CHIEF COMPLAINT: hypotension

PRESENT ILLNESS: 51 yo F paraplegic with multiple prior admissions for PNA and
UTI complicated by sepsis presented to the ED with three days of
worsening lethargy and difficulty breathing. Her husband states
that the pt started noticing foul smelling urine and lethargy on
friday (3 days PTA). She called her PCP's Office and had a
UA/UCx done at an outside clinic--she did not start any Abx at
that time. She had no symptoms of UTI as she straight caths q4h
and has no sensation in the area at baseline. Lethargy and
productive cough worsened over the weekend until late last night
when the patient produced dark sputum and had O2 sat of 82% at
home.
.
Since her MVA in [**2143**], she has been hospitalized 15 times,
almost all of these admissions have been for UTI/PNA and many of
them have involved MICU stays. She was most recently discharged
from [**Hospital1 18**] in [**2147-10-3**]; she was admitted for PNA and UTI,
underwent a prolonged intubation & tracheostomy & had a PEA
arrest.
.
In the ED, initial VS: 98.1, HR=102, 84/49, 16, 80% room air.
She was placed on non-rebreather and given 2L NS with little
effect on her BP. RIJ CVL was placed in the ED and pt was
started on levophed. Pt was noted to be increasingly lethargic,
blood gas notable for hypercapnea & acidosis (7.14/84/151). She
was intubated in the ED. In total, she received, 7L normal
saline, levophed, nebs, zosyn, vanco, fentanyl/versed prior to
transfer to the MICU.
.
On arrival to the MICU, BP=150/90 on a-line with HR in 80s-90s.
Levophed was weaned quickly. Initial CVP was [**11-13**] & CXR was
notable for pulmonary vascular congestion with possible focal
areas of infiltrate in the LUL and RML.
.
Review of prior Micro data revealed that during her most recent
hospitalization in [**Month (only) **] [**Numeric Identifier 66979**], her sputum grew pan-sensitive
kleb and MRSA. In [**2147-6-2**], her urine had grown [**Year (4 digits) 40097**] Kleb. UA
and UCx were obtained from the outside clinic where she had sent
urine on friday, this showed Citrobacter freundii resistant to
cefazolin and flouroquinolones, and senitive to Imipenem but
with only MIC<=4.
.
ROS: Pt unable to answer, but per her husband, she had
experienced some shoulder and neck aching, no subjective fevers
at home, no focal weakness. Had not c/o photophobia. No recent
sick contacts---they screen visitors given pt's frail health,
but she had been out in public recently and had been to MD
office visits.

MEDICAL HISTORY: 1. T1-T2 paraplegia following MVC [**1-5**]
2. Recurrent UTIs: [**Month/Year (2) 40097**] klebsiella
3. HCV, viral load suppressed
4. H/o recurrent PNAs: MRSA, pan-sensitive Kleb
5. Anxiety
6. DVT in [**2142**] -IVC filter placed in [**2142**]
7. Pulmonary nodules
8. Hypothyroidism
9. Chronic pain
10. Chronic gastritis
11. H/o obstructive lung disease
12. Anemia of chronic disease
13. S/p PEA arrest during last hospitalization in [**2147-10-3**]

MEDICATION ON ADMISSION: albuterol neb prn
baclofen 20mg qam, 10mg noon, 20mg qhs
citalopram 40mg daily
clonazepam 1mg qid prn, 2mg qhs
fluconazole 150mg qd prn yeast infxn
combivent 2 puffs tid
levothyroxine 75mcg qd
methadone 5mg tid
omeprazole 20mg [**Hospital1 **]
oxybutynin 10mg qam, 5mg noon, 10mg qhs
oxycodone 5mg q4-6h prn
lyrica 150mg tid
carafate 1g qid
trazodone 200mg qhs
calcium 500mg [**Hospital1 **]
cranberry extract 500mg [**Hospital1 **]
loratadine 10mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals - afebrile, BP 95/60, HR 70s
GENERAL: Sitting up in bed in no apparent distress
CARDIAC: normal S1/S2, no murmurs appreciable
LUNG: clear bilaterally, no rales noted
ABDOMEN: soft and nontender
EXT: no lower extremity edema
NEURO: alert and oriented X3

