CHIEF COMPLAINT: Fevers, chills, abdominal pain

PRESENT ILLNESS: 43 yo F, neurologist at [**Hospital1 18**] with PMH of systemic lupus
erythematosus with leukopenia, positive anticardiolipin
antibodies, recurrent UTIs, who presents with fever, rigors, and
abdominal pain.
.
Patient reports that two nights prior to admission, she
developed a diffuse left lower abdominal pain at dinner time.
She initially thought it was due to constipation. The pain did
not radiate anywhere. However, she then developed subjective
fever, shaking chills, nightsweats, dizziness, fatigue, and
nausea. The pain improved somewhat by the following morning and
she went to work, only to realize that she was feeling more ill
and thus presented to the ED. Patient denied dysuria, hematuria,
blood in the stool. No cough, headache, vomiting, or diarrhea.
Of note, she had similar abdominal pain two weeks ago which
spontaneously resolved.
.
In the ED, initial vs were: T:103.5 HR:116 BP:137/88 RR:20
O2at:98% RA. Labs were notable for a marked leukocytosis to 7.2
(baseline wbc 1.5-2 from SLE) with 51% bands, mild hyponatremia
of 132, lactate of 2.9, and anemia with Hct of 34.8 compared to
recent baseline of ~37. Urinanalysis notable for large leuks,
125 wbc, and few bacteria. CT abdomen/pelvis showed left
proximal ureteric stone with mild hydronephrosis on ultrasound.
Patient was given Levofloxacin 750 mg x1, zosyn 4.5 g x1,
acetaminophen 1000 mg x2. Received a total of 3 liters of IVF.
Urology was consulted and recommended percutaneous nephrostomy
tube versus ureteral stent, and patient chose the former.
Interventional radiology was consulted and patient taken to OR
for placement of nephrostomy tube. Prior to leaving the ED, Tm
was 103.5 with BP 138/80.
.
Patient arrived at the ICU shortly after palcement of the
percutaneous nephrostomy tube. She was alert and oriented,
expressing [**4-26**] pain, tachycardic to the 120s, hypertensive to
the 160s, and in some mild discomfort.

MEDICAL HISTORY: - Systemic lupus erythematosus: leukopenia main symptom
- Positive anticardiolipin antibodies with postpartum DVT (off
coumadin for years)
- Mastitis
- Recurrent UTIs (Proteus: pan-sensitive, E. Coli: sensitive to
Zosyn)
- Mild depression

MEDICATION ON ADMISSION: - Citalopram 10 mg po qd
- Hydroxychloroquine 400 mg po qd
- Imipramine 25 mg po qd
- Vitamin D2 1000 units capsule qd
- Kenalog in orabase 0.1 % Paste - apply thin layer to affected
areas three times a day

ALLERGIES: Sulfa (Sulfonamide Antibiotics)

PHYSICAL EXAM: Vitals: T: 100.6 BP:167/103 P:112 R:26 O2:98% RA
General: Alert, oriented, notably uncomfortable
HEENT: Sclera anicteric, MM dry, oropharynx clear
Neck: supple, no LAD
Lungs: Bibasilar crackles, no wheeze
CV: Tachycardic and regular, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: +bs, soft, tender on palpation, non-distended, slight
guarding
GU: left percutaneous nephrostomy tube with bag attached,
draining clear serosanguinous fluid
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CN 2- 12 grossly intact. Alert and oriented.

FAMILY HISTORY: The patient's grandfather had a diagnosis of rheumatoid
arthritis. There is a paternal aunt with a history of mixed
connective tissue disease.

