CHIEF COMPLAINT: Septic shock

PRESENT ILLNESS: Ms. [**Known lastname 10168**] is a 65 year old female with type 2 DM, HTN,
alcoholism who was at day 4 of detox. Per detox staff, she was
complaining of weakness and lethargy and had poor PO intake. She
was noted to be more confused yesterday and her son questioned
if she was drinking. SHe was found this evening in the bathtub
with altered mental status but was arousable. She was note
dinitiallly to have BP 82/40, RR 20, HR 70, 97% on RA by EMS.
She was given 500 cc of fluid.
.
She was taken to [**Hospital 26580**] Hospital. She was found to have
leukocytosis (19.1) and hypothermia (T 92.6). She had acute
renal failure (Cr 9.9) and hyperkalemia (7.7). She had profound
acidosis (pH 6.89/22/102/5) with bicarb of less than 5. She was
intubated for airway protection. She was then started on
Levophed 10 mcg/hour and Dopamine 20 mcg/keg/min due to
hypotension. She was given vancomycinand ceftriaxone. For her
hyperkalemia, she was given 5IV insul, 1 amp dextrose, and 1
gram of calcium gluconate, and kayexalate. There was concern for
a guiaic positive NG return, so started on protonix drip. She
was then trasported to [**Hospital1 18**] by [**Location (un) **].
.
In th ED,she arrive intubated and sedated. She remained
hyperkalemic and acidotic. She was given an amp of bicarb, 1
gram of calcium gluiconate and remained on the dopamine and
levophed drips. She got a total of 7L IVF and remained anuric. A
CT abdomen pelvis showed pancreatitis and her lipase was
elevated to >[**2112**]. Renal was consulted and recommended CVVHD.
She was not given any further antibiotics. SHe had a bedside
ultrasound that was fast negative and no pericardial effusion
seen. In the ED, right femoral line was placed.
.
Patient arrived in the MICU intubated. She denied pain

MEDICAL HISTORY: HTN
Type 2 DM
Hypercholesterolemia

MEDICATION ON ADMISSION: Lovastatin 20 mg daily
Metoprolol 50 mg [**Hospital1 **]
Lisinopril 20 mg daily
HCTZ 25 mg daily
Metformin 1000 [**Hospital1 **]
Prilosec 20 mg daily
Celexa 10 mg daily
Naproxen 500 PO BID

ALLERGIES: No Drug Allergy Information on File

PHYSICAL EXAM: VS: HR 87, BP 97/34, RR 29, 96% on
Gen: Intubated, Sedated
HEENT: Edematous, Pupils sluggish
CV: Tachy, No MRG
Pulm: Coarse BS Anteriorly
Abd: Firm, BS+
Ext:2+ edema

FAMILY HISTORY: Non-Contributory

SOCIAL HISTORY: Historically heavy EtOH use, but currently at a detox facility
with reportedly little supervision. Per medical records from
detox facility, last drink [**2121-11-20**]. Denies drug use.
Unspecified septicemia,Septic shock,Acute kidney failure, unspecified,Acidosis,Acute respiratory failure,Acute pancreatitis,Severe sepsis,Other and unspecified alcohol dependence, unspecified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Septicemia NOS,Septic shock,Acute kidney failure NOS,Acidosis,Acute respiratry failure,Acute pancreatitis,Severe sepsis,Alcoh dep NEC/NOS-unspec,Hypertension NOS,DMII wo cmp nt st uncntr
Admission Date:  [**2121-11-25**]              Discharge Date:   [**2121-11-27**]

Date of Birth:  [**2056-1-9**]             Sex:   F

Service: MEDICINE

Allergies:
No Drug Allergy Information on File

Attending:[**First Name3 (LF) 2817**]
Chief Complaint:
Septic shock

Major Surgical or Invasive Procedure:
Mechanical Ventilation

History of Present Illness:
Ms. [**Known lastname 10168**] is a 65 year old female with type 2 DM, HTN,
alcoholism who was at day 4 of detox. Per detox staff, she was
complaining of weakness and lethargy and had poor PO intake. She
was noted to be more confused yesterday and her son questioned
if she was drinking. SHe was found this evening in the bathtub
with altered mental status but was arousable. She was note
dinitiallly to have BP 82/40, RR 20, HR 70, 97% on RA by EMS.
She was given 500 cc of fluid.
.
She was taken to [**Hospital 26580**] Hospital. She was found to have
leukocytosis (19.1) and hypothermia (T 92.6). She had acute
renal failure (Cr 9.9) and hyperkalemia (7.7). She had profound
acidosis (pH 6.89/22/102/5) with bicarb of less than 5. She was
intubated for airway protection. She was then started on
Levophed 10 mcg/hour and Dopamine 20 mcg/keg/min due to
hypotension. She was given vancomycinand ceftriaxone. For her
hyperkalemia, she was given 5IV insul, 1 amp dextrose, and 1
gram of calcium gluconate, and kayexalate. There was concern for
a guiaic positive NG return, so started on protonix drip. She
was then trasported to [**Hospital1 18**] by [**Location (un) **].
.
In th ED,she arrive intubated and sedated. She remained
hyperkalemic and acidotic. She was given an amp of bicarb, 1
gram of calcium gluiconate and remained on the dopamine and
levophed drips. She got a total of 7L IVF and remained anuric. A
CT abdomen pelvis showed pancreatitis and her lipase was
elevated to >[**2112**]. Renal was consulted and recommended CVVHD.
She was not given any further antibiotics. SHe had a bedside
ultrasound that was fast negative and no pericardial effusion
seen. In the ED, right femoral line was placed.
.
Patient arrived in the MICU intubated. She denied pain