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: The patient currently lives at home wiht her husband and 2
children, ages 15 and 22. Former 35 packyear smoker. Denies
current tobacco or alcohol use.
Other septicemia due to gram-negative organisms,Methicillin resistant pneumonia due to Staphylococcus aureus,Acute respiratory failure,Other encephalopathy,Chronic airway obstruction, not elsewhere classified,Infection and inflammatory reaction due to indwelling urinary catheter,Urinary tract infection, site not specified,Other primary cardiomyopathies,Paraplegia,Severe sepsis,Late effect of spinal cord injury,Congestive heart failure, unspecified,Tracheostomy status,Urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Late effects of motor vehicle accident,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group C,Other chronic pain,Dysthymic disorder,Unspecified acquired hypothyroidism,Atrophic gastritis, without mention of hemorrhage,Anemia of other chronic disease,Personal history of venous thrombosis and embolism,Other postprocedural status
Gram-neg septicemia NEC,Meth res pneu d/t Staph,Acute respiratry failure,Encephalopathy NEC,Chr airway obstruct NEC,React-indwell urin cath,Urin tract infection NOS,Prim cardiomyopathy NEC,Paraplegia NOS,Severe sepsis,Late eff spinal cord inj,CHF NOS,Tracheostomy status,Abn react-urinary cath,Late eff motor vehic acc,Streptococcus group c,Chronic pain NEC,Dysthymic disorder,Hypothyroidism NOS,Atrph gastrtis w/o hmrhg,Anemia-other chronic dis,Hx-ven thrombosis/embols,Post-proc states NEC
Admission Date:  [**2147-12-18**]              Discharge Date:   [**2148-1-3**]

Date of Birth:  [**2096-10-22**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3151**]
Chief Complaint:
hypotension

Major Surgical or Invasive Procedure:
intubation, CVL

History of Present Illness:
51 yo F paraplegic with multiple prior admissions for PNA and
UTI complicated by sepsis presented to the ED with three days of
worsening lethargy and difficulty breathing. Her husband states
that the pt started noticing foul smelling urine and lethargy on
friday (3 days PTA). She called her PCP's Office and had a
UA/UCx done at an outside clinic--she did not start any Abx at
that time. She had no symptoms of UTI as she straight caths q4h
and has no sensation in the area at baseline. Lethargy and
productive cough worsened over the weekend until late last night
when the patient produced dark sputum and had O2 sat of 82% at
home.
.
Since her MVA in [**2143**], she has been hospitalized 15 times,
almost all of these admissions have been for UTI/PNA and many of
them have involved MICU stays. She was most recently discharged
from [**Hospital1 18**] in [**2147-10-3**]; she was admitted for PNA and UTI,
underwent a prolonged intubation & tracheostomy & had a PEA
arrest.
.
In the ED, initial VS: 98.1, HR=102, 84/49, 16, 80% room air.
She was placed on non-rebreather and given 2L NS with little
effect on her BP. RIJ CVL was placed in the ED and pt was
started on levophed. Pt was noted to be increasingly lethargic,
blood gas notable for hypercapnea & acidosis (7.14/84/151). She
was intubated in the ED. In total, she received, 7L normal
saline, levophed, nebs, zosyn, vanco, fentanyl/versed prior to
transfer to the MICU.
.
On arrival to the MICU, BP=150/90 on a-line with HR in 80s-90s.
Levophed was weaned quickly. Initial CVP was [**11-13**] & CXR was
notable for pulmonary vascular congestion with possible focal
areas of infiltrate in the LUL and RML.
.
Review of prior Micro data revealed that during her most recent
hospitalization in [**Month (only) **] [**Numeric Identifier 66979**], her sputum grew pan-sensitive
kleb and MRSA. In [**2147-6-2**], her urine had grown [**Year (4 digits) 40097**] Kleb. UA
and UCx were obtained from the outside clinic where she had sent
urine on friday, this showed Citrobacter freundii resistant to
cefazolin and flouroquinolones, and senitive to Imipenem but
with only MIC<=4.
.
ROS: Pt unable to answer, but per her husband, she had
experienced some shoulder and neck aching, no subjective fevers
at home, no focal weakness. Had not c/o photophobia. No recent
sick contacts---they screen visitors given pt's frail health,
but she had been out in public recently and had been to MD
office visits.


