CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient was transferred with
acute pancreatitis secondary to hypertriglyceridemia.

MEDICAL HISTORY: 1.  Hypercholesterolemia.
2.  History of high triglycerides.
3.  History of cholecystectomy [**37**] years ago.
4.  Endoscopic retrogram cholangiopancreatography eight years
ago for biliary sludge.
5.  Nephrolithiasis.

MEDICATION ON ADMISSION: 1.  Atorvastatin.
2.  Estrogen.
3.  A cough medicine with codeine.

ALLERGIES: To medications include sulfa leading to
anaphylaxis and penicillin causing a rash.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She denies tobacco and denies alcohol
consumption.  She is married and lives near [**Hospital1 1474**].
Acute pancreatitis,Unspecified pleural effusion,Pulmonary collapse,Intestinal infection due to Clostridium difficile,Pure hyperglyceridemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Acute pancreatitis,Pleural effusion NOS,Pulmonary collapse,Int inf clstrdium dfcile,Pure hyperglyceridemia,DMII wo cmp nt st uncntr
Admission Date:  [**2117-2-18**]     Discharge Date:  [**2117-2-27**]

Date of Birth:   [**2054-6-11**]     Sex:  F

Service:  [**Location (un) 259**]

HISTORY OF PRESENT ILLNESS:  The patient was transferred with
acute pancreatitis secondary to hypertriglyceridemia.

[**First Name8 (NamePattern2) **] [**Known lastname **] is a 62 year old woman with a history of
hypercholesterolemia.  She is status post cholecystectomy [**37**]
years ago, an ERCP eight years ago for biliary sludge.  She
initially presented to [**Hospital 1474**] Hospital on [**2117-2-13**], with
severe abdominal pain radiating to the back.  By report, she
had felt malaise and flu-like symptoms in the weeks prior to
admission but when such severe pain occurred, she presented
to the Emergency Room.  Review of systems at that time with
pertinent negatives of no nausea, vomiting, fever or chills.
She was treated with pain relievers in the Emergency
Department and had labs significant for amylase of 1140,
lipase of 4318 and triglycerides of 3650.  Liver function
tests could not be done at that time due to the
hyperlipidemia.

A CT scan of the abdomen was done and had a fatty
infiltration of liver with prominence and inflammatory
changes surrounding the pancreatic head.  She was given
morphine on the floor and had complications of pancreatitis
including a calcium of 5.1 and albumin of 3.2.  On hospital
day two at this outside hospital, she had an episode of
delirium and a chest x-ray at that time showed a left pleural
effusion and right-sided atelectasis.  She was started
empirically on Gatifloxacin.

Over the next few days, the amylase came down from 1140 to
86, lipase from 4318 to 389.  The CT scan was repeated
showing extension of the peripancreatic fluid throughout the
retroperitoneum and into the pelvis.  At this point, she was
transferred to Intensive Care Unit due to her delirium and
deteriorating respiratory status.  When her O2 saturation
fell to 80% she was intubated electively in the Intensive
Care Unit and was then transferred to the [**Hospital1 346**] on [**2117-2-18**].

PAST MEDICAL HISTORY:
1.  Hypercholesterolemia.
2.  History of high triglycerides.
3.  History of cholecystectomy [**37**] years ago.
4.  Endoscopic retrogram cholangiopancreatography eight years
ago for biliary sludge.
5.  Nephrolithiasis.

MEDICATIONS ON ADMISSION:
1.  Atorvastatin.
2.  Estrogen.
3.  A cough medicine with codeine.

ALLERGIES:   To medications include sulfa leading to
anaphylaxis and penicillin causing a rash.

SOCIAL HISTORY:  She denies tobacco and denies alcohol
consumption.  She is married and lives near [**Hospital1 1474**].

