CHIEF COMPLAINT: fatigue/ hyponatremia

PRESENT ILLNESS: 71F with a pmHx cryptogenic cirrhosis c/b portal HTN and most
recent EGD in [**6-/2157**] showing varices, h/o moderate AS, admitted
on [**2158-8-22**] for hyponatremia.  Pt was seen in liver clinic and
found to be fatigued with Na of 119 (baseline in low 130s).

MEDICAL HISTORY: 1. Cirrhosis with portal hypertension
2. Hypertension.
3. Hyperlipidemia (monitored only.)
4. Reported history of UC diagnosed 3 years ago on colonoscopy,

MEDICATION ON ADMISSION: ERGOCALCIFEROL (VITAMIN D2) - 50,000 unit capsule - 1 Capsule(s)
by mouth Q week x 12 weeks
LISINOPRIL - 5 mg tablet - 1 Tablet(s) by mouth once a day
SPIRONOLACTONE -  (Prescribed by Other Provider) - 50 mg tablet
-
3 Tablet(s) by mouth daily
TORSEMIDE - 20 mg tablet - 2 tablet(s) by mouth twice a day

ALLERGIES: Codeine / Percocet

PHYSICAL EXAM: ADMISSION EXAM
VS: 97.8, 127/65, p71 r18 100RA
GENERAL: Well appearing in NAD.  AOx3.
HEENT: Sclera anicteric. MMM.
CARDIAC: RRR with late peaking SEM heard best at the RUSB, but
heard throughout the precordium
LUNGS: mild bibasilar crackles
ABDOMEN: Soft, non-tender to palpation. Dullness to percussion
over dependent areas but tympanic anteriorly. No HSM or
tenderness appreciated.
EXTREMITIES: no edema.  Warm and well perfused, no clubbing or
cyanosis. <2s cap refill
NEUROLOGY: no asterixis, CN 2-12 grossly intact

FAMILY HISTORY: No liver disease in family.

SOCIAL HISTORY: She lives alone. No history of alcohol excess. Lifelong
nonsmoker. Competent of all ADLS IADLS. Previously worked as a
jewelry maker and [**Hospital Ward Name **].
Hyposmolality and/or hyponatremia,Hepatic encephalopathy,Malignant neoplasm of liver, primary,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Cirrhosis of liver without mention of alcohol,Diarrhea,Other and unspecified hyperlipidemia,Aortic valve disorders,Osteoporosis, unspecified,Personal history of pulmonary embolism,Hip joint replacement
Hyposmolality,Hepatic encephalopathy,Mal neo liver, primary,Esoph varice oth dis NOS,Cirrhosis of liver NOS,Diarrhea,Hyperlipidemia NEC/NOS,Aortic valve disorder,Osteoporosis NOS,Hx pulmonary embolism,Joint replaced hip
Admission Date:  [**2158-8-22**]              Discharge Date:   [**2158-8-29**]

Date of Birth:  [**2087-2-2**]             Sex:   F

Service: MEDICINE

Allergies:
Codeine / Percocet

Attending:[**First Name3 (LF) 1377**]
Chief Complaint:
fatigue/ hyponatremia

Major Surgical or Invasive Procedure:
none

History of Present Illness:
71F with a pmHx cryptogenic cirrhosis c/b portal HTN and most
recent EGD in [**6-/2157**] showing varices, h/o moderate AS, admitted
on [**2158-8-22**] for hyponatremia.  Pt was seen in liver clinic and
found to be fatigued with Na of 119 (baseline in low 130s).

Patient was discharged from the hospital on [**2158-8-4**] where she
was admitted with abdominal pain and increasing ascites and
found to have SBP. She was admitted in [**6-/2158**] s/p ERCP with
sphincterotomy due to hyperbilirubinemia and dilation of the
common bile duct.

On admission, she complained of progressive fatigue and chronic
DOE that is not worsening as well as 2 days of confusion.  She
has been compliant with her lactulose and denies fevers chills,
abdominal pain or cough or dysuria.

Of note, on pt's discharge from [**Hospital1 18**] on [**2158-8-7**] several
medication changes were made: her Lasix dose was increased from
40mg daily to 80mg daily and her aldactone dose was increased
from 50mg to 200mg daily.  Two days later her lasix was changed
to torsemide 80mg.  According to [**Name (NI) **], pt's weight on [**2158-6-9**] was
196lbs and on [**2158-8-18**] it was 167lbs.  On admission her wt was
164lbs.

