CHIEF COMPLAINT: recurrent fevers to 104, chills, and headache

PRESENT ILLNESS: This is a healthy 26 year old woman who presented with a 3 week
history of fever, headache, and dysuria. She was in her USOH
until about 3 weeks ago when she developed dysuria, followed
over three days by fever to 105 degrees and headache. She went
to [**Hospital **] [**Hospital 1459**] hospital and got blood cultures, UA which
was positive, and LP which was negative. She was discharged on
Augmentin for 10 days, and over the next few days felt much
better. A few days after stopping the augmentin, she has
developed recurrent fevers to 104, chills, and headache and came
to the [**Hospital1 18**] on [**2145-6-6**].
.
In the ED she was initially febrile to 103.1, tachycardic to
122, and hypotensive to 94/56. She initially received
approximately 5 liters of IVF for a bp of 76/50 and responded up
to the 100s-110s. Her UOP was excellent (approx 400 cc/hr),
lactate initially 1.4 and mental status appropriate. She was
given levofloxacin 500 mg po and admitted to medicine. Her bp
then dropped again to the 80s/50s and she was febrile to 103.8.
She was given 3 additional liters of fluid, given ceftriaxone,
and admitted to the MICU.
.

MEDICAL HISTORY: hydrosclerosis of hands
h/o UTI

MEDICATION ON ADMISSION: augmentin course recently completed
tylenol / motrin prn
OCP (though not last month)
robinul (for hydrosclerosis)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS-  T max 101.7, T 98.1 BP 95/53 RR 17 Sats 98%
I/O 350/2.5L
GEN- non apparent distress, pleasant
HEENT:moist oral mucouse, no oral lesions, no sinus tenderness.
NECK- Supple, no LAD, no JVP
CV- RRR, s1-s2 normal, slighly tachy, no m/r/g appreciated
Lungs: slightly decrease in the bases. no crackles.
ABD- soft, mild tenderness to palpation on the left upper
quadrant. No rebound. MIld costovertebral tenderness to
percussion.
EXT- Warm, good cap refill, no cyanosis or edema.
NEURO- AAO x 3 , MAEW, CN grossly intact

FAMILY HISTORY: Denies any kidney disease.

SOCIAL HISTORY: lives at home with her boyfriend. Denies tobacco. Rarely drinks
alcohol. Is a full-time student at [**Hospital1 498**] [**Location (un) 86**] and works
part-time as a banquet server. She is sexually active with her
boyfriend only, and uses barrier contraception most of the time.
Unspecified septicemia,Acute pyelonephritis without lesion of renal medullary necrosis,Unspecified pleural effusion,Congestive heart failure, unspecified,Pulmonary collapse,Pneumonia, organism unspecified,Sepsis,Anemia, unspecified,Tachycardia, unspecified
Septicemia NOS,Ac pyelonephritis NOS,Pleural effusion NOS,CHF NOS,Pulmonary collapse,Pneumonia, organism NOS,Sepsis,Anemia NOS,Tachycardia NOS
Admission Date:  [**2145-6-6**]              Discharge Date:   [**2145-6-11**]

Date of Birth:  [**2118-10-10**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 8487**]
Chief Complaint:
recurrent fevers to 104, chills, and headache

Major Surgical or Invasive Procedure:
None

History of Present Illness:
This is a healthy 26 year old woman who presented with a 3 week
history of fever, headache, and dysuria. She was in her USOH
until about 3 weeks ago when she developed dysuria, followed
over three days by fever to 105 degrees and headache. She went
to [**Hospital **] [**Hospital 1459**] hospital and got blood cultures, UA which
was positive, and LP which was negative. She was discharged on
Augmentin for 10 days, and over the next few days felt much
better. A few days after stopping the augmentin, she has
developed recurrent fevers to 104, chills, and headache and came
to the [**Hospital1 18**] on [**2145-6-6**].
.
In the ED she was initially febrile to 103.1, tachycardic to
122, and hypotensive to 94/56. She initially received
approximately 5 liters of IVF for a bp of 76/50 and responded up
to the 100s-110s. Her UOP was excellent (approx 400 cc/hr),
lactate initially 1.4 and mental status appropriate. She was
given levofloxacin 500 mg po and admitted to medicine. Her bp
then dropped again to the 80s/50s and she was febrile to 103.8.
She was given 3 additional liters of fluid, given ceftriaxone,
and admitted to the MICU.
.


