CHIEF COMPLAINT: low Hct

PRESENT ILLNESS: History of Present Illness:  This is a 52 year old male with
metastatic esophageal cancer with recurrent GI bleeding who
presented to the ED yesterday with low Hct of 20.6.  Pt was seen
by his outpt onc provider in clinic yesterday clinic yesterday
for possible chemotherapy, however, it was delayed because of
the low Hct.  Of note, pt recently received 2 units of blood on
[**12-31**] with a hematocrit of 24 and 2 units on [**12-28**]. Pt reported
several episodes of hematemesis likely due to a migrated
esophageal stent vs. erosion through the gasric wall. Of note
the patient was admitted last month for a similar presentation
and no EGD was performed at that time.
.
In the [**Name (NI) **], pt triggered for a SBP of 88 but stated that his
blood pressure runs in the high-80s to low-90s. The patient
received 2 units of pRBCs with a post-transfusion hematocrit of
22.9. He was also started on a Protonix drip. GI was consulted
and they felt the stent appears adherent to the gastric wall and
will be difficult to remove. Endoscopy is also unlikely to be
pursued but there may be potential for embolization. Pt was then
sent to ICU for close monitoring.
.
In the ICU, pt received a total of 3 more units of pRBCs.  This
am, Hct was 24.2, with another post-transfusion Hct pending.  Pt
remained hemodynamically stable.  GI is following, decided not
to pursue endoscopy.  Role for IR procedure to identify the
source of bleed is also not likely to be high yield.  Pt's outpt
oncologist is planning for further chemotherapy once pt is
stablized after blood transfusions.
.
On the floor, pt has no complaints. He reports continuing black
bowl movements, has not had hematemesis since admission. Has
some abdominal discomfort, but feels this is more from hunger
than anything else, is not complaining of pain. Denies cough,
fevers, chills or any other complaints. Has unit of blood
running currently.
.
Review of Systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denies chest pain or tightness, palpitations. Denies
cough, shortness of breath, or wheezes. Denies nausea, vomiting,
diarrhea, constipation or abdominal pain. No recent change in
bowel or bladder habits. No dysuria. Denies arthralgias or
myalgias. Denies rashes or skin breakdown. No numbness/tingling
in extremities. No feelings of depression or anxiety. All other
review of systems negative

MEDICAL HISTORY: Past Oncologic History:
Metastatic esophogeal cancer to the liver, tissue diagnosis
on [**6-4**] poorly-differentiated carcinoma with neuroendocrine
differentiation, s/p esophagogastroduodenoscopy with esophageal
stent placement [**2123-6-3**], chemotherapy, s/p cycle 7 of EOX
(epirubicin, oxaliplatin and xeloda)
.
Other Past Medical History:
History of torn R ACL (not repaired)
Left leg > right leg varicose veins which is chronic since
remote skiing accident
History of RUE DVT in the setting of PICC line ([**6-/2123**])
Osteoarthritis

MEDICATION ON ADMISSION: 1. Citalopram 10 mg PO daily
2. Lorazepam 1 mg PO Q8H anxiety or insomnia
3. Ondansetron ODT 8 mg Q6-8H nausea
4. Oxycodone 5 mg tablets, 1-2 tablets Q4-6H pain
5. OxyContin 10 mg [**Hospital1 **]
6. Pantoprazole 40 mg daily
7. Zolpidem 10 mg HS insomnia
8. Mylanta Oral
9. Dilaudid Oral
10. Capecitabine Oral

ALLERGIES: Prochlorperazine

PHYSICAL EXAM: exam at discharge:

FAMILY HISTORY: - denies cancer, heart disease, diabetes, clotting or bleeding
diseases

SOCIAL HISTORY: - technology officer to guide engineers, now on long term
disability
- Tobacco:  None
- Alcohol:  None (socially, none since [**5-/2123**])
- Illicits:  None
Hematemesis,Malignant neoplasm of cardia,Malignant neoplasm of liver, secondary,Acute venous embolism and thrombosis of superficial veins of upper extremity,Thrombocytopenia, unspecified,Hypocalcemia,Hyposmolality and/or hyponatremia,Cardiac complications, not elsewhere classified,Acute posthemorrhagic anemia,Other specified cardiac dysrhythmias,Insomnia, unspecified,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Depressive disorder, not elsewhere classified
Hematemesis,Mal neo stomach cardia,Second malig neo liver,Ac embl suprfcl up ext,Thrombocytopenia NOS,Hypocalcemia,Hyposmolality,Surg compl-heart,Ac posthemorrhag anemia,Cardiac dysrhythmias NEC,Insomnia NOS,Abn react-procedure NEC,Depressive disorder NEC
Admission Date:  [**2124-1-4**]              Discharge Date:   [**2124-1-18**]