SOCIAL HISTORY: Neurologist at [**Hospital1 18**]. Married with two kids and lives with
family.
- alcohol: none
- tobacco: none
- illicits: none
Other septicemia due to gram-negative organisms,Thrombocytopenia, unspecified,Hyposmolality and/or hyponatremia,Systemic lupus erythematosus,Hydronephrosis,Acute pyelonephritis without lesion of renal medullary necrosis,Calculus of ureter,Sepsis,Depressive disorder, not elsewhere classified,Anemia, unspecified
Gram-neg septicemia NEC,Thrombocytopenia NOS,Hyposmolality,Syst lupus erythematosus,Hydronephrosis,Ac pyelonephritis NOS,Calculus of ureter,Sepsis,Depressive disorder NEC,Anemia NOS
Admission Date:  [**2178-6-18**]              Discharge Date:   [**2178-6-22**]

Date of Birth:  [**2134-12-26**]             Sex:   F

Service: MEDICINE

Allergies:
Sulfa (Sulfonamide Antibiotics)

Attending:[**Last Name (NamePattern4) 290**]
Chief Complaint:
Fevers, chills, abdominal pain


Major Surgical or Invasive Procedure:
Percutaneous nephrostomy tube placement

History of Present Illness:
43 yo F, neurologist at [**Hospital1 18**] with PMH of systemic lupus
erythematosus with leukopenia, positive anticardiolipin
antibodies, recurrent UTIs, who presents with fever, rigors, and
abdominal pain.
.
Patient reports that two nights prior to admission, she
developed a diffuse left lower abdominal pain at dinner time.
She initially thought it was due to constipation. The pain did
not radiate anywhere. However, she then developed subjective
fever, shaking chills, nightsweats, dizziness, fatigue, and
nausea. The pain improved somewhat by the following morning and
she went to work, only to realize that she was feeling more ill
and thus presented to the ED. Patient denied dysuria, hematuria,
blood in the stool. No cough, headache, vomiting, or diarrhea.
Of note, she had similar abdominal pain two weeks ago which
spontaneously resolved.
.
In the ED, initial vs were: T:103.5 HR:116 BP:137/88 RR:20
O2at:98% RA. Labs were notable for a marked leukocytosis to 7.2
(baseline wbc 1.5-2 from SLE) with 51% bands, mild hyponatremia
of 132, lactate of 2.9, and anemia with Hct of 34.8 compared to
recent baseline of ~37. Urinanalysis notable for large leuks,
125 wbc, and few bacteria. CT abdomen/pelvis showed left
proximal ureteric stone with mild hydronephrosis on ultrasound.
Patient was given Levofloxacin 750 mg x1, zosyn 4.5 g x1,
acetaminophen 1000 mg x2. Received a total of 3 liters of IVF.
Urology was consulted and recommended percutaneous nephrostomy
tube versus ureteral stent, and patient chose the former.
Interventional radiology was consulted and patient taken to OR
for placement of nephrostomy tube. Prior to leaving the ED, Tm
was 103.5 with BP 138/80.
.
Patient arrived at the ICU shortly after palcement of the
percutaneous nephrostomy tube. She was alert and oriented,
expressing [**4-26**] pain, tachycardic to the 120s, hypertensive to
the 160s, and in some mild discomfort.


Past Medical History:
- Systemic lupus erythematosus: leukopenia main symptom
- Positive anticardiolipin antibodies with postpartum DVT (off
coumadin for years)
- Mastitis
- Recurrent UTIs (Proteus: pan-sensitive, E. Coli: sensitive to
Zosyn)
- Mild depression


Social History:
Neurologist at [**Hospital1 18**]. Married with two kids and lives with
family.
- alcohol: none
- tobacco: none
- illicits: none


Family History:
The patient's grandfather had a diagnosis of rheumatoid
arthritis. There is a paternal aunt with a history of mixed
connective tissue disease.


Physical Exam:
Vitals: T: 100.6 BP:167/103 P:112 R:26 O2:98% RA
General: Alert, oriented, notably uncomfortable
HEENT: Sclera anicteric, MM dry, oropharynx clear
Neck: supple, no LAD
Lungs: Bibasilar crackles, no wheeze
CV: Tachycardic and regular, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: +bs, soft, tender on palpation, non-distended, slight
guarding
GU: left percutaneous nephrostomy tube with bag attached,
draining clear serosanguinous fluid
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CN 2- 12 grossly intact. Alert and oriented.

