CHIEF COMPLAINT: necrotic pancreatitis

PRESENT ILLNESS: Ms [**Known lastname **] is a 70 y.o. woman with a history of COPD, EtOH
abuse, pancreas divisum & pancreatitis, and hemochromatosis who
presented to [**Hospital3 **] on [**2128-1-13**] with abdominal pain,
nausea, vomiting, WBC 19, and amylase of 3815.  She was
diagnosed
with acute alcoholic pancreatitis. She was made NPO and started
on IVF. On presentation, she was "very uncomfortable", but
alert,
oriented and able to relay a coherent history.During HD#1, her
BP dropped to the 80s systolic and a dopamine drip was started.
She was also started on Zosyn. She started to become more
lethargic and less communicative during the first 24 hours of
her
hospitalization (which her family attributed to pain meds).
Then,
on [**1-14**] she had an ABG with pH 7.20, pCO2 60. Pt was then sedated
and intubated for acidosis/respiratory failure. Abdominal CT
showed pancreatic necrosis and she was transferred to [**Hospital1 18**] on
[**1-15**] for further management.

MEDICAL HISTORY: PMH:
1. pancreatitis with pancreas divisum
2. EtOH abuse
3. GERD
4. Htn
5. Hemachromatosis
6. COPD

MEDICATION ON ADMISSION: 1. Ipratropium Bromide MDI 2 PUFF IH Q4H
2. AcetaZOLAMIDE 250 mg IV Q6H
3. Levofloxacin 500 mg PO Q24H
4. Acetaminophen 325-650 mg PO Q4-6H:PRN
5. Lorazepam 0.5-2 mg IV Q4H:PRN
6. Albuterol 2 PUFF IH Q4H
7. Magnesium Sulfate 2 gm / 100 ml D5W IV PRN Mag<1.9
8. Ampicillin 2 gm IV Q6H
9. Metronidazole 500 mg PO TID
10. Calcium Gluconate 2 gm / 100 ml D5W IV PRN iCa++<1.12
11. Metoprolol 5 mg IV Q6H
12. Clonidine TTS 1 Patch 1 PTCH TD QFRI
13. Neutra-Phos 2 PKT PO ONCE
14. DopAmine 0-5 mcg/kg/min IV DRIP TITRATE TO MAP of 65
15. Pantoprazole 40 mg IV Q12H
16. Fentanyl Citrate 25-100 mcg/hr IV DRIP INFUSION
17. Potassium Phosphate 15 mmol / 250 ml NS IV ONCE
18. Folic Acid 1 mg IV DAILY
19. Potassium Chloride 40 mEq / 100 ml SW IV PRN K<3.8
20. Heparin 5000 UNIT SC BID
21. Propofol 5-50 mcg/kg/min IV DRIP TITRATE TO sedation
22. Insulin SC
23. Thiamine HCl 100 mg IV DAILY

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Gen: NAD
Card: RRR
Pulm:  clear to ascultation
Abd:soft, bowel sounds present, no tenderness
ext:no edema noted, pedal and radial pulses present

FAMILY HISTORY: FH: Maternal aunt with stroke. Family denies other history of
seizure, stroke, neurologic disorders.

SOCIAL HISTORY: SH: [**3-13**] drinks EtOH/day. 30 pack-year tobacco history but has
since quit. Married with children.  At baseline, she is an
active and highly functioning woman. She works and is completely
independent.
Acute respiratory failure,Acute pancreatitis,Chronic airway obstruction, not elsewhere classified,Other and unspecified alcohol dependence, unspecified,Alcohol withdrawal,Pneumonia due to escherichia coli [E. coli],Paralytic ileus,Bacteremia,Unspecified essential hypertension,Esophageal reflux
Acute respiratry failure,Acute pancreatitis,Chr airway obstruct NEC,Alcoh dep NEC/NOS-unspec,Alcohol withdrawal,Pneumonia e coli,Paralytic ileus,Bacteremia,Hypertension NOS,Esophageal reflux
Admission Date:  [**2128-1-15**]              Discharge Date:   [**2128-2-4**]

Date of Birth:  [**2057-12-12**]             Sex:   F

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 148**]
Chief Complaint:
necrotic pancreatitis

