CHIEF COMPLAINT: Fever and chills

PRESENT ILLNESS: 46 y/o male s/p OLT in [**2121-11-16**] with complicated post op course
and extended hospitalizations for hepatic artery thrombosis, VRE
bacteremia, sepsis, multiple liver abcesses, SBO. Recent
admission on [**9-12**] for placement of a new hepatic drain in the
right lobe that grew out B-lactamase producing Klebsiella and
Enterococcus that was resistant to Synercid. Past infections
also include Klebsiella bacteremia, Klebsiella from the abscess
drain. There is also history of [**First Name5 (NamePattern1) 564**] [**Last Name (NamePattern1) 563**] from the
hepatic abscesses found 5 months ago. Current Antibiotic regimen
at rehab included Synercid, Meropenem, Posaconazole and
Levaquin.
Patient had been afebrile following the last discharge until day
of admission when he developed fever and chills. Patient denies
SOB, cough, chest pain. He also has chronic abdominal pain which
has not worsened.Denies dysuria or constipation/diarrhea

MEDICAL HISTORY: cryptogenic cirrhosis, s/p liver transplant [**11-21**]
hepatic artery thrombosis
VRE bacteremia
sepsis
multiple liver abcesses
SBO with surgical repair [**4-21**]
chronic renal insufficiency
inguinal hernia
diverticulitis
depression
esophageal varices
hyperkalemia
anemia

MEDICATION ON ADMISSION: levo 500, [**Last Name (un) 2830**] 500q6, posaconazole 200"", rifaximin 200q8,
bactrim, synercid 500", epo 40mcg qMWF, nifedipine 10", protonix
40, zoloft 50, sirolimus 2, dilaudid 4mg q4prn

ALLERGIES: Penicillins / Benzocaine

PHYSICAL EXAM: On admission:
VS:100.5, 112, 100/57, 24, 97%RA
Gen: NAD, Cachectic
HEENT: Sclera anicteric, no cervical LAD
Lungs: CTA bilaterally
Heart: RRR
Abd: Soft, Non-tender, non-distended, no guarding, no rebound,
3drains in place
Extr: No LE edema, warm, well prefused

FAMILY HISTORY: single
lives with Mother
[**Name (NI) **] 3 siblings with 1 deceased sibling

SOCIAL HISTORY: no tobacco, no EtOH, former chef
Complications of transplanted liver,Abscess of liver,Cholangitis,Bacteremia,Acute kidney failure, unspecified,Cachexia,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Compl liver transplant,Abscess of liver,Cholangitis,Bacteremia,Acute kidney failure NOS,Cachexia,Oth gram negatv bacteria,DMII wo cmp nt st uncntr
Name:  [**Known lastname **],[**Known firstname **] V.                   Unit No:   [**Numeric Identifier 11193**]

Admission Date:  [**2122-9-26**]              Discharge Date:   [**2122-10-16**]

Date of Birth:  [**2075-12-28**]             Sex:   M

Service: SURGERY

Allergies:
Penicillins / Benzocaine

Attending:[**First Name3 (LF) 48**]
Addendum:
Patient signed Comfort Care Form [**2122-10-15**]. He was discharged
home with hospice services arranged. No further follow up
appointment and  no further labs to be done. R IJ cline was
removed with incident on [**2122-10-16**].

Discharge Disposition:
Home With Service

Facility:
Home Hospice Care of RI

Followup Instructions:
Please call [**Telephone/Fax (1) 242**] for questions


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 51**] MD, [**MD Number(3) 52**]

Completed by:[**2122-10-16**]

Admission Date:  [**2122-9-26**]              Discharge Date:   [**2122-10-16**]

Date of Birth:  [**2075-12-28**]             Sex:   M

Service: SURGERY

Allergies:
Penicillins / Benzocaine

Attending:[**First Name3 (LF) 695**]
Chief Complaint:
Fever and chills

Major Surgical or Invasive Procedure:
Hepatic abscess drain placement [**2122-10-12**]