Hospital Course:
On presentation, her Na was 119, urine lytes were significant
UNa of 66 and Uosm of 499.  She was put on a free water
restriction and tolvaptan was started [**2158-8-25**].  Her Na continued
to drop to a nadar of 111.  Her mental status began to become
sluggish and she began to experience increasing lethargy.  An AM
cortisol was checked on [**8-23**] and it was 17.

[**2158-8-26**], renal team was consulted and felt that etiology of
hyponatremia [**2-9**] to nonosmotic ADH release from hypovolemia
given significant wt loss and UNa <10 with Uosm of 311.  At this
time pt's free water restriction was lifted and she consumed
500cc of free water in several hours and a repeat Na was checked
and dropped to 109.  Pt began to get tachypneic but maintained
o2 sats.  Chest xray was checked at this time and appears dryer
than cxr on admission.  ABG revealed:7.50/31/101/25.  Due to
altered mental status and rapidly dropping [**Name (NI) **], pt was
transferred to MICU for hypertonic saline administration.

On arrival to the MICU, pts vitals are stable, she is answering
questions appropriately and has no focal neuro deficits

Review of systems:
ROS: Per HPI, also, no night sweats, head aches, palpitations,
vision changes, N/V/C/D. No increased LE edema.

Past Medical History:
1. Cirrhosis with portal hypertension
2. Hypertension.
3. Hyperlipidemia (monitored only.)
4. Reported history of UC diagnosed 3 years ago on colonoscopy,

but she is asymptomatic is not on pharmacologic therapy.
5. Left knee arthroscopy.
6. Left shoulder and elbow fracture with pins (unable to
undergo
MRs.)
7. Left total hip replacement in [**2148**].
8. Total hysterectomy in the [**2116**].
9. Appendectomy at age 30.
10. Tonsillectomy.
11. Cholecystectomy in the [**2126**].
12. Osteoporosis.
13. Systolic heart murmur.
14. Reported history of PE/DVT, on Coumadin in the [**2116**].

Social History:
She lives alone. No history of alcohol excess. Lifelong
nonsmoker. Competent of all ADLS IADLS. Previously worked as a
jewelry maker and [**Hospital Ward Name **].


Family History:
No liver disease in family.


Physical Exam:
ADMISSION EXAM
VS: 97.8, 127/65, p71 r18 100RA
GENERAL: Well appearing in NAD.  AOx3.
HEENT: Sclera anicteric. MMM.
CARDIAC: RRR with late peaking SEM heard best at the RUSB, but
heard throughout the precordium
LUNGS: mild bibasilar crackles
ABDOMEN: Soft, non-tender to palpation. Dullness to percussion
over dependent areas but tympanic anteriorly. No HSM or
tenderness appreciated.
EXTREMITIES: no edema.  Warm and well perfused, no clubbing or
cyanosis. <2s cap refill
NEUROLOGY: no asterixis, CN 2-12 grossly intact

DISCHARGE EXAM
VS: 98.6/98.1 BP 100-116/50-62 HR 49-84 RR18 97%RA  I:3200
O:[**2096**] +5BM
GENERAL: Pt appears more awake. NAD.
HEENT: Sclera anicteric. MMM.
CARDIAC: RRR with 3/6 late peaking SEM heard best at the RUSB,
but heard throughout the precordium
LUNGS: CTA b/l no w/r/r
ABDOMEN: Soft, non-tender to palpation. Nondistended. Slightly
tender to palpation.
EXTREMITIES: no edema.  Warm and well perfused, no clubbing or
cyanosis. <2s cap refill
NEUROLOGY: no asterixis

Pertinent Results:
[**8-26**]: URINE CULTURE (Final [**2158-8-28**]):
      MIXED BACTERIAL FLORA ( >= 3 COLONY TYPES), CONSISTENT
WITH SKIN
      AND/OR GENITAL CONTAMINATION

CT ABDOMEN/PELVIS [**2158-8-23**]
IMPRESSION:
1.  2.0 cm Segment III hepatic lesion with arterial enhancement
and delayed washout concerning for HCC.
2.  Cirrhotic liver with numerous additional lesions showing
delayed
hypoenhancement but no arterial phase hyperenhancement, most
likely represent regenerative nodules.
3.  Sequelae of portal hypertension including gastroesophageal
varices and
recanalized umbilical vein.
4.  Multiple pancreatic body and tail hypodensities compatible
with dilated side branches, as in side branch IPMN or changes of
chronic pancreatitis; these are increased in comparison with
[**2158-5-10**].  Further evaluation could be obtained with MRCP if
clinically indicated, or attention at next follow up imaging is
recommended.