PHYSICAL EXAMINATION:  On admission to the [**Hospital1 346**] showed a temperature of 101.0 F.;
pulse 102; blood pressure 113/59 and O2 saturation at 99%;
A-C 700 by 10, total volume 700, FIO2 100%.  In general, this
is a mildly obese woman lying in bed with eyes open not
responding to voice.  HEENT:  Normocephalic, atraumatic.
Pupils equally round and reactive to light and accommodation.
Sclerae anicteric.  Chest examination:  There is decreased
breath sounds at left base and rales at the right base.
Heart examination:  Tachycardia with no murmurs, rubs or
gallops appreciated.  Abdominal examination:  Moderately
obese, well healed scar from the cholecystectomy.  Hypoactive
bowel sounds, mildly distended but soft.  Extremities showed
two plus pitting edema up to the ankles.  There was no skin
lesions.  Neurologic:  Eyes open, no tracking.  Moving all
four limbs spontaneously.

LABORATORY:  Pertinent laboratory values include on
[**2117-2-18**], a CBC showing white blood cell count 7.9,
hematocrit 23.3, and platelets 248.  The differential was 72
neutrophils, 12 bands and 8 lymphs.

The Chem-7 was significant for a potassium of 3.2.  All other
normal.  Triglycerides were found to be 599; ALT was 18, AST
30, LDH 739, alkaline phosphatase 74.  Amylase 97.  Total
bilirubin 0.6.  Lipase 200.  Albumin 2.4, phosphorus 0.8,
calcium 7.1, magnesium 1.6.  Free calcium 1.01.

On [**2117-2-21**], the amylase was down to 44 and lipase at 85.
Hematocrit on [**2-23**] was 28.5.

IMAGING:  CT scan of abdomen showing a diffuse fatty
infiltration of liver, prominent and inflammatory changes
surrounding the pancreas, simple right renal cyst.

Right upper quadrant ultrasound showed a common bile duct
slightly prominent and fatty infiltration of the liver.

A [**2-18**] chest x-ray showed a left pleural effusion and right
base atelectasis.  A [**2-18**] CT scan:  Inflammation of the
pancreas with peripancreatic fluids but no signs of necrosis.

SUMMARY OF HOSPITAL COURSE:  This is a 62 year old woman with
a history of hypertriglyceridemia, previously healthy, and
admitted to [**Hospital 1474**] Hospital on [**2117-2-13**] with a severe
abdominal pain radiating to the back.  Diagnosis was
pancreatitis with the very high amylase, lipase and
triglycerides of 3650.  She had complications due to this
pancreatitis including inflammation of the lungs
necessitating intubation for three days.  By systems, her
course is as follows.

1.  Pancreatitis:  She was placed on bowel rest and
supportive measures.  She was NPO until [**2117-2-23**], and
sustained on TPN on [**2-18**] through [**2-25**].  There was
aggressive rehydration and ion repletion due to the low
calcium, magnesium and phosphorus.  She was in the Intensive
Care Unit until [**2117-2-22**], at which time she was moved to
the floor for five more days of support and recovery.  The
pancreatitis resolved with minimal abdominal discomfort on
examination late it the course of her admission.  Her diet
was advanced beginning with clears on [**2117-2-22**], and she was
discharged on a low fat American Diabetic Association diet on
[**2-27**].

There were discussions concerning the etiology to this
episode of acute pancreatitis.  It was felt that there was a
low possibility of biliary sludge causing this episode and an
MRCP was not done because of the low volume in the setting of
normal liver function tests at presentation and throughout
the admission, and history of normal anatomy on ERCP eight
years ago.  Triglycerides were checked and came down to the
300 level which is her baseline as an outpatient.

She was started on Niaspan and Gemfibrozil to help decrease
her hypertriglyceridemia and to prevent another episode of
pancreatitis.

2.  Hematologic:  Her hematocrit fell to 22.7 on [**2-19**], given
the aggressive intravenous fluids and she was given two units
packed red blood cells.  Her hematocrit was stable after that
and at discharge was 28.3 with the recommendation to have
outpatient anemia work-up.