Past Medical History:
hydrosclerosis of hands
h/o UTI


Social History:
lives at home with her boyfriend. Denies tobacco. Rarely drinks
alcohol. Is a full-time student at [**Hospital1 498**] [**Location (un) 86**] and works
part-time as a banquet server. She is sexually active with her
boyfriend only, and uses barrier contraception most of the time.

Family History:
Denies any kidney disease.


Physical Exam:
VS-  T max 101.7, T 98.1 BP 95/53 RR 17 Sats 98%
I/O 350/2.5L
GEN- non apparent distress, pleasant
HEENT:moist oral mucouse, no oral lesions, no sinus tenderness.
NECK- Supple, no LAD, no JVP
CV- RRR, s1-s2 normal, slighly tachy, no m/r/g appreciated
Lungs: slightly decrease in the bases. no crackles.
ABD- soft, mild tenderness to palpation on the left upper
quadrant. No rebound. MIld costovertebral tenderness to
percussion.
EXT- Warm, good cap refill, no cyanosis or edema.
NEURO- AAO x 3 , MAEW, CN grossly intact

Pertinent Results:
[**2145-6-6**] 11:03PM   LACTATE-0.8
[**2145-6-6**] 06:50PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.008
[**2145-6-6**] 06:50PM URINE  BLOOD-SM NITRITE-POS PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5
LEUK-SM
[**2145-6-6**] 06:50PM URINE  RBC-0-2 WBC-21-50* BACTERIA-MOD
YEAST-NONE EPI-[**4-11**]
[**2145-6-6**] 06:46PM   LACTATE-1.4
[**2145-6-6**] 06:35PM   GLUCOSE-163* UREA N-8 CREAT-0.7 SODIUM-136
POTASSIUM-3.3 CHLORIDE-100 TOTAL CO2-22 ANION GAP-17
[**2145-6-6**] 06:35PM   WBC-14.8* RBC-3.67* HGB-11.5* HCT-33.1*
MCV-90 MCH-31.4 MCHC-34.8 RDW-13.5
[**2145-6-6**] 06:35PM   NEUTS-88.0* BANDS-0 LYMPHS-6.7* MONOS-5.0
EOS-0.2 BASOS-0.2
[**2145-6-6**] 06:35PM   HYPOCHROM-NORMAL ANISOCYT-NORMAL
POIKILOCY-NORMAL MACROCYT-NORMAL MICROCYT-NORMAL
POLYCHROM-NORMAL
[**2145-6-6**] 06:35PM   PLT SMR-NORMAL PLT COUNT-264

Discharge Labs
HEMATOLOGIC calTIBC Ferritn TRF
[**2145-6-9**] 05:55AM    194* 188* 149*
 COMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct
[**2145-6-11**] 06:20AM    6.4 3.32* 10.3* 30.3* 92 31.0 33.8 14.2
321
RENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap
[**2145-6-11**] 06:20AM    88 6 0.6 139 3.8 104 25 14
ENZYMES & BILIRUBIN ALT AST LD(LDH) CK(CPK) AlkPhos Amylase
TotBili DirBili
[**2145-6-8**] 07:00AM    251 192     81   0.3

CHEST (PORTABLE AP)  [**2145-6-6**] 11:51 PM
HISTORY: Fever, pyelonephritis and hypotension.

IMPRESSION: AP chest reviewed in the absence of prior chest
radiographs:

Heart size top normal. Lungs clear. No pleural effusion.
.
CTA CHEST W&W/O C &RECONS; CT 100CC NON IONIC CONTRAST

CTA CHEST WITH IV CONTRAST: Pulmonary arteries enhance normally
without filling defect. Densely calcified right lung granuloma.
There are small bilateral pleural effusions with trace medial
bibasilar consolidation, most consistent with atelectasis. There
is septal fluid at the bases, suggesting a component of volume
overload/congestive heart failure. Prominent thymic tissue in
this young patient. No abnormal lymph nodes are seen throughout
the chest. The heart, pericardium, and great vessels are
otherwise unremarkable. Minimally prominent thymus, likely
within normal limits allowing for patient's age. Axial images
through the upper abdomen demonstrate no abnormalities. Bone
windows demonstrate no abnormalities.