ABD U/S [**2158-8-23**]
IMPRESSION:
1.  Hypoechoic liver lesion in the right lobe measuring 2.9 x
1.7 x 1.9 cm, with appearance concerning for hepatoma.
recommend MRI.
2.  Nodular liver.

ABD U/S [**2158-8-25**]:
1. No ascites

CXR [**2158-8-25**]: IMPRESSION:  No failure.  Lungs clear.

[**2158-8-22**] 01:25PM BLOOD WBC-9.2 RBC-3.71* Hgb-12.9 Hct-37.1
MCV-100* MCH-34.9* MCHC-34.8 RDW-15.3
[**2158-8-24**] 06:50AM BLOOD WBC-11.1* RBC-3.86* Hgb-13.4 Hct-38.4
MCV-100* MCH-34.7* MCHC-34.9 RDW-15.1 Plt Ct-215
[**2158-8-27**] 03:17AM BLOOD WBC-10.8 RBC-3.65* Hgb-12.6 Hct-36.6
MCV-100* MCH-34.6* MCHC-34.5 RDW-14.6 Plt Ct-173
[**2158-8-29**] 04:40AM BLOOD WBC-7.7 RBC-2.73* Hgb-9.5* Hct-27.9*
MCV-102* MCH-34.7* MCHC-33.9 RDW-14.7 Plt Ct-UNABLE TO
[**2158-8-29**] 06:00AM BLOOD WBC-7.0 RBC-2.94* Hgb-10.4* Hct-30.1*
MCV-102* MCH-35.2* MCHC-34.4 RDW-14.7 Plt Ct-UNABLE TO

[**2158-8-22**] 01:25PM BLOOD PT-17.3* PTT-32.0 INR(PT)-1.6*
[**2158-8-26**] 06:20AM BLOOD PT-17.4* INR(PT)-1.6*
[**2158-8-27**] 03:17AM BLOOD PT-17.5* PTT-37.5* INR(PT)-1.6*

[**2158-8-21**] 12:00PM BLOOD UreaN-21* Creat-0.7 Na-119* K-5.6* Cl-87*
HCO3-23 AnGap-15
[**2158-8-22**] 01:25PM BLOOD Glucose-93 UreaN-15 Creat-0.6 Na-115*
K-5.8* Cl-87* HCO3-23 AnGap-11
[**2158-8-23**] 06:05AM BLOOD Glucose-105* UreaN-21* Creat-0.8 Na-118*
K-4.4 Cl-83* HCO3-24 AnGap-15
[**2158-8-24**] 06:50AM BLOOD Glucose-107* UreaN-27* Creat-0.9 Na-116*
K-4.5 Cl-80* HCO3-26 AnGap-15
[**2158-8-24**] 03:10PM BLOOD Glucose-113* UreaN-25* Creat-1.0 Na-117*
K-4.5 Cl-82* HCO3-25 AnGap-15
[**2158-8-25**] 06:19AM BLOOD Glucose-106* UreaN-25* Creat-0.8 Na-116*
K-4.8 Cl-85* HCO3-24 AnGap-12
[**2158-8-25**] 12:50PM BLOOD Glucose-69* UreaN-25* Creat-0.8 Na-115*
K-4.9 Cl-82* HCO3-25 AnGap-13
[**2158-8-26**] 06:20AM BLOOD Glucose-92 UreaN-24* Creat-0.7 Na-114*
K-5.1 Cl-83* HCO3-25 AnGap-11
[**2158-8-26**] 02:40PM BLOOD Glucose-156* UreaN-23* Creat-0.9 Na-111*
K-5.4* Cl-81* HCO3-23 AnGap-12
[**2158-8-26**] 08:05PM BLOOD Glucose-186* UreaN-24* Creat-0.9 Na-109*
K-5.5* Cl-80* HCO3-19* AnGap-16
[**2158-8-27**] 03:17AM BLOOD Glucose-105* UreaN-25* Creat-0.7 Na-114*
K-5.8* Cl-86* HCO3-24 AnGap-10

