CHIEF COMPLAINT: Fever, Abdominal pain

PRESENT ILLNESS: Ms. [**Known lastname 16479**] is a 32 yo female with a history of type 1 diabetes,
s/p living related renal transplant [**2146-5-5**], pancreas
transplant in [**2147-7-5**], who presents with fever of 103.8F at
home. She was recently discharged from the hospital on [**9-29**]
after being treated for abdominal pain and urinary retention.
She was discharged home with a foley in place, but reports
d/c'ing foley by herself 3 days prior to this admission. She now
also complains of severe RLQ and suprapubic pain that she
describes as sharp and constant.

MEDICAL HISTORY: 1. Type I diabetes with neuropathy
2. s/p living related kidney transplant and pancreas
after kidney transplant
3. Laser treatment OU
4. Gastritis
5. Hypotension
6. Hypothyroidism
7. Adenopathy
8. Klippel-Trenaunes syndrome

MEDICATION ON ADMISSION: 1. Colace 100 mg [**Hospital1 **]
2. Levothyroxine sodium 100 mcg once daily
3. MMF 1000 [**Hospital1 **]
4. Protonix 40 q24
5. Prednisone 10 once daily
6. Sirolimus 4 mg once daily
7. Bactrim SS 1 tab once daily
8. Tacrolimus 7 mg [**Hospital1 **]
9. Valganciclovir 450 once daily

ALLERGIES: Pyridium

PHYSICAL EXAM: At time of discharge:

FAMILY HISTORY: NC

SOCIAL HISTORY: Pt. does not work, does not smoke and drinks alcohol rarely.
Other septicemia due to gram-negative organisms,Urinary tract infection, site not specified,Kidney replaced by transplant,Pancreas replaced by transplant,Acute kidney failure, unspecified,Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled,Severe sepsis,Unspecified acquired hypothyroidism,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site
Gram-neg septicemia NEC,Urin tract infection NOS,Kidney transplant status,Trnspl status-pancreas,Acute kidney failure NOS,DMI renl nt st uncntrld,Severe sepsis,Hypothyroidism NOS,Klebsiella pneumoniae
Admission Date:  [**2147-10-3**]              Discharge Date:   [**2147-10-9**]

Date of Birth:  [**2114-12-30**]             Sex:   F

Service: SURGERY

Allergies:
Pyridium

Attending:[**First Name3 (LF) 1384**]
Chief Complaint:
Fever, Abdominal pain

Major Surgical or Invasive Procedure:
None


History of Present Illness:
Ms. [**Known lastname 16479**] is a 32 yo female with a history of type 1 diabetes,
s/p living related renal transplant [**2146-5-5**], pancreas
transplant in [**2147-7-5**], who presents with fever of 103.8F at
home. She was recently discharged from the hospital on [**9-29**]
after being treated for abdominal pain and urinary retention.
She was discharged home with a foley in place, but reports
d/c'ing foley by herself 3 days prior to this admission. She now
also complains of severe RLQ and suprapubic pain that she
describes as sharp and constant.

Past Medical History:
1. Type I diabetes with neuropathy
2. s/p living related kidney transplant and pancreas
after kidney transplant
3. Laser treatment OU
4. Gastritis
5. Hypotension
6. Hypothyroidism
7. Adenopathy
8. Klippel-Trenaunes syndrome

Social History:
Pt. does not work, does not smoke and drinks alcohol rarely.


Family History:
NC

Physical Exam:
At time of discharge:

A&O X 3, NAD
PERRL, EOMI, anicteric
Heart RRR, no murmurs
Lungs CTAB, no W/R/R
Abd soft, mild TTP in RLQ over well healed incision.
Nondistended, no rebound or guarding; +bs x 4, no masses
Ext without c/c/e

Pertinent Results:
[**2147-10-3**]: WBC-8.8# RBC-3.87*# Hgb-10.4*# Hct-30.9*# MCV-80*
MCH-26.9* MCHC-33.6 RDW-15.5 Plt Ct-126*
Neuts-76* Bands-10* Lymphs-4* Monos-4 Eos-0 Baso-0 Atyps-1*
Metas-5* Myelos-0
Plt Smr-LOW Plt Ct-126* PT-13.3 PTT-37.5* INR(PT)-1.2
Glucose-135* UreaN-48* Creat-3.0*# Na-137 K-3.9 Cl-101 HCO3-19*
AnGap-21*
08ALT-14 AST-18 AlkPhos-40 Amylase-50 TotBili-0.7 Lipase-22
Albumin-4.3 Calcium-9.3 Phos-4.4 Mg-1.2*
Cortsol-15.1 Cortsol-26.6* Cortsol-32.1*
FK506-<1.5
[**2147-10-9**]: WBC-4.6 RBC-3.81* Hgb-9.9* Hct-30.8* MCV-81* MCH-26.1*
MCHC-32.2 RDW-16.4* Plt Ct-110*# Plt Ct-110*#
Glucose-92 UreaN-17 Creat-1.1 Na-138 K-3.4 Cl-101 HCO3-23
AnGap-17
Calcium-8.6 Phos-3.3 Mg-1.5*

Blood and Urine culture [**10-3**]: 2 types of Klebsiella pneumoniae

Renal US [**10-3**]: normal flow in kidney
LENIs [**10-3**]: negative for DVT
CXR [**10-3**]: negative for cardiopulmonary process
CT abdomen [**10-3**]: no change from prior scan, no free air or fluid

