CHIEF COMPLAINT: hyponatremia

PRESENT ILLNESS: 74F with recent D/C from [**Hospital1 18**] s/p fall down stairs with c-spine
fractures presents today with Nausea, headache, and feeling dry
x4 days. She was admitted on [**2109-9-2**] with multiple fractures of
the spinous process of C4, C7and T1 as well as a retropharyngeal
hematoma. She was placed in aC-collar and remaine neurologically
stable. She was discharged torehab on [**2109-9-4**] and completed a
dexamethasone taper. She represented to the ED today complaining
of HA and  Patient states she was d/c from [**Hospital1 18**] on [**9-4**] feeling
well. 4 days ago she began to feel nausea with decreased ability
to tolerate PO. Patient developed constant frontal headache and
felt dehydrated. Patient with labs done at rehab center today
showing Na+ = 119, at that time patient sent to ER for
evaluation. Patient denies f/c, CP, sob, diarrhea, joint pain,
or rash.  No change in mental status or seizures.

MEDICAL HISTORY: osteoporosis

MEDICATION ON ADMISSION: -bisacodyl 10mg daily
-colase 100mg [**Hospital1 **]
-senna [**Hospital1 **]
-dilaudid 2mg 1-2mg Q4 PRN for pain
-dexamethasone taper

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission PEx:
VS: 98.7  66  141/69  14  99%RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Lives and takes care of husband, denies ETOH or tobacco
use.
Hyposmolality and/or hyponatremia,Osteoporosis, unspecified,Nausea with vomiting
Hyposmolality,Osteoporosis NOS,Nausea with vomiting
Admission Date:  [**2109-9-10**]              Discharge Date:   [**2109-9-11**]

Date of Birth:  [**2035-6-12**]             Sex:   F

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 338**]
Chief Complaint:
hyponatremia

Major Surgical or Invasive Procedure:
none.


History of Present Illness:
74F with recent D/C from [**Hospital1 18**] s/p fall down stairs with c-spine
fractures presents today with Nausea, headache, and feeling dry
x4 days. She was admitted on [**2109-9-2**] with multiple fractures of
the spinous process of C4, C7and T1 as well as a retropharyngeal
hematoma. She was placed in aC-collar and remaine neurologically
stable. She was discharged torehab on [**2109-9-4**] and completed a
dexamethasone taper. She represented to the ED today complaining
of HA and  Patient states she was d/c from [**Hospital1 18**] on [**9-4**] feeling
well. 4 days ago she began to feel nausea with decreased ability
to tolerate PO. Patient developed constant frontal headache and
felt dehydrated. Patient with labs done at rehab center today
showing Na+ = 119, at that time patient sent to ER for
evaluation. Patient denies f/c, CP, sob, diarrhea, joint pain,
or rash.  No change in mental status or seizures.

Vital signs in the ED were - 97.8, 64, 138/59, 18, 100%
Patient in c-collar, in NAD, dry mucus membranes
Patient with left arm weakness, no other focal deficits
abdomen soft, NT/ND.  She was given 500 ml fluid bolus followed
by NS at 100 cc/hr.  Patient reported improvement in her
headache.


Past Medical History:
osteoporosis


Social History:
Lives and takes care of husband, denies ETOH or tobacco
use.


Family History:
non-contributory

Physical Exam:
Admission PEx:
VS: 98.7  66  141/69  14  99%RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

Discharge PEx:
VS: 98.1  63  125/68  12  100%RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD, with collar
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

Pertinent Results:
Labs on admission:
[**2109-9-10**] 01:48PM BLOOD WBC-12.2* RBC-3.97* Hgb-12.4 Hct-34.0*
MCV-86 MCH-31.2 MCHC-36.4* RDW-13.3 Plt Ct-303
[**2109-9-11**] 04:43AM BLOOD WBC-11.7* RBC-4.08* Hgb-12.6 Hct-35.7*
MCV-88 MCH-30.9 MCHC-35.3* RDW-13.0 Plt Ct-328
[**2109-9-10**] 01:48PM BLOOD Plt Smr-NORMAL Plt Ct-303
[**2109-9-10**] 01:48PM BLOOD Osmolal-254*