Past Medical History:
1. T1-T2 paraplegia following MVC [**1-5**]
2. Recurrent UTIs: [**Month/Year (2) 40097**] klebsiella
3. HCV, viral load suppressed
4. H/o recurrent PNAs: MRSA, pan-sensitive Kleb
5. Anxiety
6. DVT in [**2142**] -IVC filter placed in [**2142**]
7. Pulmonary nodules
8. Hypothyroidism
9. Chronic pain
10. Chronic gastritis
11. H/o obstructive lung disease
12. Anemia of chronic disease
13. S/p PEA arrest during last hospitalization in [**2147-10-3**]


Social History:
The patient currently lives at home wiht her husband and 2
children, ages 15 and 22. Former 35 packyear smoker. Denies
current tobacco or alcohol use.


Family History:
Non-contributory.

Physical Exam:
Vitals - afebrile, BP 95/60, HR 70s
GENERAL: Sitting up in bed in no apparent distress
CARDIAC: normal S1/S2, no murmurs appreciable
LUNG: clear bilaterally, no rales noted
ABDOMEN: soft and nontender
EXT: no lower extremity edema
NEURO: alert and oriented X3


Pertinent Results:
[**2147-12-18**] 11:05AM BLOOD WBC-6.2 RBC-3.96*# Hgb-11.0*# Hct-34.3*#
MCV-87 MCH-27.8 MCHC-32.1 RDW-15.8* Plt Ct-202
[**2147-12-18**] 11:05AM BLOOD Neuts-86* Bands-1 Lymphs-7* Monos-5 Eos-1
Baso-0 Atyps-0 Metas-0 Myelos-0
[**2147-12-19**] 05:33AM BLOOD PT-18.1* PTT-35.5* INR(PT)-1.6*
[**2147-12-19**] 05:33AM BLOOD Fibrino-525*#
[**2147-12-18**] 11:05AM BLOOD Glucose-124* UreaN-10 Creat-0.5 Na-137
K-4.9 Cl-99 HCO3-32 AnGap-11
[**2147-12-18**] 03:08PM BLOOD Glucose-227* UreaN-7 Creat-0.3* Na-146*
K-3.5 Cl-114* HCO3-26 AnGap-10
[**2147-12-18**] 11:05AM BLOOD Calcium-9.0 Phos-3.9 Mg-1.8
[**2147-12-19**] 05:33AM BLOOD Hapto-208*
[**2147-12-18**] 12:19PM BLOOD Type-ART FiO2-100 pO2-151* pCO2-84*
pH-7.14* calTCO2-30 Base XS--2 AADO2-494 REQ O2-81 Intubat-NOT
INTUBA Comment-FM
[**2147-12-18**] 04:17PM BLOOD Type-ART pO2-112* pCO2-47* pH-7.25*
calTCO2-22 Base XS--6
[**2147-12-18**] 11:18AM BLOOD Glucose-125* Lactate-1.8 Na-139 K-4.5
Cl-92*
[**2147-12-18**] 04:17PM BLOOD Lactate-2.4*
[**2147-12-18**] 10:14PM BLOOD Lactate-1.5
.
Imaging:
Echo:
The left atrium is dilated. Left ventricular wall thickness,
cavity size and regional/global systolic function are normal
(LVEF >55%). There is no ventricular septal defect. Right
ventricular chamber size and free wall motion are normal. The
number of aortic valve leaflets cannot be determined. There is
no aortic valve stenosis. No aortic regurgitation is seen. The
mitral valve appears structurally normal with trivial mitral
regurgitation. There is no mitral valve prolapse. There is
borderline pulmonary artery systolic hypertension. There is a
trivial/physiologic pericardial effusion. There are no
echocardiographic signs of tamponade.
.
MRI Head:
FINDINGS: There are bilateral confluent areas of
hyperintensities seen in the parietooccipital lobes and a small
focus of hyperintensity is seen in the left thalamus consistent
with posterior reversible encephalopathy. No evidence of
restricted diffusion seen in these regions. There is no midline
shift or hydrocephalus. Mild-to-moderate brain atrophy is seen.
Suprasellar and craniocervical regions are normal on the
sagittal images. The vascular flow voids are maintained. Small
amount of fluid is seen in the left mastoid air cells.
IMPRESSION: Bilateral parietooccipital white matter
hyperintensities also
involving [**Doctor Last Name 352**] matter consistent with posterior reversible
encephalopathy. No evidence of restricted diffusion seen.