Physical exam on Day of Discharge
VS T99.8F, BP 157/106, HR 101
General: Alert, oriented, sweaty, sitting up in chair working on
computer
HEENT: Sclera anicteric, MM dry, oropharynx clear
Neck: supple, no LAD
Lungs: Moving air appropriately, bibasilar crackles
CV: Tachycardic and regular, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: +bs, soft, minimal tenderness to palpation,
non-distended
GU: left percutaneous nephrostomy tube with bag attached,
draining clear yellow urine
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema


Pertinent Results:
1. Labs on admission:
[**2178-6-18**] 03:23PM BLOOD WBC-7.2# RBC-4.03* Hgb-11.9* Hct-34.8*
MCV-86 MCH-29.5 MCHC-34.2 RDW-12.5 Plt Ct-169
[**2178-6-18**] 03:23PM BLOOD Neuts-71* Bands-6* Lymphs-12* Monos-6
Eos-0 Baso-0 Atyps-5* Metas-0 Myelos-0
[**2178-6-18**] 03:23PM BLOOD PT-13.9* PTT-27.9 INR(PT)-1.2*
[**2178-6-18**] 03:23PM BLOOD Glucose-113* UreaN-14 Creat-1.1 Na-132*
K-3.5 Cl-96 HCO3-25 AnGap-15
[**2178-6-18**] 03:23PM BLOOD ALT-29 AST-30 AlkPhos-60 TotBili-0.5
[**2178-6-18**] 03:23PM BLOOD Lipase-16
[**2178-6-18**] 03:23PM BLOOD Albumin-4.2 Calcium-8.9 Phos-3.2 Mg-1.7
[**2178-6-19**] 09:41AM BLOOD PTH-125*
.
2. Labs on discharge:
[**2178-6-20**] 01:16AM BLOOD Fibrino-911*#
[**2178-6-20**] 01:16AM BLOOD Ret Aut-1.4
[**2178-6-20**] 01:16AM BLOOD Hapto-330*
[**2178-6-19**] 09:41AM BLOOD PTH-125*
.
3. Imaging/diagnostics:
- CXR ([**2178-6-18**]): No acute intrathoracic process.
.
- Renal ultrasound ([**2178-6-18**]): Mild left hydronephrosis, source
not identified on this study.
.
- CT abdomen/pelvis ([**2178-6-18**]):  7 x 4 mm proximal to mid left
ureteral stone with mild to moderate left hydronephrosis and
left perinephric stranding. 2-3 mm stone in the inferior pole of
the left kidney.
.
- Interventional radiology ([**2178-6-18**]): 1. Mild-moderate-left-sided
hydronephrosis. 2. Only a small amount of contrast was injected
confirming location, and to minimize distension given the
patient's symptoms. However, no obvious contrast flow was seen
beyond the proximal ureter, corresponding to the site of
ureteral calculus obstruction seen on the CT scan. 3. Successful
placement of an 8 French locking pigtail nephrostomy catheter
within the left renal pelvis.
IMPRESSION: Successful placement of an 8 French locking
nephrostomy catheter within the left renal pelvis. The catheter
was attached to external bag drainage.

MICROBIOLOGY
[**2178-6-18**]
- URINE CULTURE (Final [**2178-6-20**]):
      PROTEUS MIRABILIS.    >100,000 ORGANISMS/ML..
         PRESUMPTIVE IDENTIFICATION.
         Piperacillin/tazobactam sensitivity testing available
on request.
                              SENSITIVITIES: MIC expressed in
MCG/ML
_________________________________________________________
                             PROTEUS MIRABILIS
                             |
AMPICILLIN------------   <=2 S
AMPICILLIN/SULBACTAM--   <=2 S
CEFAZOLIN-------------   <=4 S
CEFEPIME--------------   <=1 S
CEFTAZIDIME-----------   <=1 S
CEFTRIAXONE-----------   <=1 S
CIPROFLOXACIN---------<=0.25 S
GENTAMICIN------------   <=1 S
MEROPENEM-------------<=0.25 S
TOBRAMYCIN------------   <=1 S
TRIMETHOPRIM/SULFA----   <=1 S