Labs on Discharge:
[**2109-9-11**] 04:43AM BLOOD Glucose-98 UreaN-13 Creat-0.6 Na-129*
K-4.3 Cl-98 HCO3-23 AnGap-12
[**2109-9-10**] 01:48PM BLOOD Glucose-98 UreaN-10 Creat-0.6 Na-120*
K-3.7 Cl-89* HCO3-25 AnGap-10
[**2109-9-11**] 04:43AM BLOOD TSH-1.5
[**2109-9-11**] 04:43AM BLOOD Cortsol-26.4*
.
.
[**2109-9-10**] CT head:
FINDINGS: There is no evidence of hemorrhage, edema, or
infarction. There is a relative increase in the size of
bilateral CSF attenuation extra-axial frontal spaces compared to
the prior outside study. There is associated mild mass effect on
the posterior brain. No herniation is seen. The ventricles and
sulci are normal in configuration. No fractures are identified.
IMPRESSION:
1. Relative increase in size of bilateral CSF-attenuation
frontal extra-axial spaces suspicious for symmetric subdural
hygroma. Chronic subdural hematomas are felt less likely given
the time course and CSF attenuation.
2. No evidence of hemorrhage, edema or herniation.
.
[**2109-9-11**] CT Head:
preliminary read as no change in hygromas or edema

Brief Hospital Course:
Assessment:
The patient is a 74 year old female sent from rehab s/p fall
down stairs with c-spine injury presents with nausea, headache,
and dehydration, and found to have hyponatremia.
.
#Hyponatremia: Her sodium improved with IV fluids suggesting a
significant component of hypovolemia hyponatremia, likely in the
setting of dehydration from nausea and vomitting. Her sodium
improved from 121 on admission to 129 at transfer. Her
neurological exam was monitored closely in the intensive care
unit overnight and she was asymptomatic during her
hospitalization with mental status at baseline.\
.
#Subdural hygromas: She was found to have small subdural
hygromas on head imaging. She was evaluated by neurosurgery who
felt that they were likely to resolve with time. Repeat head CT
the following day showed stable appearance without evidence of
cerebral edema. Neurosurgery recommendations at discharge were
...
.
#Cervical fracture: The hard C-collar was continued.
.
# Scalp stitches were removed on [**2109-9-11**] prior to discharge.

# Code: Full (discussed with patient)
# Disposition: Rehab facility


Medications on Admission:

-bisacodyl 10mg daily
-colase 100mg [**Hospital1 **]
-senna [**Hospital1 **]
-dilaudid 2mg 1-2mg Q4 PRN for pain
-dexamethasone taper



Discharge Medications:
none; calcium may be started as outpatient and followed up on by
PCP.

Discharge Disposition:
Extended Care

Facility:
[**Hospital3 1107**] [**Hospital **] Hospital - [**Location (un) 38**]

Discharge Diagnosis:
dehydration


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


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

It was a pleasure taking care of you at the [**Hospital1 771**]. You presented to the hospital with
nausea, vomiting. Your sodium (an electrolyte) was found to be
much lower than normal. This is most likely due to being
dehydrated from the nausea/vomitting. Your sodium improved with
IV fluids.

Please continue your home medications with no changes.

Followup Instructions:
PCP
[**Name Initial (PRE) **]



Completed by:[**2109-9-11**]
{'Hyposmolality and/or hyponatremia,Osteoporosis, unspecified,Nausea with vomiting'}


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: hyponatremia

PRESENT ILLNESS: 74F with recent D/C from [**Hospital1 18**] s/p fall down stairs with c-spine
fractures presents today with Nausea, headache, and feeling dry
x4 days. She was admitted on [**2109-9-2**] with multiple fractures of
the spinous process of C4, C7and T1 as well as a retropharyngeal
hematoma. She was placed in aC-collar and remaine neurologically
stable. She was discharged torehab on [**2109-9-4**] and completed a
dexamethasone taper. She represented to the ED today complaining
of HA and  Patient states she was d/c from [**Hospital1 18**] on [**9-4**] feeling
well. 4 days ago she began to feel nausea with decreased ability
to tolerate PO. Patient developed constant frontal headache and
felt dehydrated. Patient with labs done at rehab center today
showing Na+ = 119, at that time patient sent to ER for
evaluation. Patient denies f/c, CP, sob, diarrhea, joint pain,
or rash.  No change in mental status or seizures.

MEDICAL HISTORY: osteoporosis

MEDICATION ON ADMISSION: -bisacodyl 10mg daily
-colase 100mg [**Hospital1 **]
-senna [**Hospital1 **]
-dilaudid 2mg 1-2mg Q4 PRN for pain
-dexamethasone taper

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission PEx:
VS: 98.7  66  141/69  14  99%RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Lives and takes care of husband, denies ETOH or tobacco
use. 

### Response:
{'Hyposmolality and/or hyponatremia,Osteoporosis, unspecified,Nausea with vomiting'}