Brief Hospital Course:
51 yo F paraplegic with a hx of recurrent UTIs, PNAs, sepsis,
presenting with 3 days of UTI (with + urine culture) and
worsening productive cough/hypoxia likely representing PNA, who
developed PRES in ICU setting.
.
# PNA: Patient presented in hypoxic & hypercapneic respiratory
failure, requiring intubation in ED. CXR was notable for
pulmonary vascular congestion with possible focal areas of
infiltrate in the LUL and RML. Patient received empiric
vanco/zosyn. She briefly required levophed, which was weaned at
arrival to the MICU. Given recent hospitalization in [**Month (only) **] and
MRSA in sputum, she was treated for healthcare associated PNA,
as well as for UTI, with vancomycin, meropenema and gentamycin.
She completed a 7 day course of vanco and gent, and 14 d of
meropenem.
On [**12-25**], she was extubated, but given her sedation and
incresed work of breathing, she was reintubated.  The
possibility of a tracheostomy was raised but apparently the
patient refused.
The patient was educated about good airway clearance. She
received chest PT and was able to provide good coughing on her
own. 02 sat was 94-95% on room air at discharge.
.
#PRES:  Patient became hypertensive to the 180s in the MICU
setting and was started on IV hydralazine. On [**12-29**], she
developed a severe headache with binocular blindness and
decreased facial sensation in the setting of high blood
pressures; CT and MRI were consistent with diagnosis of PRES
syndrome.  Neurology was consulted who recommended a blood
pressure between 120 and 140.  Chlorthalidone was started and BP
remained largely within goal range, with some blood pressure in
90-100s. Headache and vision greatly improved by discharge.
Neurology recommended follow-up MRI in 2 weeks and neuro clinic,
as well as [**Hospital 2081**] clinic appointments. The patient was instructed
to continue chlorthalidone and check BP at home twice daily. Dr.
[**Last Name (STitle) 665**] and neurology will determine need for continued
antihypertensives at home.
.
# UTI: Patient has h/o recurrent UTI [**3-6**] self-catheterization.
Urine culture Citrobacter Freundii, sensitive to Meropenem with
MIC < 4. ID recommended meropenem and gentamycin for synergy.
Completed 14 day course.
.
# ANEMIA: Stable. History of anemia of chronic disease. No
transfusions required.
.
# S/p traumatic spine injury/chronic pain: Initially held
methadone, oxycodone, oxybutynin, Klonapin. All meds restarted
prior to discharge.
.
# Hypothyroidism: continued home levothyroxine
.
# Hepatitis C: negative VL recently