[**2158-8-27**] 06:26AM BLOOD Na-116* K-5.4* Cl-87*
[**2158-8-27**] 08:04AM BLOOD Na-121* K-5.1 Cl-91*
[**2158-8-27**] 12:10PM BLOOD Na-120* K-5.2* Cl-88*
[**2158-8-27**] 08:48PM BLOOD Na-117* K-5.8* Cl-91*
[**2158-8-28**] 01:53AM BLOOD Na-118* K-5.2* Cl-90*
[**2158-8-28**] 05:46AM BLOOD Glucose-78 UreaN-17 Creat-0.6 Na-121*
K-5.5* Cl-93* HCO3-23 AnGap-11
[**2158-8-28**] 12:53PM BLOOD Na-121* K-4.9 Cl-93*
[**2158-8-29**] 04:40AM BLOOD Glucose-77 UreaN-14 Creat-0.4 Na-123*
K-4.9 Cl-97
HCO3-20* AnGap-11

[**2158-8-22**] 01:25PM BLOOD ALT-41* AST-137* LD(LDH)-285*
AlkPhos-153* TotBili-4.0*
[**2158-8-23**] 06:05AM BLOOD ALT-43* AST-141* AlkPhos-160*
TotBili-4.4*
[**2158-8-24**] 06:50AM BLOOD ALT-39 AST-121* AlkPhos-152* TotBili-4.4*
[**2158-8-25**] 06:19AM BLOOD ALT-49* AST-147* AlkPhos-152*
TotBili-4.9*
[**2158-8-26**] 06:20AM BLOOD ALT-48* AST-140* AlkPhos-154*
TotBili-5.2*
[**2158-8-27**] 03:17AM BLOOD ALT-47* AST-145* LD(LDH)-272*
AlkPhos-166* TotBili-4.5*
[**2158-8-29**] 04:40AM BLOOD ALT-41* AST-125* AlkPhos-154*
TotBili-2.7*

[**2158-8-25**] 12:50PM BLOOD Lipase-155*

[**2158-8-22**] 01:25PM BLOOD Albumin-3.6 Calcium-8.8 Phos-2.8 Mg-2.0
[**2158-8-23**] 06:05AM BLOOD Albumin-3.8 Calcium-8.8 Phos-3.5 Mg-1.9
[**2158-8-27**] 03:17AM BLOOD Albumin-3.3* Calcium-9.0 Phos-3.1 Mg-2.1

[**2158-8-28**] 05:46AM BLOOD Calcium-8.6 Phos-3.5 Mg-1.8
[**2158-8-29**] 04:40AM BLOOD Calcium-7.7* Phos-3.0 Mg-1.6

[**2158-8-26**] 06:20AM BLOOD TSH-0.92

[**2158-8-23**] 06:05AM BLOOD Cortsol-17.7

[**2158-8-25**] 06:19AM BLOOD AFP-5.8

[**2158-8-26**] 09:07PM BLOOD Type-ART pO2-101 pCO2-31* pH-7.50*
calTCO2-25 Base XS-2

[**2158-8-26**] 04:00PM URINE Color-Yellow Appear-Hazy Sp [**Last Name (un) **]-1.010
[**2158-8-26**] 04:00PM URINE Blood-NEG Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.5 Leuks-MOD
[**2158-8-26**] 04:00PM URINE RBC-<1 WBC-38* Bacteri-MOD Yeast-NONE
Epi-13 TransE-1
[**2158-8-26**] 04:00PM URINE CastHy-15*
[**2158-8-22**] 03:19PM URINE Hours-RANDOM UreaN-623 Creat-53 Na-66
K-41 Cl-46
[**2158-8-24**] 12:41PM URINE Hours-RANDOM UreaN-532 Na-23 K-28 Cl-30
[**2158-8-26**] 04:00PM URINE Hours-RANDOM UreaN-466 Creat-83 Na-<10
K-26 Cl-<10
[**2158-8-29**] 02:30PM URINE Hours-RANDOM UreaN-577 Na-11

[**2158-8-22**] 03:19PM URINE Osmolal-499
[**2158-8-24**] 12:41PM URINE Osmolal-364
[**2158-8-26**] 04:00PM URINE Osmolal-311
[**2158-8-29**] 02:30PM URINE Osmolal-353

Brief Hospital Course:
71yo F with HTN, HLD, cryptogenic cirrhosis with portal HTN who
p/w hyponatremia, fatigue.  Hyponatremia refractory to fluid
restriction and tolvaptan, now being transferred to MICU for
hypertonic saline administration.

