravenous  DAILY (Daily) as needed.
Disp:*30 ML(s)* Refills:*0*
2. Heparin Lock Flush (Porcine) 100 unit/mL Syringe Sig: Two (2)
ML Intravenous  DAILY (Daily) as needed.
Disp:*30 ML(s)* Refills:*0*
3. Penicillin G Potassium 20,000,000 unit Recon Soln Sig: One
(1) 4 million units Injection Q4H (every 4 hours) for 8 days.
Disp:*48 doses* Refills:*0*
4. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q4-6H
(every 4 to 6 hours) as needed for fever.
5. Lamotrigine 100 mg Tablet Sig: Four (4) Tablet PO DAILY
(Daily).


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 511**] Home Health Services

Discharge Diagnosis:
Group A streptococcus bacteremia
.
Secondary
Tuberous sclerosis
Seizure disorder


Discharge Condition:
Stable


Discharge Instructions:
Please take all mediations as prescribed.
.
Please take the antibiotic through the PICC line for the next 8
days.
.
If you have fever, cough, chest pain, rigors, nausea, vomitting,
pain in abdomen please call your primary care physcian or fo to
the emergency room


Followup Instructions:
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], RN Phone:[**Telephone/Fax (1) 876**]
Date/Time:[**2127-12-30**] 11:00
Provider: [**Last Name (NamePattern4) **]. [**Last Name (STitle) 11347**] [**Name (STitle) **] Phone:[**Telephone/Fax (1) 857**]
Date/Time:[**2128-9-30**] 9:45
.
Please make a follow up appointment with your primary care
physician Dr [**Last Name (STitle) 16583**] ([**Telephone/Fax (1) 16584**]) within 2 weeks of
discharge
.
Patient needs a follow up abdomian MRI within 1 month to
evaluate her renal lesions (suspected angiomyolipoma)
.
Patinet was guaiac positive in the hospital but the hematocrit
was stable. She will need colonoscopy as an outpatient
.
Patinet will also need endocarditis prophylaxis befoe undergoing
any minor or major surgical procedure as patinet has patent
foramen ovale.
.
Please check Iron studies.
.



Completed by:[**2127-10-28**]
{'Streptococcal septicemia,Pneumonia, organism unspecified,Urinary tract infection, site not specified,Acute respiratory failure,Acute kidney failure, unspecified,Tuberous sclerosis,Epilepsy, unspecified, without mention of intractable epilepsy,Severe sepsis'}


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: transferred from OSH for Group A strep bacteremia and SIRS

PRESENT ILLNESS: 37 yo female w/ pmhx significant for tuberous sclerosis and
seizure disorder who was transferred to [**Hospital1 18**] for Group A strep
bacteremia and possible pneumonia, concern for impending ARDS.
The patient reports that she was feeling in her USH up until
Sunday ([**10-19**]) when she experienced fever, abdominal pain,
nausea and emesis. The pt continued to feel poorly and went to
the ED on Monday ([**10-20**]), where she was found to be febrile up
to 104 RR 24 and tachycardic HR 137. WBC with 10 K wbc and 11 %
bands. She had an abnormal UA c 5 wbc . CxR was nl. The pt was
admitted for IV antibiotics/ and hydration to treat possible
pneumonia/UTI .She was given Ceftriaxone and LEvofloxacin.
Patient remained persistently febrile and on [**10-21**] her
respiratory status worsened. She was subsequently transferred to
MICU for monitoring. Never intubated. Blood cultures from [**10-20**]
turned positive for Group A strep, and the patient was started
on Ceftriaxone/ Clinda/ and PCN G. Urine culture with gropu B
streptococcus. Non contrast abdominal CT revealed markedly
enlarged R kidney w/ numerous adipose tissue densities, no air
fluid levels/ gas present, enlarged spleen. ID consult was
obtained, and the etiology of strep A was undetermined. It was
recommended that she be started on IV Ig and possibly APC, and
an MRI be obtained to further characterize renal lesion.
.
On arrival the patient denies any difficulty breathing. Reports
some flank pain on the right. No N/V, no chest pain. + feeling
LH. Recent loose stools, denies blood in stool.
Denies hx of pharyngitis or skin infection, dysuria, no muscle
aches or joint pains, had a non productive cough, no headache,
n/v. No recent trauma, wounds, areas of skin breakdown
.

MEDICAL HISTORY: 1. tuberous sclerosis with involvement of left kidney resulting
in L nephrectomy due to hemorrhage at age 7.
2. seizure disorder
3. Gyne history- G1P1, LMP [**2127-10-13**].

MEDICATION ON ADMISSION: Ceftriaxone 1 gram IV BID
Clindamycin 900 mg IV q8
PCN 4 million units q 4h
tylenol 650 mg q 6h
Duo-Nebs
Lamictal 400 mg daily
Oxygen 4L NC

ALLERGIES: Tegretol

PHYSICAL EXAM: vitals: 100.4/ 137/84/ rr 35/ hr 98
GEN: awake, alert, sitting upright, mildly distressed
HEENT: anicteric, EOMI, dry mucosa, no pharyngeal exudate
NECK: no JVD, no LAD
CV: tachy, no murmurs, no rubs
LUNGS: rhonci B/L, decreased BS at bases, L>R
ABD: soft, mild distended, mild tenderness in RUQ, no rebound,
no organomegaly.  No flank tenderness
EXT: warm, dry.  Distal pulses full and equal B/L.  No obvious
rashes, areas of skin breakdown.  No LLE.
NEURO: A/O x3, no focal deficits, reflexes brisk and symmetric

FAMILY HISTORY: non contributory.

SOCIAL HISTORY: soc hx: Married, lives with husband and 6 year-old child. Works
as a secretary, no tobacco, rare ETOH, no illicits
. 

### Response:
{'Streptococcal septicemia,Pneumonia, organism unspecified,Urinary tract infection, site not specified,Acute respiratory failure,Acute kidney failure, unspecified,Tuberous sclerosis,Epilepsy, unspecified, without mention of intractable epilepsy,Severe sepsis'}