- Blood Culture, Routine (Final [**2178-6-21**]):
      PROTEUS MIRABILIS.    FINAL SENSITIVITIES.
         Piperacillin/Tazobactam sensitivity testing confirmed
by [**First Name8 (NamePattern2) 3077**]
         [**Last Name (NamePattern1) 3060**].
      STAPHYLOCOCCUS, COAGULASE NEGATIVE.
         Isolated from only one set in the previous five days.
         SENSITIVITIES PERFORMED ON REQUEST..
                              SENSITIVITIES: MIC expressed in
MCG/ML
_________________________________________________________
                             PROTEUS MIRABILIS
                             |
AMPICILLIN------------   <=2 S
AMPICILLIN/SULBACTAM--   <=2 S
CEFAZOLIN-------------   <=4 S
CEFEPIME--------------   <=1 S
CEFTAZIDIME-----------   <=1 S
CEFTRIAXONE-----------   <=1 S
CIPROFLOXACIN---------<=0.25 S
GENTAMICIN------------   <=1 S
MEROPENEM-------------<=0.25 S
PIPERACILLIN/TAZO-----   <=4 S
TOBRAMYCIN------------   <=1 S
TRIMETHOPRIM/SULFA----   <=1 S

   Anaerobic Bottle Gram Stain (Final [**2178-6-19**]):
      GRAM NEGATIVE ROD(S).
      Reported to and read back by [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 27795**] (4I) @
8:06AM [**2178-6-19**].

   Aerobic Bottle Gram Stain (Final [**2178-6-19**]):
      GRAM POSITIVE COCCI IN CLUSTERS.
      Reported to and read back by PEI [**Doctor Last Name **] ([**Numeric Identifier 27796**]) [**2178-6-19**]
@1600.

Brief Hospital Course:
43 yo F with systemic lupus erythematosus with leukopenia,
recurrent UTIs, presents with high fevers and abdominal pain,
found to have infected ureteral calculus, now s/p percutaneous
nephrostomy tube placement, hemodynamically stable.

# Pyelonephritis/sepsis: On admission, patient had high fevers,
chills, leukocytosis with bandemia. CT abdomen showed left
proximal ureteric stone with mild hydronephrosis. Urology was
consulted and IR placed a percutaneous nephrostomy tube. Blood
cultures grew out pan-sensitive Proteus and urine culture grew
pan-sensitive Proteus. Patient initially treated with
Pipercillin-tazobactam and then transitioned to ciprofloxacin
after sensisitivities came out. She remained hemodynamically
stable throughout. Urology plans on stone removal 1-2 weeks
after resolution of fevers.  She will continue with
ciprofloxacin in the outpatient setting for a total of 14 days.

# Anemia: Hct 34.8 on admission compared to recent baseline of
39.5. No obvious hematuria and signs or symptoms to suggest
hematoma around the nephrostomy site.  This can be followed in
the outpatient setting.

# Thrombocytopenia: Platelet count dropped from 169 k -> 59 k
during the first two days of admission. Unlikely to be HIT but
heparin stopped nevertheless and patient placed on fondaparinux
given positive anticardiolipin antiboties. DIC labs were
negative. Platelet count recovered prior to discharge.

# Systemic lupus erythematosus: Diagnosed in [**2171**] when she
presented with repeated bounts of leukopenia (baseline WBC 1.5 -
2) during pregnancy as well as spontaneous DVTs. Followed
closely by Dr. [**First Name5 (NamePattern1) 9619**] [**Last Name (NamePattern1) 9620**] in Rhematology at [**Hospital1 18**].
Continued on hydroxxhloroquine 400 mg po qd while inpatient.