Past Medical History:
HTN
Type 2 DM
Hypercholesterolemia

Social History:
Historically heavy EtOH use, but currently at a detox facility
with reportedly little supervision. Per medical records from
detox facility, last drink [**2121-11-20**]. Denies drug use.

Family History:
Non-Contributory

Physical Exam:
VS: HR 87, BP 97/34, RR 29, 96% on
Gen: Intubated, Sedated
HEENT: Edematous, Pupils sluggish
CV: Tachy, No MRG
Pulm: Coarse BS Anteriorly
Abd: Firm, BS+
Ext:2+ edema

Pertinent Results:
Admission Labs:
[**2121-11-25**] 08:20PM   WBC-12.4* RBC-2.58* HGB-9.4* HCT-30.5*
MCV-119* MCH-36.4* MCHC-30.7* RDW-14.6
[**2121-11-25**] 08:20PM   NEUTS-86.6* LYMPHS-9.5* MONOS-2.7 EOS-1.0
BASOS-0.2
[**2121-11-25**] 08:20PM   PLT COUNT-164 LPLT-1+
[**2121-11-25**] 08:20PM   PT-20.9* PTT-64.4* INR(PT)-2.0*
[**2121-11-25**] 08:20PM   SED RATE-6
[**2121-11-25**] 08:20PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-POS barbitrt-NEG tricyclic-NEG
[**2121-11-25**] 08:20PM   TSH-1.2
[**2121-11-25**] 08:20PM   OSMOLAL-327*
[**2121-11-25**] 08:20PM   ALBUMIN-3.0* CALCIUM-7.0* PHOSPHATE-9.1*
MAGNESIUM-1.9
[**2121-11-25**] 08:20PM   LIPASE-2678*
[**2121-11-25**] 08:20PM   ALT(SGPT)-23 AST(SGOT)-29 ALK PHOS-72 TOT
BILI-0.4
[**2121-11-25**] 08:20PM   GLUCOSE-266* UREA N-66* CREAT-8.5*
SODIUM-131* POTASSIUM-7.1* CHLORIDE-99 TOTAL CO2-5* ANION
GAP-34*
[**2121-11-25**] 08:38PM   LACTATE-10.6*
.
CT Head: No Hemorrhage
.
CT Abdomen, Pelvis:
1. Extensive stranding and fluid surrounding the pancreas and
extending into
the transverse mesocolon, the appearance of which is most
compatible with
acute pancreatitis. Correlate with lipase and amylase.
Non-contrast technique
limits evaluation for pancreatic necrosis and vascular
complications.
2. Diffuse low attenuation of the liver consistent with fatty
infiltration.
.
IMPRESSION: New discrete multiple lung opacities could be due to
pneumonia,
but hemorrhage related to vasculitis can also be considered due
to patient's
history of renal failure.


Brief Hospital Course:
65 year old female with type 2 diabetes, HTN, HL, admitted with
shock of unclear etiology -- septic shock (leukocytosis,
hypothermia), distributive shock secondary to pancreatitis
(lipase >2500, radiographic evidence of pancreatitis), and toxic
ingestion (?ethylene glycol -- elevated osmolar gap).
.
# Acute Pancreatis: The patient presented in shock. Etiology of
shock in this complicated patient was not immedicately clear.
The differenital included septic shock (leukocytosis,
hypothermia), distributive shock secondary to pancreatitis
(lipase >2500, radiographic evidence of pancreatitis), and toxic
ingestion (?ethylene glycol -- elevated osmolar gap).
Leukocytosis and hypothermia were suggestive of septic shock,
though there is no clear source of infection. The patient had a
lactate of 10 on admission. The patient was intubated for airway
protection initially but developed increasing 02 requirements.
CXR showed no infection initially, and the patient was anuric so
we were unable to send urine. There was no evidence of
cellulitis. History limited but no localizing symptoms per
family. Patient's osmolar gap was suggestive of a toxic
ingestion such as ethylene glycol or methanol. Her history of
?intoxication per son yesterday in spite of being at rehab in
addition to acidosis and renal failure may support ethylene
glycol ingestion. The patient was placed on levo, neo, dopa,
vasopressin to maintain MAPs>65. She was treated empirically
with vanco and cefepime; hold off on empiric c. diff treatment
or antifungal therapy given lack of risk factors. The patient
was given IVF boluses in addition to 10L the patient received at
the OSH. The patient presented with a Cr of 10. Urgent CVVH was
attempted, however the patients blood pressure would not
tolerate dialysis. Ethylene glycol and methanol levels were sent
out and found to be negative. Thus given a lipase 0f 2500,
radiographic evidence of acute pancreatitis, a strong personal
history of heavy alcohol abuse, a diagnosis of Acute Pancreatis
was made for the etiology of the patients septic shock.
Following a family discussion, a decision was made to make the
patient comfortable. The patient expired shortly after withdrawl
of pressors and extubation.  A most mortem examination was
declined by the family.
.