MULTIPLANAR REFORMATS: Coronal and sagittal reformatted images
confirm the above findings.

IMPRESSION:
1) No pulmonary embolism.
2) Small bilateral pleural effusions with probable mild volume
overload/congestive heart failure.
3) Medial bibasilar consolidation, most consistent with
atelectasis. However, correlate with clinical picture if there
is suspicion for pneumonia or aspiration.
.

CTU (ABD/PEL) W/&W/O CONTRAST  [**2145-6-7**] 2:16 AM

CTU (ABD/PEL) W/&W/O CONTRAST; CT 150CC NONIONIC CONTRAST

Reason: r/o stone, r/o abscess, r/o hydro
Field of view: 36 Contrast: OPTIRAY

[**Hospital 93**] MEDICAL CONDITION:
26 year old woman with likley recurrent pyelo and abdominal
pain. Would like to rule out both stone and abscess - please do
with and without contrast.
REASON FOR THIS EXAMINATION:
r/o stone, r/o abscess, r/o hydro
CONTRAINDICATIONS for IV CONTRAST: None.

INDICATION: 26-year-old woman with likely recurrent pyelo and
abdominal pain, would like to rule out stone and abscess.

TECHNIQUE: Non-contrast and contrast-enhanced axial CT imaging
of the abdomen and pelvis was reviewed.

CT ABDOMEN WITH CONTRAST: The lung bases are clear, and the
visualized heart is normal. The liver enhances homogeneously
without focal lesions. The gallbladder, pancreas, spleen, small
bowel loops, and adrenals are normal. Multiple wedge-shaped
perfusion abnormalities are present within the left kidney that
are consistent with pyelonephritis. The right kidney
demonstrates a normal perfusion pattern. There is no evidence
for nephrolithiasis or ureterolithiasis. There is no
hydronephrosis. No perinephric fluid collections are identified.

CT PELVIS WITH CONTRAST: The distal ureters and bladder are
normal without evidence for obstruction. The uterus is normal,
no adnexal masses are identified. The rectum, and large bowel
are normal caliber. No pathologic adenopathy is present in the
abdomen and pelvis. There is no free fluid or free air in the
abdomen or pelvis.

BONE WINDOWS: Bone island is present within the left ischium,
otherwise the osseous structures are unremarkable.

IMPRESSION: Left pyelonephritis. No evidence for hydronephrosis,
stone, or perinephric abscess.
.
BILAT LOWER EXT VEINS  [**2145-6-8**] 1:42 PM

BILAT LOWER EXT VEINS

Reason: FEVER

[**Hospital 93**] MEDICAL CONDITION:
26 year old woman with fever and tachycardia
REASON FOR THIS EXAMINATION:
r/o DVT
DOPPLER ULTRASOUND STUDY OF BOTH LOWER LIMB VEINS

CLINICAL DETAILS: Evaluate for deep venous thrombosis.

FINDINGS: The right and left lower limb veins are patent and
compressible along their length. Phasic venous flow and
increased venous return with augmentation is demonstrated with
Doppler.

Incidental note is made of a small (8 mm x 7 mm x 1.9 cm
sagittal) cyst, directly adjacent to the lateral aspect of the
left knee joint, in the left fibular head. [**Month (only) 116**] represent a small
meniscal cyst for example.

CONCLUSION:

No right or left lower limb deep venous thrombosis.

.

CT PELVIS W/CONTRAST  [**2145-6-10**] 10:31 AM

INDICATION: 26-year-old woman with pyelonephritis, continuing to
spike fevers, also assess for pneumonia.

