CHIEF COMPLAINT: Hypoxia

PRESENT ILLNESS: Pt is a 83 yo female with history of bilateral PEs, HTN,
pulmonary HTN on 2 L home O2 who presents with SOB/vomiting and
found to be hypoxic. Pt states that yesterday she felt short of
breath and lightheaded ("dizzy"- which was not the room
spinning) when standing up. She vomited x 1 and her family
called 911. Pt denies recent F/C/N. No cough. No dysuria. Stable
2 pillow orthopnea. No PND.
Pt states that she has been taking her medication and partakes
in a low salt diet.  No CP. Of note, per ED note, pt states that
she did have chest pain.
.
In the ED, VS on arrival were: T: 95.7; HR: 90; BP: 155/79; RR:
18; O2: 91 2L NC. She was given 500 mg IV levaquin x 1,
prednisone 60 mg po x 1, combivent x 2, sodium bicarb in D5w and
furosemide 40 mg IV x 1.
.
Now, pt states that she feels much better. She denies CP/SOB/
feeling lightheaded or dizzy.
.
Last admission was in [**Month (only) 216**] of this year when pt came in with
SOB. She was diuresed and it was thought to be [**2-10**] increased BPs
leading to pulmonary edema in setting of other pulmonary
problems.

MEDICAL HISTORY: s/p THR 22 years ago complicated by clot in leg
s/p cataract surgery
Back pain s/p corticosteroid injections
PFTs [**8-13**]- FEv1- 52; FVC- 54%, FEV1/FVC 104.
  Spirometry is consistent with a restrictive ventilatory defect
as
  demonstrated by the reduced TLC measured on [**2152-8-29**].
Echo [**8-13**]-Left ventricular wall thicknesses and cavity size are

MEDICATION ON ADMISSION: Toprol XL 50 mg qday
Atrovent and albuterol nebs MDI q 6 hours
Lisinopril 5 mg qday
Coumadin - 4mg Monday and Friday nights
Coumadin- 3 mg Tuesday, Wednesday, Thursday, Saturday, and
Sundays
Timolol eye drops
Atrovent, albuterol MDI prn

ALLERGIES: Clindamycin / Vancomycin

PHYSICAL EXAM: VS: T: 97.7; BP: 134/117; HR: 121; RR: 17; O2: 94 50% venti
mask.
Gen: SPeaking in full sentences in accent in NAD
HEENT: Right surgical pupil. Left RRLA. EOMI; sclera anicteric;
OP clear without exudate.
Neck: JVD difficult to tell. ? 9 cm. No LAD
CV: Distant S1S2.
Lungs: Scant crackles at right base, otherwise clear with good
air movement
Abd: NABS. soft, nt, nd
Back: No spinal, paraspinal, CVA tenderness
Ext: Trace edema b/l.
Neuro: CN II-XII tested and intact. MS [**5-12**] throughout. Biceps,
brachio, patellar reflexes [**2-10**].

FAMILY HISTORY: No heart or lung disease in family.

SOCIAL HISTORY: Originally from [**Country 3399**]. Came to the US in [**2106**]. Widowed, lives
by self. Family involved in care. No smoking. No EtOH.
Pneumonia, organism unspecified,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Chronic kidney disease, unspecified,Other chronic pulmonary heart diseases,Hypoxemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other diseases of lung, not elsewhere classified,Unspecified glaucoma,Anemia, unspecified,Personal history of venous thrombosis and embolism
Pneumonia, organism NOS,Acute kidney failure NOS,CHF NOS,Chronic kidney dis NOS,Chr pulmon heart dis NEC,Hypoxemia,Hy kid NOS w cr kid I-IV,Other lung disease NEC,Glaucoma NOS,Anemia NOS,Hx-ven thrombosis/embols
Admission Date:  [**2152-12-16**]              Discharge Date:   [**2152-12-19**]


Service: MEDICINE

Allergies:
Clindamycin / Vancomycin

Attending:[**First Name3 (LF) 898**]
Chief Complaint:
Hypoxia

Major Surgical or Invasive Procedure:
None


History of Present Illness:
 Pt is a 83 yo female with history of bilateral PEs, HTN,
pulmonary HTN on 2 L home O2 who presents with SOB/vomiting and
found to be hypoxic. Pt states that yesterday she felt short of
breath and lightheaded ("dizzy"- which was not the room
spinning) when standing up. She vomited x 1 and her family
called 911. Pt denies recent F/C/N. No cough. No dysuria. Stable
2 pillow orthopnea. No PND.
Pt states that she has been taking her medication and partakes
in a low salt diet.  No CP. Of note, per ED note, pt states that
she did have chest pain.
.
In the ED, VS on arrival were: T: 95.7; HR: 90; BP: 155/79; RR:
18; O2: 91 2L NC. She was given 500 mg IV levaquin x 1,
prednisone 60 mg po x 1, combivent x 2, sodium bicarb in D5w and
furosemide 40 mg IV x 1.
.
Now, pt states that she feels much better. She denies CP/SOB/
feeling lightheaded or dizzy.
.
Last admission was in [**Month (only) 216**] of this year when pt came in with
SOB. She was diuresed and it was thought to be [**2-10**] increased BPs
leading to pulmonary edema in setting of other pulmonary
problems.