Medications on Admission:
Lovastatin 20 mg daily
Metoprolol 50 mg [**Hospital1 **]
Lisinopril 20 mg daily
HCTZ 25 mg daily
Metformin 1000 [**Hospital1 **]
Prilosec 20 mg daily
Celexa 10 mg daily
Naproxen 500 PO BID

Discharge Medications:
N/A

Discharge Disposition:
Expired

Discharge Diagnosis:
Expired

Discharge Condition:
N/A

Discharge Instructions:
N/A

Followup Instructions:
N/A
{'Unspecified septicemia,Septic shock,Acute kidney failure, unspecified,Acidosis,Acute respiratory failure,Acute pancreatitis,Severe sepsis,Other and unspecified alcohol dependence, unspecified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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: Septic shock

PRESENT ILLNESS: Ms. [**Known lastname 10168**] is a 65 year old female with type 2 DM, HTN,
alcoholism who was at day 4 of detox. Per detox staff, she was
complaining of weakness and lethargy and had poor PO intake. She
was noted to be more confused yesterday and her son questioned
if she was drinking. SHe was found this evening in the bathtub
with altered mental status but was arousable. She was note
dinitiallly to have BP 82/40, RR 20, HR 70, 97% on RA by EMS.
She was given 500 cc of fluid.
.
She was taken to [**Hospital 26580**] Hospital. She was found to have
leukocytosis (19.1) and hypothermia (T 92.6). She had acute
renal failure (Cr 9.9) and hyperkalemia (7.7). She had profound
acidosis (pH 6.89/22/102/5) with bicarb of less than 5. She was
intubated for airway protection. She was then started on
Levophed 10 mcg/hour and Dopamine 20 mcg/keg/min due to
hypotension. She was given vancomycinand ceftriaxone. For her
hyperkalemia, she was given 5IV insul, 1 amp dextrose, and 1
gram of calcium gluconate, and kayexalate. There was concern for
a guiaic positive NG return, so started on protonix drip. She
was then trasported to [**Hospital1 18**] by [**Location (un) **].
.
In th ED,she arrive intubated and sedated. She remained
hyperkalemic and acidotic. She was given an amp of bicarb, 1
gram of calcium gluiconate and remained on the dopamine and
levophed drips. She got a total of 7L IVF and remained anuric. A
CT abdomen pelvis showed pancreatitis and her lipase was
elevated to >[**2112**]. Renal was consulted and recommended CVVHD.
She was not given any further antibiotics. SHe had a bedside
ultrasound that was fast negative and no pericardial effusion
seen. In the ED, right femoral line was placed.
.
Patient arrived in the MICU intubated. She denied pain

MEDICAL HISTORY: HTN
Type 2 DM
Hypercholesterolemia

MEDICATION ON ADMISSION: Lovastatin 20 mg daily
Metoprolol 50 mg [**Hospital1 **]
Lisinopril 20 mg daily
HCTZ 25 mg daily
Metformin 1000 [**Hospital1 **]
Prilosec 20 mg daily
Celexa 10 mg daily
Naproxen 500 PO BID

ALLERGIES: No Drug Allergy Information on File

PHYSICAL EXAM: VS: HR 87, BP 97/34, RR 29, 96% on
Gen: Intubated, Sedated
HEENT: Edematous, Pupils sluggish
CV: Tachy, No MRG
Pulm: Coarse BS Anteriorly
Abd: Firm, BS+
Ext:2+ edema

FAMILY HISTORY: Non-Contributory

SOCIAL HISTORY: Historically heavy EtOH use, but currently at a detox facility
with reportedly little supervision. Per medical records from
detox facility, last drink [**2121-11-20**]. Denies drug use. 

### Response:
{'Unspecified septicemia,Septic shock,Acute kidney failure, unspecified,Acidosis,Acute respiratory failure,Acute pancreatitis,Severe sepsis,Other and unspecified alcohol dependence, unspecified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