Major Surgical or Invasive Procedure:
dobhoff feeding tube placement


History of Present Illness:
Ms [**Known lastname **] is a 70 y.o. woman with a history of COPD, EtOH
abuse, pancreas divisum & pancreatitis, and hemochromatosis who
presented to [**Hospital3 **] on [**2128-1-13**] with abdominal pain,
nausea, vomiting, WBC 19, and amylase of 3815.  She was
diagnosed
with acute alcoholic pancreatitis. She was made NPO and started
on IVF. On presentation, she was "very uncomfortable", but
alert,
oriented and able to relay a coherent history.During HD#1, her
BP dropped to the 80s systolic and a dopamine drip was started.
She was also started on Zosyn. She started to become more
lethargic and less communicative during the first 24 hours of
her
hospitalization (which her family attributed to pain meds).
Then,
on [**1-14**] she had an ABG with pH 7.20, pCO2 60. Pt was then sedated
and intubated for acidosis/respiratory failure. Abdominal CT
showed pancreatic necrosis and she was transferred to [**Hospital1 18**] on
[**1-15**] for further management.

Past Medical History:
PMH:
1. pancreatitis with pancreas divisum
2. EtOH abuse
3. GERD
4. Htn
5. Hemachromatosis
6. COPD


Social History:
SH: [**3-13**] drinks EtOH/day. 30 pack-year tobacco history but has
since quit. Married with children.  At baseline, she is an
active and highly functioning woman. She works and is completely
independent.


Family History:
FH: Maternal aunt with stroke. Family denies other history of
seizure, stroke, neurologic disorders.


Physical Exam:
Gen: NAD
Card: RRR
Pulm:  clear to ascultation
Abd:soft, bowel sounds present, no tenderness
ext:no edema noted, pedal and radial pulses present


Pertinent Results:
[**2128-1-15**] 05:41PM BLOOD WBC-12.0* RBC-3.07* Hgb-9.0* Hct-27.0*
MCV-88 MCH-29.3 MCHC-33.4 RDW-14.0 Plt Ct-196
[**2128-1-20**] 03:28AM BLOOD WBC-16.0* RBC-2.57* Hgb-7.5* Hct-22.6*
MCV-88 MCH-29.3 MCHC-33.4 RDW-14.2 Plt Ct-376
[**2128-1-26**] 04:21AM BLOOD WBC-25.3* RBC-4.09* Hgb-12.2 Hct-35.4*
MCV-87 MCH-29.8 MCHC-34.4 RDW-14.4 Plt Ct-827*
[**2128-1-30**] 04:20AM BLOOD WBC-15.6* RBC-3.57* Hgb-10.2* Hct-30.4*
MCV-85 MCH-28.6 MCHC-33.6 RDW-14.6 Plt Ct-747*
[**2128-1-15**] 05:41PM BLOOD PT-13.0 PTT-28.0 INR(PT)-1.1
[**2128-1-28**] 01:54AM BLOOD PT-12.6 PTT-26.6 INR(PT)-1.1
[**2128-1-30**] 04:20AM BLOOD Plt Ct-747*
[**2128-1-15**] 05:41PM BLOOD Glucose-97 UreaN-11 Creat-0.6 Na-145
K-4.1 Cl-120* HCO3-18* AnGap-11
[**2128-1-22**] 02:55AM BLOOD Glucose-135* UreaN-9 Creat-0.5 Na-141
K-4.4 Cl-108 HCO3-25 AnGap-12
[**2128-2-2**] 04:13AM BLOOD Glucose-101 UreaN-17 Creat-0.4 Na-140
K-4.3 Cl-105 HCO3-26 AnGap-13
[**2128-1-15**] 05:41PM BLOOD ALT-12 AST-45* LD(LDH)-471* AlkPhos-39
Amylase-492* TotBili-0.5
[**2128-1-20**] 03:28AM BLOOD ALT-15 AST-24 LD(LDH)-488* AlkPhos-116
Amylase-55 TotBili-0.5
[**2128-1-25**] 02:45AM BLOOD ALT-26 AST-23 LD(LDH)-611* AlkPhos-157*
TotBili-0.3
[**2128-1-28**] 01:54AM BLOOD ALT-13 AST-14 LD(LDH)-410* AlkPhos-84
Amylase-88 TotBili-0.2
[**2128-1-15**] 05:41PM BLOOD Lipase-653*
[**2128-1-28**] 01:54AM BLOOD Lipase-52
[**2128-1-15**] 05:41PM BLOOD Albumin-2.6* Calcium-6.5* Phos-0.9*
Mg-1.5*
[**2128-2-2**] 04:13AM BLOOD Calcium-9.1 Phos-4.0 Mg-2.0
[**2128-1-20**] 04:21PM BLOOD calTIBC-186* Ferritn-360* TRF-143*
[**2128-1-27**] 02:14AM BLOOD Triglyc-117
[**2128-1-28**] 01:54AM BLOOD Vanco-15.4*
[**2128-1-15**] 05:51PM BLOOD Type-ART pO2-107* pCO2-38 pH-7.32*
calHCO3-20* Base XS--5
[**2128-1-16**] 09:53AM BLOOD Type-ART pO2-107* pCO2-35 pH-7.40
calHCO3-22 Base XS--1
[**2128-1-20**] 04:05PM BLOOD Type-ART pO2-110* pCO2-70* pH-7.32*
calHCO3-38* Base XS-7 Intubat-INTUBATED
[**2128-1-22**] 01:13PM BLOOD Type-ART Temp-39.4 Rates-/21 PEEP-8
FiO2-40 pO2-150* pCO2-40 pH-7.38 calHCO3-25 Base XS-0
Intubat-INTUBATED Vent-SPONTANEOU
[**2128-1-24**] 06:15PM BLOOD Type-ART pO2-113* pCO2-55* pH-7.35
calHCO3-32* Base XS-3
[**2128-1-27**] 06:38AM BLOOD Type-ART pO2-81* pCO2-56* pH-7.39
calHCO3-35* Base XS-6 Intubat-NOT INTUBA
[**2128-1-15**] 05:48PM URINE Blood-MOD Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG
[**2128-1-15**] 05:48PM URINE RBC-[**6-19**]* WBC-0-2 Bacteri-RARE Yeast-NONE
Epi-0-2
[**2128-1-15**] 05:48PM URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-1.019