# Depression: Stable. Continue home medication Citalopram 10 mg
po qd.

Medications on Admission:
- Citalopram 10 mg po qd
- Hydroxychloroquine 400 mg po qd
- Imipramine 25 mg po qd
- Vitamin D2 1000 units capsule qd
- Kenalog in orabase 0.1 % Paste - apply thin layer to affected
areas three times a day


Discharge Medications:
1. hydroxychloroquine 200 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
2. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for pain.
3. ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours) for 14 days.
Disp:*28 Tablet(s)* Refills:*0*
4. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day: to
reduce risk of constipation while also using narcotics.
Disp:*60 Capsule(s)* Refills:*2*
5. citalopram 10 mg Tablet Sig: One (1) Tablet PO once a day.
6. Vitamin D 1,000 unit Capsule Sig: One (1) Capsule PO once a
day.
7. Percocet 5-325 mg Tablet Sig: 1-2 Tablets PO every six (6)
hours as needed for pain.
Disp:*45 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
PRIMARY DIAGNOSIS:
Pyelonephritis
Nephrolithiasis (infected stone)
Anemia
Thrombocytopenia
Hyponatremia

SECONDARY DIAGNOSES:
Systemic lupus erythematosus
Depression


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Dear Dr. [**Known lastname 6817**], you were admitted to the [**Hospital3 **] Medical
Center because you had fevers, chills, and abdominal pain. We
found that you had a kidney stone which was infected. We placed
a nephrostomy tube to decompress the kidney. You got antibiotics
to treat the infection in your blood and urine.

Please also see the additional NEPHROSTOMY TUBE CARE
INSTRUCTIONS provided by nursing AND the instructions provided
by interventional radiology for you and VNA.
DISCHARGE INSTRUCTIONS
--No vigorous physical activity for 2 weeks AND while tube is in
place

-Expect to see occasional blood in your urine and to experience
some minimal urgency and frequency over the next month.

-The kidney stone/fragments may still be in the process of
passing.

-You may experience some pain associated with spasm of your
ureter. This is normal. Take the narcotic pain medication as
prescribed if additional pain relief is needed.

-Tylenol should be your first line pain medication, a narcotic
pain medication has beenprescribed for breakthrough pain >4.
Replace Tylenol with narcotic pain medication.

-Max daily Tylenol (acetaminophen) dose is 4 grams from ALL
sources, note that narcotic pain medication also contains
Tylenol

-Make sure you drink plenty of fluids to help keep yourself
hydrated and facilitate passage of stone fragments.

-You may shower but do NOT bathe or immerse in water.

-Do not drive or drink alcohol while taking narcotics or operate
dangerous machinery

-Colace has been prescribed to avoid post surgical constipation
and constipation related tonarcotic pain medication. Discontinue
if loose stool or diarrhea develops.  Colace is a stool
softener, NOT a laxative

-Resume your pre-admission medications, unless otherwise noted.

-DO NOT use ASPIRIN or NSAIDs unless cleared by Dr. [**Last Name (STitle) 770**]

-Call your urologist??????s office for follow-up AND if you have any
questions.

-You may have been given a course of antibiotics--please
complete the course as instructed (two week course of
Ciprofloxacin)

Followup Instructions:
Please make an appointment and follow-up with [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) 770**],MD, who Dr. [**Last Name (STitle) **] [**Last Name (STitle) **] recommended in his absence. Dr.
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 770**] may be reached via [**First Name8 (NamePattern2) 2147**] [**Last Name (NamePattern1) **], administrative
assistant, at [**Telephone/Fax (1) 164**]. He will gladly speak with you by
telephone and has informed Ms. [**Name13 (STitle) **] of such.

You must make arrangements to have your stone treated and tube
managed. This should arranged within the next 1-2 weeks time.

Dr. [**Last Name (STitle) **] [**First Name (STitle) **] be reached at [**Telephone/Fax (1) 921**].

You also have the following appointment listed as upcoming:
Department: RHEUMATOLOGY
When: THURSDAY [**2178-9-3**] at 9:30 AM
With: [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **], MD [**Telephone/Fax (1) 2226**]
Building: LM [**Hospital Ward Name **] Bldg ([**Last Name (NamePattern1) **]) [**Location (un) 861**]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage


                             [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**]

Completed by:[**2178-6-22**]
{'Other septicemia due to gram-negative organisms,Thrombocytopenia, unspecified,Hyposmolality and/or hyponatremia,Systemic lupus erythematosus,Hydronephrosis,Acute pyelonephritis without lesion of renal medullary necrosis,Calculus of ureter,Sepsis,Depressive disorder, not elsewhere classified,Anemia, unspecified'}