Brief Hospital Course:
On [**2147-10-3**] Ms. [**Known lastname 16479**] was admitted to the transplant service
under the care of Dr. [**Last Name (STitle) 816**]. She was pan cultured and started on
Vancomycin and Zosyn empirically. Initially her blood pressure
was somewhat low (SBP 70's) and she was placed in the ICU, but
was transferred to the floor later on the night of admission.
She was given a 500 cc bolus on the floor overnight. Her urine
output remained high and she was kept comfortable with IV
dilaudid. Her immunosuppressant regimen was altered while she
was here. She was weaned off of Tacrolimus and maintained on
Rapamycin. By hospital day 2 her blood and urine cultures were
growing gram negative rods. She continued on IV antibiotics and
slowly improved. ID and the renal team were consulted during her
hospital stay. She was given a cosyntropin stimulation test due
to her low blood pressure and responded appropriately. By
hospital day 4 Ms. [**Known lastname 16479**] had remained afebrile and began
tolerating a po diet. Her cultures were growing Klebsiella
pneumoniae in both her blood and urine. Her antibiotic regimen
was changed to Ceftriaxone and her diet was advanced. On
hospital day 6 she was started on po Ciprofloxacin. She
continued to be afebrile and her abdominal pain improved
greatly. By hospital day 7 she was ready for discharge home on a
14 day course of Cipro. She was instructed to follow-up in the
transplant clinic and to resume her biweekly blood work. At the
time of discharge her [**Last Name (un) 1380**] level was 11.3.

Medications on Admission:
1. Colace 100 mg [**Hospital1 **]
2. Levothyroxine sodium 100 mcg once daily
3. MMF 1000 [**Hospital1 **]
4. Protonix 40 q24
5. Prednisone 10 once daily
6. Sirolimus 4 mg once daily
7. Bactrim SS 1 tab once daily
8. Tacrolimus 7 mg [**Hospital1 **]
9. Valganciclovir 450 once daily

Discharge Medications:
1. Levothyroxine Sodium 100 mcg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
2. Trimethoprim-Sulfamethoxazole 80-400 mg Tablet Sig: One (1)
Tablet PO DAILY (Daily).
3. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).

4. Prednisone 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Midodrine 5 mg Tablet Sig: One (1) Tablet PO Q AM ().
6. Midodrine 2.5 mg Tablet Sig: One (1) Tablet PO Q PM ().
7. Midodrine 2.5 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
8. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
9. Mycophenolate Mofetil 500 mg Tablet Sig: One (1) Tablet PO
Q6H (every 6 hours).
10. Valganciclovir 450 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
11. Sirolimus 1 mg Tablet Sig: Four (4) Tablet PO ONCE (once)
for 1 doses.
12. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours) for 7 days.
Disp:*14 Tablet(s)* Refills:*0*
13. Percocet 5-325 mg Tablet Sig: One (1) Tablet PO every six
(6) hours as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Urosepsis


Discharge Condition:
Good


Discharge Instructions:
Patient to call transplant surgery immediately at [**Telephone/Fax (1) 673**]
if any feves, chills, nausea, vomiting, abdominal pain, decrease
energy, change in bowel movements or urine output. Also please
call with any questions about medications. Continue blood tests
twice a week at your usual lab. Please have them fax the results
to the transplant office.

Followup Instructions:
Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) 819**] [**Name Initial (NameIs) **].  [**Telephone/Fax (1) 673**]  Call to schedule
appointment

Provider: [**Name10 (NameIs) 2105**] [**Name11 (NameIs) 2106**], MD Where: LM [**Hospital Unit Name 3126**] CENTER Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2147-10-10**] 1:20
{"Other septicemia due to gram-negative organisms,Urinary tract infection, site not specified,Kidney replaced by transplant,Pancreas replaced by transplant,Acute kidney failure, unspecified,Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled,Severe sepsis,Unspecified acquired hypothyroidism,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site"}


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: Fever, Abdominal pain

PRESENT ILLNESS: Ms. [**Known lastname 16479**] is a 32 yo female with a history of type 1 diabetes,
s/p living related renal transplant [**2146-5-5**], pancreas
transplant in [**2147-7-5**], who presents with fever of 103.8F at
home. She was recently discharged from the hospital on [**9-29**]
after being treated for abdominal pain and urinary retention.
She was discharged home with a foley in place, but reports
d/c'ing foley by herself 3 days prior to this admission. She now
also complains of severe RLQ and suprapubic pain that she
describes as sharp and constant.

MEDICAL HISTORY: 1. Type I diabetes with neuropathy
2. s/p living related kidney transplant and pancreas
after kidney transplant
3. Laser treatment OU
4. Gastritis
5. Hypotension
6. Hypothyroidism
7. Adenopathy
8. Klippel-Trenaunes syndrome

MEDICATION ON ADMISSION: 1. Colace 100 mg [**Hospital1 **]
2. Levothyroxine sodium 100 mcg once daily
3. MMF 1000 [**Hospital1 **]
4. Protonix 40 q24
5. Prednisone 10 once daily
6. Sirolimus 4 mg once daily
7. Bactrim SS 1 tab once daily
8. Tacrolimus 7 mg [**Hospital1 **]
9. Valganciclovir 450 once daily

ALLERGIES: Pyridium

PHYSICAL EXAM: At time of discharge:

FAMILY HISTORY: NC

SOCIAL HISTORY: Pt. does not work, does not smoke and drinks alcohol rarely. 

### Response:
{"Other septicemia due to gram-negative organisms,Urinary tract infection, site not specified,Kidney replaced by transplant,Pancreas replaced by transplant,Acute kidney failure, unspecified,Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled,Severe sepsis,Unspecified acquired hypothyroidism,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site"}