History of Present Illness:
46 y/o male s/p OLT in [**2121-11-16**] with complicated post op course
and extended hospitalizations for hepatic artery thrombosis, VRE
bacteremia, sepsis, multiple liver abcesses, SBO. Recent
admission on [**9-12**] for placement of a new hepatic drain in the
right lobe that grew out B-lactamase producing Klebsiella and
Enterococcus that was resistant to Synercid. Past infections
also include Klebsiella bacteremia, Klebsiella from the abscess
drain. There is also history of [**First Name5 (NamePattern1) 564**] [**Last Name (NamePattern1) 563**] from the
hepatic abscesses found 5 months ago. Current Antibiotic regimen
at rehab included Synercid, Meropenem, Posaconazole and
Levaquin.
Patient had been afebrile following the last discharge until day
of admission when he developed fever and chills. Patient denies
SOB, cough, chest pain. He also has chronic abdominal pain which
has not worsened.Denies dysuria or constipation/diarrhea

Past Medical History:
cryptogenic cirrhosis, s/p liver transplant [**11-21**]
hepatic artery thrombosis
VRE bacteremia
sepsis
multiple liver abcesses
SBO with surgical repair [**4-21**]
chronic renal insufficiency
inguinal hernia
diverticulitis
depression
esophageal varices
hyperkalemia
anemia

Social History:
no tobacco, no EtOH, former chef


Family History:
single
lives with Mother
[**Name (NI) **] 3 siblings with 1 deceased sibling

Physical Exam:
On admission:
VS:100.5, 112, 100/57, 24, 97%RA
Gen: NAD, Cachectic
HEENT: Sclera anicteric, no cervical LAD
Lungs: CTA bilaterally
Heart: RRR
Abd: Soft, Non-tender, non-distended, no guarding, no rebound,
3drains in place
Extr: No LE edema, warm, well prefused

Pertinent Results:
On Admission:[**2122-9-26**]
GLUCOSE-160* UREA N-23* CREAT-0.9 SODIUM-130* POTASSIUM-5.1
CHLORIDE-103 TOTAL CO2-17* ANION GAP-15
ALT(SGPT)-35 AST(SGOT)-37 ALK PHOS-343* AMYLASE-11 TOT BILI-1.3
DIR BILI-0.8* INDIR BIL-0.5  LIPASE-8
ALBUMIN-2.7* CALCIUM-8.5 PHOSPHATE-2.8 MAGNESIUM-1.7
WBC-5.4# RBC-3.26* HGB-10.1* HCT-27.2* MCV-83 MCH-31.0
MCHC-37.2* RDW-16.6*
PLT COUNT-40*
PT-15.5* PTT-32.6 INR(PT)-1.4*

Brief Hospital Course:
Patient admitted from [**Hospital **] Rehab with recurrent fever with
chills.
Central Line was changed on Admission. Triple lumen now in place
with tip at atriocaval junction. Tip was negative for growth.
Synercid was discontinued with initial addition of Daptomycin to
antibiotic regimen.
CT Abdomen/pelvis performed on [**9-27**] showed: Two new low
attenuation regions within the right lobe of the liver that
likely represented new bile lakes. Diffuse pneumatosis of the
colon and unchanged appearance of partially occlusive thrombus
at the confluence of the SMV and portal vein. It was felt that
these bile collections were too small to add an additional drain
at that time.
Patient spiked fevers to 104. ID was consulted for revision of
the antibiotic regimen
to include Amikacin, Colistin and Tigecycline for the Klebsiella
and Posaconazole & Caspofungin for the [**Female First Name (un) 564**] and Mucor. All
other antibiotics d/c'd. He remained on Bactrim for post
transplant prophylaxis. LFTs increased and this was attributed
to the antibiotics as liver duplex was stable and
immunosuppression was such that rejection was unlikely.
Klebsiella was recovered from blood cultures drawn on the 13th
and all subsequent blood cultures drawn on [**10-29**],
On [**10-3**] blood cultures were positive for [**Female First Name (un) 564**] Torulopsis
[**Female First Name (un) **].  CXRs were stable with small right pleural effusion.
Infectious disease followed closely during this hospitalization.