Date of Birth:  [**2071-5-15**]             Sex:   M

Service: MEDICINE

Allergies:
Prochlorperazine

Attending:[**First Name3 (LF) 2024**]
Chief Complaint:
low Hct

Major Surgical or Invasive Procedure:
left gastric artery embolization
triple lumen placement
port-a-cath placement

History of Present Illness:
History of Present Illness:  This is a 52 year old male with
metastatic esophageal cancer with recurrent GI bleeding who
presented to the ED yesterday with low Hct of 20.6.  Pt was seen
by his outpt onc provider in clinic yesterday clinic yesterday
for possible chemotherapy, however, it was delayed because of
the low Hct.  Of note, pt recently received 2 units of blood on
[**12-31**] with a hematocrit of 24 and 2 units on [**12-28**]. Pt reported
several episodes of hematemesis likely due to a migrated
esophageal stent vs. erosion through the gasric wall. Of note
the patient was admitted last month for a similar presentation
and no EGD was performed at that time.
.
In the [**Name (NI) **], pt triggered for a SBP of 88 but stated that his
blood pressure runs in the high-80s to low-90s. The patient
received 2 units of pRBCs with a post-transfusion hematocrit of
22.9. He was also started on a Protonix drip. GI was consulted
and they felt the stent appears adherent to the gastric wall and
will be difficult to remove. Endoscopy is also unlikely to be
pursued but there may be potential for embolization. Pt was then
sent to ICU for close monitoring.
.
In the ICU, pt received a total of 3 more units of pRBCs.  This
am, Hct was 24.2, with another post-transfusion Hct pending.  Pt
remained hemodynamically stable.  GI is following, decided not
to pursue endoscopy.  Role for IR procedure to identify the
source of bleed is also not likely to be high yield.  Pt's outpt
oncologist is planning for further chemotherapy once pt is
stablized after blood transfusions.
.
On the floor, pt has no complaints. He reports continuing black
bowl movements, has not had hematemesis since admission. Has
some abdominal discomfort, but feels this is more from hunger
than anything else, is not complaining of pain. Denies cough,
fevers, chills or any other complaints. Has unit of blood
running currently.
.
Review of Systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denies chest pain or tightness, palpitations. Denies
cough, shortness of breath, or wheezes. Denies nausea, vomiting,
diarrhea, constipation or abdominal pain. No recent change in
bowel or bladder habits. No dysuria. Denies arthralgias or
myalgias. Denies rashes or skin breakdown. No numbness/tingling
in extremities. No feelings of depression or anxiety. All other
review of systems negative

Past Medical History:
Past Oncologic History:
Metastatic esophogeal cancer to the liver, tissue diagnosis
on [**6-4**] poorly-differentiated carcinoma with neuroendocrine
differentiation, s/p esophagogastroduodenoscopy with esophageal
stent placement [**2123-6-3**], chemotherapy, s/p cycle 7 of EOX
(epirubicin, oxaliplatin and xeloda)
.
Other Past Medical History:
History of torn R ACL (not repaired)
Left leg > right leg varicose veins which is chronic since
remote skiing accident
History of RUE DVT in the setting of PICC line ([**6-/2123**])
Osteoarthritis


Social History:
- technology officer to guide engineers, now on long term
disability
- Tobacco:  None
- Alcohol:  None (socially, none since [**5-/2123**])
- Illicits:  None


Family History:
- denies cancer, heart disease, diabetes, clotting or bleeding
diseases


Physical Exam:
exam at discharge:

96.5 104/56 75 18 94%

Pertinent Results:
[**2124-1-4**] 09:27AM BLOOD WBC-8.1 RBC-2.18* Hgb-6.6* Hct-20.6*
MCV-95 MCH-30.4 MCHC-32.2 RDW-18.0* Plt Ct-227
[**2124-1-6**] 03:20PM BLOOD Hct-26.0*
[**2124-1-8**] 06:10AM BLOOD WBC-12.8*# RBC-2.92* Hgb-8.5* Hct-26.1*
MCV-89 MCH-29.1 MCHC-32.6 RDW-17.8* Plt Ct-345
[**2124-1-10**] 07:56AM BLOOD WBC-10.2 RBC-2.89* Hgb-8.9* Hct-25.5*
MCV-88 MCH-30.9 MCHC-35.1* RDW-16.1* Plt Ct-155
[**2124-1-12**] 12:00PM BLOOD WBC-8.6 RBC-2.17* Hgb-6.7* Hct-18.7*
MCV-86 MCH-31.0 MCHC-36.0* RDW-15.2 Plt Ct-134*
[**2124-1-13**] 05:52PM BLOOD WBC-7.1 RBC-3.41* Hgb-10.3* Hct-28.7*
MCV-84 MCH-30.2 MCHC-35.9* RDW-15.6* Plt Ct-117*
[**2124-1-16**] 07:30AM BLOOD WBC-4.9 RBC-2.76* Hgb-8.4* Hct-24.4*
MCV-88 MCH-30.4 MCHC-34.4 RDW-15.4 Plt Ct-103*
[**2124-1-18**] 04:38AM BLOOD WBC-1.6*# RBC-2.81* Hgb-8.8* Hct-24.1*
MCV-86 MCH-31.3 MCHC-36.5* RDW-15.0 Plt Ct-106*
[**2124-1-17**] 06:30AM BLOOD PT-11.8 PTT-25.5 INR(PT)-1.0
[**2124-1-13**] 06:16AM BLOOD PT-17.3* PTT-55.8* INR(PT)-1.5*
[**2124-1-10**] 07:56AM BLOOD PT-14.7* PTT-28.1 INR(PT)-1.3*
[**2124-1-4**] 11:00AM BLOOD PT-13.2 PTT-26.4 INR(PT)-1.1
[**2124-1-13**] 05:52PM BLOOD Fibrino-660*
[**2124-1-18**] 04:38AM BLOOD Glucose-89 UreaN-9 Creat-0.5 Na-127*
K-3.7 Cl-95* HCO3-29 AnGap-7*
[**2124-1-16**] 06:00AM BLOOD Glucose-94 UreaN-12 Creat-0.5 Na-127*
K-3.7 Cl-97 HCO3-28 AnGap-6*
[**2124-1-14**] 06:32AM BLOOD Glucose-108* UreaN-12 Creat-0.4* Na-126*
K-3.8 Cl-96 HCO3-26 AnGap-8
[**2124-1-12**] 12:00PM BLOOD Glucose-84 UreaN-12 Creat-0.4* Na-132*
K-3.5 Cl-100 HCO3-24 AnGap-12
[**2124-1-10**] 07:56AM BLOOD Glucose-94 UreaN-23* Creat-0.4* Na-133
K-3.5 Cl-104 HCO3-23 AnGap-10
[**2124-1-6**] 07:15AM BLOOD Glucose-84 UreaN-16 Creat-0.6 Na-133
K-4.4 Cl-100 HCO3-28 AnGap-9
[**2124-1-4**] 09:27AM BLOOD UreaN-10 Creat-0.5 Na-133 K-4.1 Cl-99
HCO3-31 AnGap-7*
[**2124-1-14**] 06:32AM BLOOD ALT-10 AST-36 LD(LDH)-787* AlkPhos-149*
TotBili-0.6
[**2124-1-4**] 09:27AM BLOOD ALT-16 AST-36 LD(LDH)-248 AlkPhos-223*
TotBili-0.4
[**2124-1-18**] 04:38AM BLOOD Albumin-1.8* Calcium-7.3* Phos-3.5 Mg-1.7
[**2124-1-10**] 07:56AM BLOOD Albumin-1.5* Calcium-7.0* Phos-2.8 Mg-1.7
[**2124-1-4**] 09:27AM BLOOD Albumin-2.1* Calcium-7.9* Mg-2.0
.
MICRO:
[**2124-1-5**] BLOOD CULTURE Blood Culture,
Routine-negative
[**2124-1-5**] URINE URINE CULTURE-negative
.
[**2124-1-10**] Transcatheter embolization: IMPRESSION: Successful coil
and particle embolization of the left gastric artery with
satisfactory angiographic results. Successful deployment of
right common femoral artery closure device with good hemostasis.