# Hyponatremia: Etiology is consistent with hypovolemic
hyponatremia with nonosmotic adh release given massive weight
loss over past several weeks, as well as worsening Na in setting
of free water restriction.  Patient was treated with 3% normal
saline while in MICU with good response.  At time of MICU
transfer, serum Na was 118 from 109. Patient was started on NS @
75/hr at time of transfer. Na continued to improve and she felt
less fatigued and was d/c with a Na of 123. She should continue
fluid restriction at home, but hold diuretics because she was
slightly orthostatic morning of discharge.

# Cirrhosis: Cryptogenic cirrhosis. Not currently on transplant
list as being worked up for AS and PHTN. Will be discussed at
tumor conference on [**8-31**] due to newly diagnosed HCC.

# Hepatic Encephalopathy: Patient reports some confusion for the
2 days prior to admission. Her granddaughter believes she
stopped taking her Lactulose, patient is unsure. With regular
lactulose dosing her confusion resolved. However, she had some
diarrhea as an inpatient. Lactulose dose is to be decreased as
an outpatient to prevent encephalopathy but not to cause
diarrhea (goal 3-4BM a day).

# Hyperkalemia: presented with K 5.8. Cortisol was checked in
setting of hyponatremia as well (normal). 4.9 on discharge.

# Aortic Stenosis: Patient with late peaking SEM. Held
lisinopril in setting of  hyperkalemia.  Lisinopril restarted on
discharge, will require follow up electrolyte labs.

# Newly diagnosed HCC: Patient with new mass seen on CT.
Discussed that it was diagnostic for HCC and the likely
therapeutic options. Patient will be discussed at tumor board,
currently her cardiac status is being evaluated prior to being
considered for transplant.

Transition Issues:
# Electrolytes: Patient will require electrolytes to be checked
in setting of hyponatremia and hyperkalemia. Her diuretics are
currently being held, can be uptitrated as an outpatient. Her
Lisinopril was restarted.

# Cirrhosis/HCC: Patient will need hepatology follow up to
discuss her options for her cirrhosis and newly diagnosed HCC.

Medications on Admission:
ERGOCALCIFEROL (VITAMIN D2) - 50,000 unit capsule - 1 Capsule(s)
by mouth Q week x 12 weeks
LISINOPRIL - 5 mg tablet - 1 Tablet(s) by mouth once a day
SPIRONOLACTONE -  (Prescribed by Other Provider) - 50 mg tablet
-
3 Tablet(s) by mouth daily
TORSEMIDE - 20 mg tablet - 2 tablet(s) by mouth twice a day

Medications - OTC
ACETAMINOPHEN -  (Prescribed by Other Provider) - 650 mg tablet
extended release - 1 Tablet(s) by mouth no more than 3 tablets
daily as needed for arthritic pain (not to exceed [**2146**] mg in 24
hours)
ASCORBIC ACID -  (Prescribed by Other Provider) - 1,000 mg
tablet
- 1 Tablet(s) by mouth once a day
ASPIRIN -  (Prescribed by Other Provider) - 81 mg tablet,
chewable - 1 Tablet(s) by mouth daily
CALCIUM CARBONATE [CALCIUM 500] -  (Prescribed by Other
Provider)
- 500 mg calcium (1,250 mg) tablet - 1 Tablet(s) by mouth once a
day
CHOLECALCIFEROL (VITAMIN D3) -  (Prescribed by Other Provider) -
1,000 unit capsule - 1 Capsule(s) by mouth once a day
.

Discharge Medications:
1. Lisinopril 5 mg PO DAILY
2. Acetaminophen 325 mg PO Q6H:PRN pain
do not exceed 2g in 24 hour perior
3. Ascorbic Acid 1000 mg PO DAILY
4. Aspirin 81 mg PO DAILY
5. Calcium Carbonate 500 mg PO DAILY
6. Lactulose 15 mL PO TID
7. Outpatient Lab Work
Please perform Chem10 within two days of discharge


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Primary diagnosis:

Hyponatremia

Secondary diagnosis:

Hepatocellular carcinoma
Diarrhea


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


Discharge Instructions:
Dear Ms. [**Known lastname 25699**],

It was a pleasure caring for you at [**Hospital1 18**].  You came for further
evaluation of low sodium levels.  This was corrected with IV
fluids and oral fluid restriction.  You are now being discharged
home with visiting nurse services and physical therapy.  The
liver mass noted on imaging while you were admitted will be
followed up by your primary care doctor and liver doctor.  It is
important that you follow up with your appointments listed below
and continue to take your medications as prescribed.