On [**10-12**], he underwent successful CT-guided aspiration and
catheter placement within a biloma/abscess in segment VI/VII
secondary to inadvertent self removal of this drainage catheter.
The catheter was left to suction bulb drainage. J tube was also
self removed when he was delerious during a febrile/hypotensive
episode necessitating SICU management. J tube was replace with a
red rubber catheter without difficulty.

He continued to spike temps intermittently and his condition
worsened with increased lethargy/endurance.
Tube feeds were continued and he was seen by nutrition during
this hospitalization as well as PT.

After much deliberation by the patient and the transplant team,
the patient was informed that his chance of receiving a liver
was very unlikely due to persistent high grade klebsiella
antibiotic resistance and fungemia. ID recommended colistin as
the last option and unfortunately he did not clear the
bacteremia. Given the low probability of retransplant, the
patient decided to be discharged home with hospice.

He was discharged on his transplant immunosuppression to prevent
rejection which consisted of Rapamune 0.5mg qd via the J tube.
Bactrim was continued for PCP prophylaxis and [**Name9 (PRE) 8005**] for
prevention of encephalopathy. His abdominal pain was managed
well with po dilaudid. Three hepatic abscess drains remain in
place to gravity drainage which do not require flushing. They
continue to drain bile and purulent drainage.
Most recent labs on [**10-15**] were wbc 3.5, hct 29.9, creat 1.3, bun
30, ast 18, alt 14, alk phos 319, and t.bili 2.7. He continued
to have persistent hypokalemia requiring daily repletion. Last K
3.2 on [**2122-10-16**].
Hospice will be authorized by his R.I. MD.


Medications on Admission:
levo 500, [**Last Name (un) 2830**] 500q6, posaconazole 200"", rifaximin 200q8,
bactrim, synercid 500", epo 40mcg qMWF, nifedipine 10", protonix
40, zoloft 50, sirolimus 2, dilaudid 4mg q4prn


Discharge Medications:
1. Equipment
Hospital bed-electric for home
2. TF supplies
Tubefeeding: Nepro 3/4 strength; Additives: Beneprotein, 25
gm/day rate:60 ml/hr; Do not advance rate Goal rate:60 ml/hr
Syringes/pump/formula
Flush w/ 50 ml water q8h

3. HYDROmorphone 2 mg Tablet [**Last Name (un) **]: 1-2 Tablets PO Q4H (every 4
hours) as needed.
Disp:*40 Tablet(s)* Refills:*0*
4. Sertraline 50 mg Tablet [**Last Name (un) **]: One (1) Tablet PO DAILY (Daily).

5. Sirolimus 1 mg/mL Solution [**Last Name (un) **]: 0.5 ml PO DAILY (Daily).
6. Trimethoprim-Sulfamethoxazole 80-400 mg Tablet [**Last Name (un) **]: One (1)
Tablet PO 3X/WEEK (MO,WE,FR).
7. syringes
insulin
1 box
8. Acetaminophen 325 mg Tablet [**Last Name (un) **]: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
9. Rifaximin 200 mg Tablet [**Last Name (un) **]: One (1) Tablet PO TID (3 times a
day).
10. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
11. Lancets
1 box
refills-none
12. glucometer
One Touch Ultra-Test Strips
1 bottle
refill: 1
13. Insulin Glargine 100 unit/mL Solution [**Last Name (STitle) **]: Six (6)
Subcutaneous at bedtime.