.
[**2124-1-11**] LENIs: IMPRESSION:
Non-occlusive thrombus within the right cephalic vein at the
site of a
catheter.
.
[**2124-1-12**]: Catheter placement: IMPRESSION: Placement of a
double-lumen Port-A-Cath was deferred due to the patient's
development of a supraventricular tachycardia . The medical team
requested a 16 cm x 7 French triple-lumen central venous line to
be placed for administration of IV fluids, access, and
medications. The line was placed without complication, secured,
and a sterile dressing was applied.
.
[**2124-1-17**]: Port-A-Cath placement: IMPRESSION: Uncomplicated
placement of 20 cm double-lumen chest Port-A-Cath via right
internal jugular vein with ultrasound guidance with hard copy
images on file. The tip of the catheter terminates at the
cavoatrial junction and is ready to use.


Brief Hospital Course:
This is a 52 yo male with metastatic esophageal cancer with
recurrent GI bleeding who presented to the ED [**1-4**] with low
Hct.
.
# Anemia/Hemetemesis: This is likely [**3-9**] to active GIB from
known esophageal + gastric masses. Pt was initially admitted to
the ICU.  Pt received 2 units of pRBCs in ED and started on a
Protonix drip. GI was consulted and they felt the stent appears
adherent to the gastric wall and will be difficult to remove.
Endoscopy was not pursued.  Pt received 3 more units of pRBCs in
the ICU and pt's Hct was stable, pt remained hemodynamically
stable, this he was transferred to the floor.  On the OMED
service, transfusions were continued, Hct was checked q8-12h.
Pt was then taken for IR embolization on [**1-10**], during the left
gastric artery was successfully embolized. Pt however had
recurrent bleeding and downtrending of Hct post procedure down
to 18.9, requiring more transfusions. Also had thrombocytopenia,
likely due to dilution, consumption and possibly BM supression
from chemo which improved after 1 platelet transfusion. INR and
PTT trended up likely d/t nutritional deficiency and dilution,
now improved with single dose of Vit K yesterday. Fibrinogen was
not low. Pt was continued on IV PPI [**Hospital1 **], then transitioned to
PO.  Pt's Hct stabilized somewhat by day of discharge and pt was
discharged with a close f/u with outpt oncologist for further
blood check.
.
# Esophageal ca:  Pt has metastatic esophogeal cancer to the
liver, tissue diagnosis on [**6-4**] showed poorly-differentiated
carcinoma with neuroendocrine differentiation. Pt is s/p
esophagogastroduodenoscopy with esophageal stent placement on
[**2123-6-3**], chemotherapy, s/p cycle 7 of EOX (epirubicin,
oxaliplatin and xeloda).  Pt's outpt oncologist, Dr. [**Last Name (STitle) 3274**],
intiated chemotherapy during this admission.  Pt received
Cisplatin/CPT11 on [**1-5**] and again on [**1-13**]. Pain control with
Acetaminophen, Oxycontin and Dialudid PRN.  Nausea was managed
with Zofran and Ativan PRN. Oral Maalox PRN was used for
heartburn.
.
# SVT: Pt had a single episode of SVT during IR placement of
central line on [**2124-1-12**]. This is was likely a complication of
guide-wire insertion during the vascular access procedure. The
episode resolved with 6mg IV Adenosine. Pt remained in NSR
since.  Pt was monitored on tele.
.
# Hyponatremia: Pt's Na was slowly down trending to 126. Was
perhaps due to a lot of fluids he received with chemo. Na
improved with increased salt intake and fluid restriction to
1000ml/day.
.
# Asymetrical extremity edema: DVT ruled RUE and LLE ruled out
per US.
.
# Access: Pt had poor IV access, so pt went down to IR for a
Port-A-Cath.  Pt however had SVT, this only a triple lumen IJ
was placed.  Pt returned to IR suite on [**1-17**] and the line was
successfully converted to a port.
.
# Depression: Pt was continued on home Citalopram.
.
Pt had a regular diet as tolerated, Nutrition was following who
recommended Ensure suppl.  Pt was also on oncology repletion
scales.  Pain control was with Oxycontin, Acetaminophen and
Dialudid PRN.  Pt was on a bowel regimen. DVT PPx was with
pneumoboots given GI bleed. Pt was full code.