COMPARISONS: CT abdomen and pelvis of [**2145-6-7**] and CTA chest of
[**2145-6-7**].
TECHNIQUE: Axial MDCT images through the chest, abdomen, and
pelvis with oral and 150 cc of nonionic Optiray contrast. No
reformats were performed.

CT CHEST WITH IV CONTRAST: Stable appearance of small bilateral
pleural effusions. Left basilar atelectasis, less prominent than
on the prior study. The lungs are otherwise clear with the
exception of a small calcified granuloma in the right lung. The
heart, pericardium, and great vessels are normal. The pulmonary
arteries appear patent, though this is not a dedicated study to
assess for this. No abnormal lymphadenopathy in the chest.

CT ABDOMEN WITH IV CONTRAST: Again demonstrated is diffuse
hypoperfusing striations within the left kidney consistent with
pyelonephritis. There is a more focal area of underperfusion in
the upper pole of the left kidney, however, this is unchanged
from the prior CT. No hydronephrosis on the left. The right
kidney is normal in appearance. The liver, gallbladder, spleen,
pancreas, proximal small bowel are normal.

CT PELVIS WITH IV CONTRAST: The distal ureters, bladder, uterus,
and adnexa are unremarkable with the exception of a small likely
hemorrhagic cyst versus prominent follicle on the right. Small
amount of likely physiologic free fluid in the dependent pelvis.
No abnormal lymph nodes in the deep pelvis.

BONE WINDOWS: No osseous abnormalities.

IMPRESSION:
1) Left pyelonephritis, the CT appearance of which is not
significantly changed compared to [**2145-6-7**].
2) Small bilateral pleural effusions, also unchanged.
3) Left basilar atelectasis, improved.

.


Brief Hospital Course:
26 year old woman with pyelonephritis,  left sided abdominal
pain and systemic inflammatory response.
.
In the MICU, she was initially started on CTX, which was changed
to amp/gent while awaiting culture results and sensitivities.
She was aggressively fluid resuscitated, remained febrile and
tachycardic without any compromise in her BP. She never required
pressors.  She had a CTU which showed multiple wedge-shaped
perfusion defects in the left kidney consistent with
pyelonephritis. Renal US showed no nephrolithiasis or
hydronephrosis. Her electrolytes were repleted. Given persistent
tachycardia with some evidence of right heart strain on ECG, she
was taken for CTA that was negative for PE. It did showed small
bilateral pleural effusions and medial bibasilar consolidation,
most consistent with atelectasis. Vital signs improved and
patient was called out.
.
Patient was transfer to the floor.

#Pyelonephritis/SIRS: Urine Cultures showed E coli sensitive to
quinolones and also ceftriaxones. Admission Blood Cx also came
back positive for E coli. Patient was switched prior to leaving
the MICU to ceftriaxone and the follwing day was swith to PO
ciprofloxacine. She remained febrile for about 36 hours after
being transfered. Given this persitent fevers, another Ct
Abdomen was order looking for complications. Ct abdomen did not
showed worsening of disease. It also showed that the atelectasis
on the left lower lobe was improving. She eventually defervesed
and had remained afebrile more than 24 hours prior to discharge.
She was also given incentive spirometry to help improving his
atelectaisis. Subsequent blood cx from [**2145-6-8**] and [**2145-6-9**]
remained negative up to date of discharged. 3 subsequent urine
cx also negative finalized.
Patient was discharged with 11 more days of cyprofloxacine and
follow up in 15 days.
.
# Anemia: Patient with normocitic anemia. Her iron studies
showed low iron, low TIBC and slighlty elevated ferritin. Her
HCt initially dropped after initial fluid resucitation. She did
not required any blood transfusions. Her HCT slowly started to
trend up during hospitaliztion. Her iron studies showed very low
iron but also low TIBC. More likely anemia of chronic disease.
.
# FEN: Patient was kept on regular diet.
Electrolytes were repleated PRN
.
# Code: Full



Medications on Admission:
augmentin course recently completed
tylenol / motrin prn
OCP (though not last month)
robinul (for hydrosclerosis)

Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
Disp:*20 Tablet(s)* Refills:*0*
2. Ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed.
Disp:*20 Tablet(s)* Refills:*0*
3. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours) for 11 days.
Disp:*22 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
Left Pyelonephritis complicated by systemic inflammatory
response
Left lower lobe atelectasis and pleural effusion

Secondary:
Anemia of chronic disease


Discharge Condition:
Stable condition with resolution of fevers, chills, tachycardia,
and hypotension.