Medications on Admission:
albuterol neb prn
baclofen 20mg qam, 10mg noon, 20mg qhs
citalopram 40mg daily
clonazepam 1mg qid prn, 2mg qhs
fluconazole 150mg qd prn yeast infxn
combivent 2 puffs tid
levothyroxine 75mcg qd
methadone 5mg tid
omeprazole 20mg [**Hospital1 **]
oxybutynin 10mg qam, 5mg noon, 10mg qhs
oxycodone 5mg q4-6h prn
lyrica 150mg tid
carafate 1g qid
trazodone 200mg qhs
calcium 500mg [**Hospital1 **]
cranberry extract 500mg [**Hospital1 **]
loratadine 10mg daily


Discharge Medications:
1. Baclofen 10 mg Tablet [**Hospital1 **]: One (1) Tablet PO QID (4 times a
day).
2. Citalopram 40 mg Tablet [**Hospital1 **]: One (1) Tablet PO once a day.
3. Levothyroxine 75 mcg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY
(Daily).
4. Pregabalin 150 mg Capsule [**Hospital1 **]: One (1) Capsule PO three times
a day.
5. Sucralfate 1 gram Tablet [**Hospital1 **]: One (1) Tablet PO QID (4 times
a day).
6. Senna 8.6 mg Tablet [**Hospital1 **]: 1-2 Tablets PO BID (2 times a day)
as needed for Constipation.
7. Polyethylene Glycol 3350 17 gram/dose Powder [**Hospital1 **]: One (1)  PO
DAILY (Daily) as needed for constipation.
8. Docusate Sodium 100 mg Capsule [**Hospital1 **]: One (1) Capsule PO BID (2
times a day).
9. Chlorthalidone 25 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
10. Trazodone 100 mg Tablet [**Hospital1 **]: 1-2 Tablets PO HS (at bedtime).

11. Oxycodone 5 mg Tablet [**Hospital1 **]: One (1) Tablet PO Q6H (every 6
hours) as needed for pain.
12. Oxybutynin Chloride 5 mg Tablet [**Hospital1 **]: Two (2) Tablet PO BID
(2 times a day).
13. Oxybutynin Chloride 5 mg Tablet [**Hospital1 **]: One (1) Tablet PO QPM
(once a day (in the evening)).
14. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization [**Hospital1 **]: One (1)  Inhalation Q4H (every 4 hours) as
needed for wheeze, sob.
15. Clonazepam 1 mg Tablet [**Hospital1 **]: One (1) Tablet PO four times a
day as needed for restlessness, agitation.
16. Combivent 18-103 mcg/Actuation Aerosol [**Hospital1 **]: Two (2) puffs
Inhalation three times a day.
17. Methadone 5 mg Tablet [**Hospital1 **]: One (1) Tablet PO TID (3 times a
day).
18. Omeprazole 20 mg Capsule, Delayed Release(E.C.) [**Hospital1 **]: One (1)
Capsule, Delayed Release(E.C.) PO twice a day.
19. Calcium Carbonate 500 mg Capsule [**Hospital1 **]: One (1) Capsule PO
twice a day.
20. Cranberry Extract 500 mg Capsule [**Hospital1 **]: One (1) Capsule PO
twice a day.


Discharge Disposition:
Home

Discharge Diagnosis:
primary:
urosepsis
healthcare associated pneumonia
PRES (posterior reversible encephalopathy syndrome)


Discharge Condition:
Mental Status:Clear and coherent
Level of Consciousness:Alert and interactive
Activity Status:Out of Bed with assistance to chair or
wheelchair


Discharge Instructions:
It was a pleasure taking care of you. You were admitted for
urinary tract infection and pneumonia. You required intubation
for the pneumonia. You are at especially high risk for pneumonia
and should work on deep breathing and good coughing to clear
your lungs. You received antibiotics and improved.
You also had a syndrome called PRES, which caused vision loss
and headache. This occurred because your blood pressure
increased causing swelling in the back of your brain. This
syndrome gets better on its own and you will follow up with
neurology and opthalmology to make sure you completely recover.
You will need another MRI in 2 weeks. You will continue to take
chlorthalidone to control your blood pressure until you see Dr.
[**Last Name (STitle) 665**]. Please check your blood pressure twice a day and make a
record to show Dr. [**Last Name (STitle) 665**].