GRAM STAIN (Final [**2128-1-16**]):
      >25 PMNs and <10 epithelial cells/100X field.
      2+   (1-5 per 1000X FIELD):   MULTIPLE ORGANISMS
CONSISTENT WITH
                                    OROPHARYNGEAL FLORA.

   RESPIRATORY CULTURE (Final [**2128-1-18**]):
      SPARSE GROWTH OROPHARYNGEAL FLORA.
      ESCHERICHIA COLI.    SPARSE GROWTH.

CT HEAD W/O CONTRAST

Reason: please eval for bleed, infarct

[**Hospital 93**] MEDICAL CONDITION:
70 year old woman with pancreatitis, now change in mental status
off sedation
REASON FOR THIS EXAMINATION:
please eval for bleed, infarct
CONTRAINDICATIONS for IV CONTRAST: None.

INDICATION: Pancreatitis, no change in mental status off
sedation, please evaluate for bleed or infarct.

COMPARISON: None.

TECHNIQUE: Non-contrast head CT.

FINDINGS: There is no evidence for acute intracranial
hemorrhage. Multiple subcortical and periventricular
hypodensities in the white matter of both cerebral hemispheres
are noted, likely a remnant of chronic small- vessel infarction.
The [**Doctor Last Name 352**]- white matter junction is distinct. The ventricles,
sulci, and cisterns are normalm without effacement. There is no
evidence for hydrocephalus. There is no mass effect or shift of
normally midline structures. The paranasal sinuses are clear.
Osseous structures are unremarkable. The cavernous carotid
arteries are calcified, atherosclerotic in origin.

IMPRESSION: No evidence for acute intracranial hemorrhage.
Previous small vessel infarcts. MR is more sensitive for the
evaluation of acute brain ischemia.

CT ABDOMEN W/CONTRAST  [**2128-1-23**] 2:56 PM

CT CHEST W/CONTRAST; CT ABDOMEN W/CONTRAST

Reason: Pt with recent pancreatitis, recurrent fevers,
unidentified
Contrast: OPTIRAY

[**Hospital 93**] MEDICAL CONDITION:
70 year old woman with chronic pancr, recent episode req intub,
slow to wean from vent, recurrent fevers, elev WBC
REASON FOR THIS EXAMINATION:
Pt with recent pancreatitis, recurrent fevers, unidentified
source, pls re-eval
CONTRAINDICATIONS for IV CONTRAST: None.

HISTORY: Chronic and acute pancreatitis, recurrent fevers.
Intubated.

No CTs for comparison.

TECHNIQUE: Axial images through the chest, abdomen and pelvis
with oral and IV contrast.

CT OF THE CHEST WITH CONTRAST: There are moderate bilateral
pleural effusions with bibasilar atelectasis. The endotracheal
tube is above the carina. There are no pathologically enlarged
axillary, hilar, or mediastinal lymph nodes. There are no
pulmonary consolidations or nodules. The airways are patent to
the level of the subsegmental bronchi bilaterally. The heart and
pericardium, and great vessels are normal.