Discharge Instructions:
Please continue your medicatiosn as prescribed.
Please follow up your appointments as scheduled.
Please return to the hospital if you experience the following
symptoms: fever > 101.5, chills, nausea, vomiting, severe
abdominal or back pain,
Continue to use the incentive spirometer for one week and walk
several times per day.  Drink at least 8 glasses of fluid per
day.  Use tylenol and ibuprofen for pain and low grade fevers as
needed.


Followup Instructions:
Please follow-up with PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **], at the date and time
indicated below:
[**First Name4 (NamePattern1) 19243**] [**Name8 (MD) 19244**], MD Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2145-6-30**]
3:00



Completed by:[**2145-6-11**]
{'Unspecified septicemia,Acute pyelonephritis without lesion of renal medullary necrosis,Unspecified pleural effusion,Congestive heart failure, unspecified,Pulmonary collapse,Pneumonia, organism unspecified,Sepsis,Anemia, unspecified,Tachycardia, 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: recurrent fevers to 104, chills, and headache

PRESENT ILLNESS: This is a healthy 26 year old woman who presented with a 3 week
history of fever, headache, and dysuria. She was in her USOH
until about 3 weeks ago when she developed dysuria, followed
over three days by fever to 105 degrees and headache. She went
to [**Hospital **] [**Hospital 1459**] hospital and got blood cultures, UA which
was positive, and LP which was negative. She was discharged on
Augmentin for 10 days, and over the next few days felt much
better. A few days after stopping the augmentin, she has
developed recurrent fevers to 104, chills, and headache and came
to the [**Hospital1 18**] on [**2145-6-6**].
.
In the ED she was initially febrile to 103.1, tachycardic to
122, and hypotensive to 94/56. She initially received
approximately 5 liters of IVF for a bp of 76/50 and responded up
to the 100s-110s. Her UOP was excellent (approx 400 cc/hr),
lactate initially 1.4 and mental status appropriate. She was
given levofloxacin 500 mg po and admitted to medicine. Her bp
then dropped again to the 80s/50s and she was febrile to 103.8.
She was given 3 additional liters of fluid, given ceftriaxone,
and admitted to the MICU.
.

MEDICAL HISTORY: hydrosclerosis of hands
h/o UTI

MEDICATION ON ADMISSION: augmentin course recently completed
tylenol / motrin prn
OCP (though not last month)
robinul (for hydrosclerosis)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS-  T max 101.7, T 98.1 BP 95/53 RR 17 Sats 98%
I/O 350/2.5L
GEN- non apparent distress, pleasant
HEENT:moist oral mucouse, no oral lesions, no sinus tenderness.
NECK- Supple, no LAD, no JVP
CV- RRR, s1-s2 normal, slighly tachy, no m/r/g appreciated
Lungs: slightly decrease in the bases. no crackles.
ABD- soft, mild tenderness to palpation on the left upper
quadrant. No rebound. MIld costovertebral tenderness to
percussion.
EXT- Warm, good cap refill, no cyanosis or edema.
NEURO- AAO x 3 , MAEW, CN grossly intact

FAMILY HISTORY: Denies any kidney disease.

SOCIAL HISTORY: lives at home with her boyfriend. Denies tobacco. Rarely drinks
alcohol. Is a full-time student at [**Hospital1 498**] [**Location (un) 86**] and works
part-time as a banquet server. She is sexually active with her
boyfriend only, and uses barrier contraception most of the time. 

### Response:
{'Unspecified septicemia,Acute pyelonephritis without lesion of renal medullary necrosis,Unspecified pleural effusion,Congestive heart failure, unspecified,Pulmonary collapse,Pneumonia, organism unspecified,Sepsis,Anemia, unspecified,Tachycardia, unspecified'}