Discharge Disposition:
Home With Service

Facility:
Home Hospice Care of RI

Discharge Diagnosis:
-Two new low attenuation regions within the right lobe of the
liver may represent new bile lakes, not drainable.
-Diffuse pneumatosis of the colon
-Partially occlusive thrombus at the confluence of the SMV and
portal vein


Discharge Condition:
Stable


Discharge Instructions:
Please call [**Telephone/Fax (1) 673**] if the patient experiences recurrence
of fevers, chills. Please call if nausea, vomiting, diarrhea,
inability to eat, difficulties with drains, sudden increase in
output of drains or change in nature of output.
Labs to be drawn and faxed q Monday and Thursday: CBC, Chem 10,
AST, ALT, Alk Phos, T Bili, Albumin, Trough Rapamycin level

Followup Instructions:
Please call [**Telephone/Fax (1) 673**] for appointment with Dr [**Last Name (STitle) 816**], to be
seen within the next 2 weeks


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**] MD, [**MD Number(3) 709**]

Completed by:[**2122-10-16**]

Name:  [**Known lastname **],[**Known firstname **] V.                   Unit No:   [**Numeric Identifier 11193**]

Admission Date:  [**2122-9-26**]              Discharge Date:   [**2122-10-16**]

Date of Birth:  [**2075-12-28**]             Sex:   M

Service: SURGERY

Allergies:
Penicillins / Benzocaine

Attending:[**First Name3 (LF) 48**]
Addendum:
correction on addendum to discharge summary: R IJ cline removed
without complications on [**2122-10-16**]

Discharge Disposition:
Home With Service

Facility:
Home Hospice Care of RI

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 51**] MD, [**MD Number(3) 52**]

Completed by:[**2122-10-16**]
{'Complications of transplanted liver,Abscess of liver,Cholangitis,Bacteremia,Acute kidney failure, unspecified,Cachexia,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms,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: Fever and chills

PRESENT ILLNESS: 46 y/o male s/p OLT in [**2121-11-16**] with complicated post op course
and extended hospitalizations for hepatic artery thrombosis, VRE
bacteremia, sepsis, multiple liver abcesses, SBO. Recent
admission on [**9-12**] for placement of a new hepatic drain in the
right lobe that grew out B-lactamase producing Klebsiella and
Enterococcus that was resistant to Synercid. Past infections
also include Klebsiella bacteremia, Klebsiella from the abscess
drain. There is also history of [**First Name5 (NamePattern1) 564**] [**Last Name (NamePattern1) 563**] from the
hepatic abscesses found 5 months ago. Current Antibiotic regimen
at rehab included Synercid, Meropenem, Posaconazole and
Levaquin.
Patient had been afebrile following the last discharge until day
of admission when he developed fever and chills. Patient denies
SOB, cough, chest pain. He also has chronic abdominal pain which
has not worsened.Denies dysuria or constipation/diarrhea

MEDICAL HISTORY: cryptogenic cirrhosis, s/p liver transplant [**11-21**]
hepatic artery thrombosis
VRE bacteremia
sepsis
multiple liver abcesses
SBO with surgical repair [**4-21**]
chronic renal insufficiency
inguinal hernia
diverticulitis
depression
esophageal varices
hyperkalemia
anemia

MEDICATION ON ADMISSION: levo 500, [**Last Name (un) 2830**] 500q6, posaconazole 200"", rifaximin 200q8,
bactrim, synercid 500", epo 40mcg qMWF, nifedipine 10", protonix
40, zoloft 50, sirolimus 2, dilaudid 4mg q4prn

ALLERGIES: Penicillins / Benzocaine

PHYSICAL EXAM: On admission:
VS:100.5, 112, 100/57, 24, 97%RA
Gen: NAD, Cachectic
HEENT: Sclera anicteric, no cervical LAD
Lungs: CTA bilaterally
Heart: RRR
Abd: Soft, Non-tender, non-distended, no guarding, no rebound,
3drains in place
Extr: No LE edema, warm, well prefused

FAMILY HISTORY: single
lives with Mother
[**Name (NI) **] 3 siblings with 1 deceased sibling

SOCIAL HISTORY: no tobacco, no EtOH, former chef 

### Response:
{'Complications of transplanted liver,Abscess of liver,Cholangitis,Bacteremia,Acute kidney failure, unspecified,Cachexia,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