Followup Instructions:
Appointment #1
MD: Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
Specialty: [**Hospital3 **] Post [**Hospital **] Clinic
Date/ Time: Monday, [**1-15**] at 1:50pm
Location: [**Hospital3 **], [**Hospital Ward Name 23**] Clinical Center, [**Apartment Address(1) **] Central, [**Location (un) 830**], [**Location (un) 86**]
Phone number: [**Telephone/Fax (1) 250**]
Special instructions for patient: This appointment is for follow
up to your hospitalization (Dr [**Last Name (STitle) 665**] not available that day
but will check his schedule and call you).

Appointment #2
MD:
Specialty: MRI
Date/ Time: Thursday, [**1-11**] at 3:55pm
Location: [**Hospital Ward Name 23**] Clinical Center, [**Location (un) **] radiology, [**Location (un) **], [**Location (un) 86**]
Phone number: [**Telephone/Fax (1) 327**]

Appointment #3
MD: Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
Specialty: Neurology
Date/ Time: [**1-15**] at 4pm
Location: [**Hospital Ward Name 23**] Clinical Center, [**Location (un) **], [**Location (un) 3387**], [**Location (un) 86**]
Phone number: [**Telephone/Fax (1) 44**]

You may call the [**Hospital 464**] clinic to make an appointment at
your convenience. [**Telephone/Fax (1) 253**]
{'Other septicemia due to gram-negative organisms,Methicillin resistant pneumonia due to Staphylococcus aureus,Acute respiratory failure,Other encephalopathy,Chronic airway obstruction, not elsewhere classified,Infection and inflammatory reaction due to indwelling urinary catheter,Urinary tract infection, site not specified,Other primary cardiomyopathies,Paraplegia,Severe sepsis,Late effect of spinal cord injury,Congestive heart failure, unspecified,Tracheostomy status,Urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Late effects of motor vehicle accident,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group C,Other chronic pain,Dysthymic disorder,Unspecified acquired hypothyroidism,Atrophic gastritis, without mention of hemorrhage,Anemia of other chronic disease,Personal history of venous thrombosis and embolism,Other postprocedural status'}