CT OF THE ABDOMEN WITH CONTRAST: The liver, spleen, adrenal
glands, gallbladder, right kidney, and both ureters are normal.
A feeding tube is seen terminating in the duodenum. There is
free fluid tracking down both paracolic gutters, right greater
than left. There is nonenhancement of the majority of the
pancreatic body, with only limited enhancement seen within the
head and tail. There is fluid within the peripancreatic space,
as well as within the lesser sac and anterior perirenal space.
There is atherosclerotic calcification of the descending aorta,
and the branch points of the celiac axis, superior mesenteric
artery, renal artery, and inferior mesenteric artery. There are
no pathologically enlarged mesenteric or retroperitoneal lymph
nodes. Within the left kidney is an area of nonenhancement.
There are also two cysts within the left kidney. There is no
hydronephrosis.

CT OF THE PELVIS WITH CONTRAST: There is free fluid within the
pelvis. The uterus, rectum, sigmoid colon, and adnexa are
unremarkable. A Foley catheter is in the bladder. There are no
pathologically enlarged inguinal or pelvic lymph nodes.

BONE WINDOWS: Hardware within the left femur. No suspicious
lesions.

IMPRESSION:

1. Findings consistent with necrotizing pancreatitis with
peripancreatic stranding and effusions extending in the lesser
sac and anterior paparenal space. Moderate bilateral pleural
effusions, and ascites.

2. Focal area of nonenhancement within the left kidney, an
infarct and acute pyelonephritis on the differential diagnosis.
These findings were discussed with Dr. [**First Name (STitle) **] at 3:30 p.m. on
[**2128-1-23**].


Brief Hospital Course:
Here, she was weaned off pressors. She was found to have E. coli
in sputum cx and was treated initially with ampicillin, then
switched to vanc, levo, & flagyl which was completed by the time
of discharge. Attempts to wean from ventilator were intially
unsuccessful largely because of agitation, hypertension,
tachycardia, and tachypneiawhen propofol and fentanyl are
weaned.
Neurology was consulted who thought her exam to be consistent
with ETOH withdrawl. Recs of benzodiazepines standing and prn
per CIWA scale were followed.
Tube feeds were started on HD 6 via a Dobhoff tube. CT scan on
HD9 demonstrated bilateral pleural effusions and an abdomen c/w
necrotizig pancreatitis.  Eventually, she was able to be
successfully extubated on HD10. Her sedation was minimized and
she tolerated weaning to oxygen via nasal cannula. She
eventually regained full orientation and was out of bed with
assistance.
She did develop abdominal distension and vomiting on HD13. An
NGT was placed with >1L of output per day. A KUB was consistent
with an ileus, TF were held and TPN was started. Foley was out
on HD17. Her NGT was self-d/c'ed and the patient did not have
any nausea/vomiting. Her diet was slowly advanced - clears
started on HD18, low fat diet on HD19, TPN halved. Patient was
discharged on HD21 in good condtion to [**Hospital3 **] for
further physical therapy and acute recovery.




Medications on Admission:
1. Ipratropium Bromide MDI 2 PUFF IH Q4H
2. AcetaZOLAMIDE 250 mg IV Q6H
3. Levofloxacin 500 mg PO Q24H
4. Acetaminophen 325-650 mg PO Q4-6H:PRN
5. Lorazepam 0.5-2 mg IV Q4H:PRN
6. Albuterol 2 PUFF IH Q4H
7. Magnesium Sulfate 2 gm / 100 ml D5W IV PRN Mag<1.9
8. Ampicillin 2 gm IV Q6H
9. Metronidazole 500 mg PO TID
10. Calcium Gluconate 2 gm / 100 ml D5W IV PRN iCa++<1.12
11. Metoprolol 5 mg IV Q6H
12. Clonidine TTS 1 Patch 1 PTCH TD QFRI
13. Neutra-Phos 2 PKT PO ONCE
14. DopAmine 0-5 mcg/kg/min IV DRIP TITRATE TO MAP of 65
15. Pantoprazole 40 mg IV Q12H
16. Fentanyl Citrate 25-100 mcg/hr IV DRIP INFUSION
17. Potassium Phosphate 15 mmol / 250 ml NS IV ONCE
18. Folic Acid 1 mg IV DAILY
19. Potassium Chloride 40 mEq / 100 ml SW IV PRN K<3.8
20. Heparin 5000 UNIT SC BID
21. Propofol 5-50 mcg/kg/min IV DRIP TITRATE TO sedation
22. Insulin SC
23. Thiamine HCl 100 mg IV DAILY

Discharge Disposition:
Extended Care

Facility:
[**Hospital6 85**] - [**Location (un) 86**]

Discharge Diagnosis:
necrotizing pancreatitis


Discharge Condition:
improved, stable


Discharge Instructions:
Please come to the emergency room if you have persistent
abdominal pain, nausea/vomiting, shortness of breath, inability
to eat or drink, dizziness/weakness or diarrhea.
Please don't drive while taking pain medications.