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: Fevers, chills, abdominal pain

PRESENT ILLNESS: 43 yo F, neurologist at [**Hospital1 18**] with PMH of systemic lupus
erythematosus with leukopenia, positive anticardiolipin
antibodies, recurrent UTIs, who presents with fever, rigors, and
abdominal pain.
.
Patient reports that two nights prior to admission, she
developed a diffuse left lower abdominal pain at dinner time.
She initially thought it was due to constipation. The pain did
not radiate anywhere. However, she then developed subjective
fever, shaking chills, nightsweats, dizziness, fatigue, and
nausea. The pain improved somewhat by the following morning and
she went to work, only to realize that she was feeling more ill
and thus presented to the ED. Patient denied dysuria, hematuria,
blood in the stool. No cough, headache, vomiting, or diarrhea.
Of note, she had similar abdominal pain two weeks ago which
spontaneously resolved.
.
In the ED, initial vs were: T:103.5 HR:116 BP:137/88 RR:20
O2at:98% RA. Labs were notable for a marked leukocytosis to 7.2
(baseline wbc 1.5-2 from SLE) with 51% bands, mild hyponatremia
of 132, lactate of 2.9, and anemia with Hct of 34.8 compared to
recent baseline of ~37. Urinanalysis notable for large leuks,
125 wbc, and few bacteria. CT abdomen/pelvis showed left
proximal ureteric stone with mild hydronephrosis on ultrasound.
Patient was given Levofloxacin 750 mg x1, zosyn 4.5 g x1,
acetaminophen 1000 mg x2. Received a total of 3 liters of IVF.
Urology was consulted and recommended percutaneous nephrostomy
tube versus ureteral stent, and patient chose the former.
Interventional radiology was consulted and patient taken to OR
for placement of nephrostomy tube. Prior to leaving the ED, Tm
was 103.5 with BP 138/80.
.
Patient arrived at the ICU shortly after palcement of the
percutaneous nephrostomy tube. She was alert and oriented,
expressing [**4-26**] pain, tachycardic to the 120s, hypertensive to
the 160s, and in some mild discomfort.

MEDICAL HISTORY: - Systemic lupus erythematosus: leukopenia main symptom
- Positive anticardiolipin antibodies with postpartum DVT (off
coumadin for years)
- Mastitis
- Recurrent UTIs (Proteus: pan-sensitive, E. Coli: sensitive to
Zosyn)
- Mild depression

MEDICATION ON ADMISSION: - Citalopram 10 mg po qd
- Hydroxychloroquine 400 mg po qd
- Imipramine 25 mg po qd
- Vitamin D2 1000 units capsule qd
- Kenalog in orabase 0.1 % Paste - apply thin layer to affected
areas three times a day

ALLERGIES: Sulfa (Sulfonamide Antibiotics)

PHYSICAL EXAM: Vitals: T: 100.6 BP:167/103 P:112 R:26 O2:98% RA
General: Alert, oriented, notably uncomfortable
HEENT: Sclera anicteric, MM dry, oropharynx clear
Neck: supple, no LAD
Lungs: Bibasilar crackles, no wheeze
CV: Tachycardic and regular, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: +bs, soft, tender on palpation, non-distended, slight
guarding
GU: left percutaneous nephrostomy tube with bag attached,
draining clear serosanguinous fluid
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CN 2- 12 grossly intact. Alert and oriented.

FAMILY HISTORY: The patient's grandfather had a diagnosis of rheumatoid
arthritis. There is a paternal aunt with a history of mixed
connective tissue disease.

SOCIAL HISTORY: Neurologist at [**Hospital1 18**]. Married with two kids and lives with
family.
- alcohol: none
- tobacco: none
- illicits: none 

### Response:
{'Other septicemia due to gram-negative organisms,Thrombocytopenia, unspecified,Hyposmolality and/or hyponatremia,Systemic lupus erythematosus,Hydronephrosis,Acute pyelonephritis without lesion of renal medullary necrosis,Calculus of ureter,Sepsis,Depressive disorder, not elsewhere classified,Anemia, unspecified'}