Medications on Admission:
1. Citalopram 10 mg PO daily
2. Lorazepam 1 mg PO Q8H anxiety or insomnia
3. Ondansetron ODT 8 mg Q6-8H nausea
4. Oxycodone 5 mg tablets, 1-2 tablets Q4-6H pain
5. OxyContin 10 mg [**Hospital1 **]
6. Pantoprazole 40 mg daily
7. Zolpidem 10 mg HS insomnia
8. Mylanta Oral
9. Dilaudid Oral
10. Capecitabine Oral

Discharge Medications:
1. lorazepam 1 mg Tablet Sig: One (1) Tablet PO every eight (8)
hours as needed for nausea/anxiety.
2. citalopram 20 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
3. ondansetron 8 mg Tablet, Rapid Dissolve Sig: One (1) Tablet,
Rapid Dissolve PO every 6-8 hours as needed for nausea.
4. oxycodone 10 mg Tablet Sustained Release 12 hr Sig: Three (3)
Tablet Sustained Release 12 hr PO Q12H (every 12 hours).
Disp:*60 Tablet Sustained Release 12 hr(s)* Refills:*0*
5. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO twice a day.
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
6. zolpidem 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime)
as needed for insomnia.
7. hydromorphone 4 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for pain.
8. capecitabine  Oral
9. Mylanta  Oral
10. metoclopramide 10 mg Tablet Sig: 0.5 Tablet PO TID (3 times
a day).
Disp:*45 Tablet(s)* Refills:*0*
11. simethicone 80 mg Tablet, Chewable Sig: One (1) Tablet,
Chewable PO QID (4 times a day) as needed for bloating.
Disp:*30 Tablet, Chewable(s)* Refills:*0*
12. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day) as needed for constipation.
Disp:*30 Capsule(s)* Refills:*0*
13. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
Disp:*30 Tablet(s)* Refills:*0*
14. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours as
needed for pain.


Discharge Disposition:
Home

Discharge Diagnosis:
esophageal carcinoma
upper GI bleeding


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


Discharge Instructions:
Dear Mr. [**Known lastname 86651**],

You were admitted because of anemia caused by bleeding from your
upper intestinal tract. You recieved blood transfusions to
compensate for your blood loss. You underwent an embolization
procedure by interventional radiology in attempt to stop the
bleeding from the arteries near your esophagus and stomach.  You
also recieved chemotherapy during your hospital stay.  A
Port-a-cath was placed to help in future chemotherapy infusions.
.
The following change was made to your medications:
INCREASE pantoprazole 40mg tablet to twice daily
INCREASE oxycontin to 30mg twice daily for control of your pain
(this is a long acting medication which is taken regularly and
should be distinguished from oxycodone which is short acting and
taken as needed for pain)
START metoclopramide 5 mg 3 times a day
START simethicone 80 mg 4 times a day as needed for bloating
START docusate sodium 100 mg 2 times a day as needed for
constipation
START senna 8.6 mg 2 times a day as needed for constipation
.
Please continue to take the rest of your home medications
without change.


Followup Instructions:
Please come in for a hematocrit and electrolyte check on
Thursday at Dr.[**Name (NI) 3279**] office.