Followup Instructions:
Please follow up with Dr. [**Last Name (STitle) **] in [**3-13**] weeks. Call
[**Telephone/Fax (1) 1231**] for an appointment.



Completed by:[**2128-2-4**]
{'Acute respiratory failure,Acute pancreatitis,Chronic airway obstruction, not elsewhere classified,Other and unspecified alcohol dependence, unspecified,Alcohol withdrawal,Pneumonia due to escherichia coli [E. coli],Paralytic ileus,Bacteremia,Unspecified essential hypertension,Esophageal reflux'}


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: necrotic pancreatitis

PRESENT ILLNESS: Ms [**Known lastname **] is a 70 y.o. woman with a history of COPD, EtOH
abuse, pancreas divisum & pancreatitis, and hemochromatosis who
presented to [**Hospital3 **] on [**2128-1-13**] with abdominal pain,
nausea, vomiting, WBC 19, and amylase of 3815.  She was
diagnosed
with acute alcoholic pancreatitis. She was made NPO and started
on IVF. On presentation, she was "very uncomfortable", but
alert,
oriented and able to relay a coherent history.During HD#1, her
BP dropped to the 80s systolic and a dopamine drip was started.
She was also started on Zosyn. She started to become more
lethargic and less communicative during the first 24 hours of
her
hospitalization (which her family attributed to pain meds).
Then,
on [**1-14**] she had an ABG with pH 7.20, pCO2 60. Pt was then sedated
and intubated for acidosis/respiratory failure. Abdominal CT
showed pancreatic necrosis and she was transferred to [**Hospital1 18**] on
[**1-15**] for further management.

MEDICAL HISTORY: PMH:
1. pancreatitis with pancreas divisum
2. EtOH abuse
3. GERD
4. Htn
5. Hemachromatosis
6. COPD

MEDICATION ON ADMISSION: 1. Ipratropium Bromide MDI 2 PUFF IH Q4H
2. AcetaZOLAMIDE 250 mg IV Q6H
3. Levofloxacin 500 mg PO Q24H
4. Acetaminophen 325-650 mg PO Q4-6H:PRN
5. Lorazepam 0.5-2 mg IV Q4H:PRN
6. Albuterol 2 PUFF IH Q4H
7. Magnesium Sulfate 2 gm / 100 ml D5W IV PRN Mag<1.9
8. Ampicillin 2 gm IV Q6H
9. Metronidazole 500 mg PO TID
10. Calcium Gluconate 2 gm / 100 ml D5W IV PRN iCa++<1.12
11. Metoprolol 5 mg IV Q6H
12. Clonidine TTS 1 Patch 1 PTCH TD QFRI
13. Neutra-Phos 2 PKT PO ONCE
14. DopAmine 0-5 mcg/kg/min IV DRIP TITRATE TO MAP of 65
15. Pantoprazole 40 mg IV Q12H
16. Fentanyl Citrate 25-100 mcg/hr IV DRIP INFUSION
17. Potassium Phosphate 15 mmol / 250 ml NS IV ONCE
18. Folic Acid 1 mg IV DAILY
19. Potassium Chloride 40 mEq / 100 ml SW IV PRN K<3.8
20. Heparin 5000 UNIT SC BID
21. Propofol 5-50 mcg/kg/min IV DRIP TITRATE TO sedation
22. Insulin SC
23. Thiamine HCl 100 mg IV DAILY

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Gen: NAD
Card: RRR
Pulm:  clear to ascultation
Abd:soft, bowel sounds present, no tenderness
ext:no edema noted, pedal and radial pulses present

FAMILY HISTORY: FH: Maternal aunt with stroke. Family denies other history of
seizure, stroke, neurologic disorders.

SOCIAL HISTORY: SH: [**3-13**] drinks EtOH/day. 30 pack-year tobacco history but has
since quit. Married with children.  At baseline, she is an
active and highly functioning woman. She works and is completely
independent. 

### Response:
{'Acute respiratory failure,Acute pancreatitis,Chronic airway obstruction, not elsewhere classified,Other and unspecified alcohol dependence, unspecified,Alcohol withdrawal,Pneumonia due to escherichia coli [E. coli],Paralytic ileus,Bacteremia,Unspecified essential hypertension,Esophageal reflux'}