The following changes have been made to your medications:

We STOPPED torsemide and spironolactone (Aldactone) because we
feel that you were dehydrated while you were here.  Your doctors
[**Name5 (PTitle) **] [**Name5 (PTitle) **] [**Name5 (PTitle) **] when to resume these medications in the future.
We DECREASED your lactulose dosing

Followup Instructions:
Name: [**Last Name (LF) **],[**First Name3 (LF) 251**] T.
Location: [**Hospital3 **] INTERNAL MEDICINE ASSOCIATES
Address: [**Street Address(2) 4472**], [**Apartment Address(1) 4473**], [**Hospital1 **],[**Numeric Identifier 9331**]
Phone: [**Telephone/Fax (1) 4475**]
Appt:  Thursday, [**8-31**] at 11:30am

Department: TRANSPLANT
With: [**Name6 (MD) 1382**] [**Name8 (MD) 1383**], MD [**Telephone/Fax (1) 673**]
Building: LM [**Hospital Unit Name **] [**Location (un) **]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage
***The office is working on an appt for you and will call you at
home with the appt.  IF you dont hear from them by tomorrow
afternoon, please call them directly to book.

Department: CARDIAC SERVICES
When: THURSDAY [**2158-12-7**] at 10:20 AM
With: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], MD [**Telephone/Fax (1) 62**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage


                             [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**MD Number(1) 1379**]
{'Hyposmolality and/or hyponatremia,Hepatic encephalopathy,Malignant neoplasm of liver, primary,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Cirrhosis of liver without mention of alcohol,Diarrhea,Other and unspecified hyperlipidemia,Aortic valve disorders,Osteoporosis, unspecified,Personal history of pulmonary embolism,Hip joint replacement'}


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: fatigue/ hyponatremia

PRESENT ILLNESS: 71F with a pmHx cryptogenic cirrhosis c/b portal HTN and most
recent EGD in [**6-/2157**] showing varices, h/o moderate AS, admitted
on [**2158-8-22**] for hyponatremia.  Pt was seen in liver clinic and
found to be fatigued with Na of 119 (baseline in low 130s).

MEDICAL HISTORY: 1. Cirrhosis with portal hypertension
2. Hypertension.
3. Hyperlipidemia (monitored only.)
4. Reported history of UC diagnosed 3 years ago on colonoscopy,

MEDICATION ON ADMISSION: ERGOCALCIFEROL (VITAMIN D2) - 50,000 unit capsule - 1 Capsule(s)
by mouth Q week x 12 weeks
LISINOPRIL - 5 mg tablet - 1 Tablet(s) by mouth once a day
SPIRONOLACTONE -  (Prescribed by Other Provider) - 50 mg tablet
-
3 Tablet(s) by mouth daily
TORSEMIDE - 20 mg tablet - 2 tablet(s) by mouth twice a day

ALLERGIES: Codeine / Percocet

PHYSICAL EXAM: ADMISSION EXAM
VS: 97.8, 127/65, p71 r18 100RA
GENERAL: Well appearing in NAD.  AOx3.
HEENT: Sclera anicteric. MMM.
CARDIAC: RRR with late peaking SEM heard best at the RUSB, but
heard throughout the precordium
LUNGS: mild bibasilar crackles
ABDOMEN: Soft, non-tender to palpation. Dullness to percussion
over dependent areas but tympanic anteriorly. No HSM or
tenderness appreciated.
EXTREMITIES: no edema.  Warm and well perfused, no clubbing or
cyanosis. <2s cap refill
NEUROLOGY: no asterixis, CN 2-12 grossly intact

FAMILY HISTORY: No liver disease in family.

SOCIAL HISTORY: She lives alone. No history of alcohol excess. Lifelong
nonsmoker. Competent of all ADLS IADLS. Previously worked as a
jewelry maker and [**Hospital Ward Name **]. 

### Response:
{'Hyposmolality and/or hyponatremia,Hepatic encephalopathy,Malignant neoplasm of liver, primary,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Cirrhosis of liver without mention of alcohol,Diarrhea,Other and unspecified hyperlipidemia,Aortic valve disorders,Osteoporosis, unspecified,Personal history of pulmonary embolism,Hip joint replacement'}