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: hypotension

PRESENT ILLNESS: 51 yo F paraplegic with multiple prior admissions for PNA and
UTI complicated by sepsis presented to the ED with three days of
worsening lethargy and difficulty breathing. Her husband states
that the pt started noticing foul smelling urine and lethargy on
friday (3 days PTA). She called her PCP's Office and had a
UA/UCx done at an outside clinic--she did not start any Abx at
that time. She had no symptoms of UTI as she straight caths q4h
and has no sensation in the area at baseline. Lethargy and
productive cough worsened over the weekend until late last night
when the patient produced dark sputum and had O2 sat of 82% at
home.
.
Since her MVA in [**2143**], she has been hospitalized 15 times,
almost all of these admissions have been for UTI/PNA and many of
them have involved MICU stays. She was most recently discharged
from [**Hospital1 18**] in [**2147-10-3**]; she was admitted for PNA and UTI,
underwent a prolonged intubation & tracheostomy & had a PEA
arrest.
.
In the ED, initial VS: 98.1, HR=102, 84/49, 16, 80% room air.
She was placed on non-rebreather and given 2L NS with little
effect on her BP. RIJ CVL was placed in the ED and pt was
started on levophed. Pt was noted to be increasingly lethargic,
blood gas notable for hypercapnea & acidosis (7.14/84/151). She
was intubated in the ED. In total, she received, 7L normal
saline, levophed, nebs, zosyn, vanco, fentanyl/versed prior to
transfer to the MICU.
.
On arrival to the MICU, BP=150/90 on a-line with HR in 80s-90s.
Levophed was weaned quickly. Initial CVP was [**11-13**] & CXR was
notable for pulmonary vascular congestion with possible focal
areas of infiltrate in the LUL and RML.
.
Review of prior Micro data revealed that during her most recent
hospitalization in [**Month (only) **] [**Numeric Identifier 66979**], her sputum grew pan-sensitive
kleb and MRSA. In [**2147-6-2**], her urine had grown [**Year (4 digits) 40097**] Kleb. UA
and UCx were obtained from the outside clinic where she had sent
urine on friday, this showed Citrobacter freundii resistant to
cefazolin and flouroquinolones, and senitive to Imipenem but
with only MIC<=4.
.
ROS: Pt unable to answer, but per her husband, she had
experienced some shoulder and neck aching, no subjective fevers
at home, no focal weakness. Had not c/o photophobia. No recent
sick contacts---they screen visitors given pt's frail health,
but she had been out in public recently and had been to MD
office visits.

MEDICAL HISTORY: 1. T1-T2 paraplegia following MVC [**1-5**]
2. Recurrent UTIs: [**Month/Year (2) 40097**] klebsiella
3. HCV, viral load suppressed
4. H/o recurrent PNAs: MRSA, pan-sensitive Kleb
5. Anxiety
6. DVT in [**2142**] -IVC filter placed in [**2142**]
7. Pulmonary nodules
8. Hypothyroidism
9. Chronic pain
10. Chronic gastritis
11. H/o obstructive lung disease
12. Anemia of chronic disease
13. S/p PEA arrest during last hospitalization in [**2147-10-3**]

MEDICATION ON ADMISSION: albuterol neb prn
baclofen 20mg qam, 10mg noon, 20mg qhs
citalopram 40mg daily
clonazepam 1mg qid prn, 2mg qhs
fluconazole 150mg qd prn yeast infxn
combivent 2 puffs tid
levothyroxine 75mcg qd
methadone 5mg tid
omeprazole 20mg [**Hospital1 **]
oxybutynin 10mg qam, 5mg noon, 10mg qhs
oxycodone 5mg q4-6h prn
lyrica 150mg tid
carafate 1g qid
trazodone 200mg qhs
calcium 500mg [**Hospital1 **]
cranberry extract 500mg [**Hospital1 **]
loratadine 10mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals - afebrile, BP 95/60, HR 70s
GENERAL: Sitting up in bed in no apparent distress
CARDIAC: normal S1/S2, no murmurs appreciable
LUNG: clear bilaterally, no rales noted
ABDOMEN: soft and nontender
EXT: no lower extremity edema
NEURO: alert and oriented X3

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: The patient currently lives at home wiht her husband and 2
children, ages 15 and 22. Former 35 packyear smoker. Denies
current tobacco or alcohol use. 

### Response:
{'Other septicemia due to gram-negative organisms,Methicillin resistant pneumonia due to Staphylococcus aureus,Acute respiratory failure,Other encephalopathy,Chronic airway obstruction, not elsewhere classified,Infection and inflammatory reaction due to indwelling urinary catheter,Urinary tract infection, site not specified,Other primary cardiomyopathies,Paraplegia,Severe sepsis,Late effect of spinal cord injury,Congestive heart failure, unspecified,Tracheostomy status,Urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Late effects of motor vehicle accident,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group C,Other chronic pain,Dysthymic disorder,Unspecified acquired hypothyroidism,Atrophic gastritis, without mention of hemorrhage,Anemia of other chronic disease,Personal history of venous thrombosis and embolism,Other postprocedural status'}