Completed by:[**2124-1-26**]
{'Hematemesis,Malignant neoplasm of cardia,Malignant neoplasm of liver, secondary,Acute venous embolism and thrombosis of superficial veins of upper extremity,Thrombocytopenia, unspecified,Hypocalcemia,Hyposmolality and/or hyponatremia,Cardiac complications, not elsewhere classified,Acute posthemorrhagic anemia,Other specified cardiac dysrhythmias,Insomnia, unspecified,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Depressive disorder, not elsewhere classified'}


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: low Hct

PRESENT ILLNESS: History of Present Illness:  This is a 52 year old male with
metastatic esophageal cancer with recurrent GI bleeding who
presented to the ED yesterday with low Hct of 20.6.  Pt was seen
by his outpt onc provider in clinic yesterday clinic yesterday
for possible chemotherapy, however, it was delayed because of
the low Hct.  Of note, pt recently received 2 units of blood on
[**12-31**] with a hematocrit of 24 and 2 units on [**12-28**]. Pt reported
several episodes of hematemesis likely due to a migrated
esophageal stent vs. erosion through the gasric wall. Of note
the patient was admitted last month for a similar presentation
and no EGD was performed at that time.
.
In the [**Name (NI) **], pt triggered for a SBP of 88 but stated that his
blood pressure runs in the high-80s to low-90s. The patient
received 2 units of pRBCs with a post-transfusion hematocrit of
22.9. He was also started on a Protonix drip. GI was consulted
and they felt the stent appears adherent to the gastric wall and
will be difficult to remove. Endoscopy is also unlikely to be
pursued but there may be potential for embolization. Pt was then
sent to ICU for close monitoring.
.
In the ICU, pt received a total of 3 more units of pRBCs.  This
am, Hct was 24.2, with another post-transfusion Hct pending.  Pt
remained hemodynamically stable.  GI is following, decided not
to pursue endoscopy.  Role for IR procedure to identify the
source of bleed is also not likely to be high yield.  Pt's outpt
oncologist is planning for further chemotherapy once pt is
stablized after blood transfusions.
.
On the floor, pt has no complaints. He reports continuing black
bowl movements, has not had hematemesis since admission. Has
some abdominal discomfort, but feels this is more from hunger
than anything else, is not complaining of pain. Denies cough,
fevers, chills or any other complaints. Has unit of blood
running currently.
.
Review of Systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denies chest pain or tightness, palpitations. Denies
cough, shortness of breath, or wheezes. Denies nausea, vomiting,
diarrhea, constipation or abdominal pain. No recent change in
bowel or bladder habits. No dysuria. Denies arthralgias or
myalgias. Denies rashes or skin breakdown. No numbness/tingling
in extremities. No feelings of depression or anxiety. All other
review of systems negative

MEDICAL HISTORY: Past Oncologic History:
Metastatic esophogeal cancer to the liver, tissue diagnosis
on [**6-4**] poorly-differentiated carcinoma with neuroendocrine
differentiation, s/p esophagogastroduodenoscopy with esophageal
stent placement [**2123-6-3**], chemotherapy, s/p cycle 7 of EOX
(epirubicin, oxaliplatin and xeloda)
.
Other Past Medical History:
History of torn R ACL (not repaired)
Left leg > right leg varicose veins which is chronic since
remote skiing accident
History of RUE DVT in the setting of PICC line ([**6-/2123**])
Osteoarthritis

MEDICATION ON ADMISSION: 1. Citalopram 10 mg PO daily
2. Lorazepam 1 mg PO Q8H anxiety or insomnia
3. Ondansetron ODT 8 mg Q6-8H nausea
4. Oxycodone 5 mg tablets, 1-2 tablets Q4-6H pain
5. OxyContin 10 mg [**Hospital1 **]
6. Pantoprazole 40 mg daily
7. Zolpidem 10 mg HS insomnia
8. Mylanta Oral
9. Dilaudid Oral
10. Capecitabine Oral

ALLERGIES: Prochlorperazine

PHYSICAL EXAM: exam at discharge:

FAMILY HISTORY: - denies cancer, heart disease, diabetes, clotting or bleeding
diseases

SOCIAL HISTORY: - technology officer to guide engineers, now on long term
disability
- Tobacco:  None
- Alcohol:  None (socially, none since [**5-/2123**])
- Illicits:  None 

### Response:
{'Hematemesis,Malignant neoplasm of cardia,Malignant neoplasm of liver, secondary,Acute venous embolism and thrombosis of superficial veins of upper extremity,Thrombocytopenia, unspecified,Hypocalcemia,Hyposmolality and/or hyponatremia,Cardiac complications, not elsewhere classified,Acute posthemorrhagic anemia,Other specified cardiac dysrhythmias,Insomnia, unspecified,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Depressive disorder, not elsewhere classified'}