3.  Infectious Disease:  On [**2117-2-19**], she was found to have
C. difficile colitis with positive guaiac in her stools.  She
was placed on Flagyl for a 14 day course and had clinical
improvement throughout her admission.  Her fever was as high
as 102.5, but trended down and was discharged afebrile.

4.  Pulmonary:  She was intubated at [**Hospital 1474**] Hospital due to
a left pleural effusion and atelectasis and O2 saturations
falling to 80%.  She was given antibiotics including
Gatifloxacin and Imipenem but the Gatifloxacin was
discontinued on admission.  She was extubated on [**2-20**],
without complications and started on Albuterol nebulizer
p.r.n. wheezing and over the course of 24 hours was weaned to
nasal cannula O2 and then to room air with good saturation
before discharge.  She was discharged with an MDI Albuterol
for continued problems with wheezing.

5.  Endocrine:  She had hyperglycemia, probably secondary to
pancreatitis, but cannot exclude the possibility of insulin
resistance or an undiagnosed diabetes mellitus type 2.  She
was maintained on NPH 20 units twice a day and an insulin
sliding scale and four times a day fingerstick.  She was
discharged on the oral [**Doctor Last Name 360**] Metformin to help decrease her
glucose levels and will follow-up with respect to this with
her primary care physician.

6.  Fluids, Electrolytes and Nutrition:   The patient
received TPN from [**2-19**] until [**2-26**], and diet advanced from
clear sips starting on [**2-22**] to a diabetic low fat diet by
[**2-26**].  There was aggressive electrolyte repletion early on
in the Intensive Care Unit and she was discharged with a
normal Chem-7.

7.  Musculoskeletal:  The patient experienced back pain and
had relief with Flexeril 10 mg at bedtime and Tylenol.

CONDITION AT DISCHARGE:   Good.

DISCHARGE DIAGNOSES:
1.  Acute pancreatitis.
2.  Clostridium difficile colitis.
3.  Hyperglycemia and question of diabetes mellitus type 2.
4.  Hypertriglyceridemia.

DISCHARGE MEDICATIONS:
1.  Gemfibrizol 600 mg twice a day.
2.  Albuterol MDI one to two puffs every six to eight hours
p.r.n. wheezing.
3.  Niaspan 500 mg q. h.s.
4.  Flagyl 500 mg three times a day for another nine days.
5.  Flexeril 10 mg q. h.s.
6.  Metformin 500 mg twice a day.

Her Lipitor was discontinued.



                          [**First Name8 (NamePattern2) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 11283**]

Dictated By:[**Female First Name (un) 38627**]
MEDQUIST36

D:  [**2117-2-28**]  20:17
T:  [**2117-3-2**]  14:21
JOB#:  [**Job Number 38628**]
{'Acute pancreatitis,Unspecified pleural effusion,Pulmonary collapse,Intestinal infection due to Clostridium difficile,Pure hyperglyceridemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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: The patient was transferred with
acute pancreatitis secondary to hypertriglyceridemia.

MEDICAL HISTORY: 1.  Hypercholesterolemia.
2.  History of high triglycerides.
3.  History of cholecystectomy [**37**] years ago.
4.  Endoscopic retrogram cholangiopancreatography eight years
ago for biliary sludge.
5.  Nephrolithiasis.

MEDICATION ON ADMISSION: 1.  Atorvastatin.
2.  Estrogen.
3.  A cough medicine with codeine.

ALLERGIES: To medications include sulfa leading to
anaphylaxis and penicillin causing a rash.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She denies tobacco and denies alcohol
consumption.  She is married and lives near [**Hospital1 1474**]. 

### Response:
{'Acute pancreatitis,Unspecified pleural effusion,Pulmonary collapse,Intestinal infection due to Clostridium difficile,Pure hyperglyceridemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