Past Medical History:
s/p THR 22 years ago complicated by clot in leg
s/p cataract surgery
Back pain s/p corticosteroid injections
PFTs [**8-13**]- FEv1- 52; FVC- 54%, FEV1/FVC 104.
  Spirometry is consistent with a restrictive ventilatory defect
as
  demonstrated by the reduced TLC measured on [**2152-8-29**].
Echo [**8-13**]-Left ventricular wall thicknesses and cavity size are

  normal.  Regional left ventricular wall motion is normal.
Overall
  left ventricular  systolic function is low normal (LVEF
50-55%).
  Right ventricular systolic  function is borderline normal.
There is
  abnormal septal motion/position. The
  aortic valve leaflets (3) are mildly thickened but aortic
stenosis
  is not present. Mild (1+) aortic regurgitation is seen. The
mitral
  valve leaflets are mildly thickened. There is no mitral valve
  prolapse. Mild (1+) mitral regurgitation is seen. The left
  ventricular inflow pattern suggests impaired  relaxation.
There is
  severe pulmonary artery systolic hypertension. There is  no
  pericardial effusion.


Social History:
Originally from [**Country 3399**]. Came to the US in [**2106**]. Widowed, lives
by self. Family involved in care. No smoking. No EtOH.

Family History:
No heart or lung disease in family.

Physical Exam:
VS: T: 97.7; BP: 134/117; HR: 121; RR: 17; O2: 94 50% venti
mask.
Gen: SPeaking in full sentences in accent in NAD
HEENT: Right surgical pupil. Left RRLA. EOMI; sclera anicteric;
OP clear without exudate.
Neck: JVD difficult to tell. ? 9 cm. No LAD
CV: Distant S1S2.
Lungs: Scant crackles at right base, otherwise clear with good
air movement
Abd: NABS. soft, nt, nd
Back: No spinal, paraspinal, CVA tenderness
Ext: Trace edema b/l.
Neuro: CN II-XII tested and intact. MS [**5-12**] throughout. Biceps,
brachio, patellar reflexes [**2-10**].


Pertinent Results:
Admission Labs:
[**2152-12-16**] 05:16PM URINE  EOS-NEGATIVE
[**2152-12-16**] 04:59PM   CREAT-1.6* POTASSIUM-3.8
[**2152-12-16**] 04:59PM   cTropnT-<0.01
[**2152-12-16**] 11:06AM   GLUCOSE-210* UREA N-24* CREAT-1.5* SODIUM-136
POTASSIUM-3.6 CHLORIDE-93* TOTAL CO2-29 ANION GAP-18
[**2152-12-16**] 11:06AM   CK(CPK)-76
[**2152-12-16**] 11:06AM   CK-MB-NotDone cTropnT-<0.01
[**2152-12-16**] 11:06AM   CALCIUM-9.0 PHOSPHATE-3.0 MAGNESIUM-1.9
[**2152-12-16**] 11:06AM   WBC-12.1* RBC-3.83* HGB-11.0* HCT-33.4*
MCV-87 MCH-28.8 MCHC-32.9 RDW-16.6*
[**2152-12-16**] 11:06AM   PLT COUNT-263
[**2152-12-16**] 11:06AM   PT-28.4* PTT-28.9 INR(PT)-2.9*
[**2152-12-16**] 11:05AM URINE  HOURS-RANDOM UREA N-91 CREAT-9
SODIUM-116
[**2152-12-16**] 11:05AM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.010
[**2152-12-16**] 11:05AM URINE  BLOOD-SM  NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-8.0
LEUK-NEG
[**2152-12-16**] 02:25AM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.011
[**2152-12-16**] 02:25AM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-TR
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-TR
[**2152-12-16**] 02:25AM URINE  HYALINE-0-2
[**2152-12-16**] 01:07AM   LACTATE-3.5*
[**2152-12-15**] 11:59PM   K+-5.5*
[**2152-12-15**] 11:40PM   estGFR-Using this
[**2152-12-15**] 11:40PM   ALT(SGPT)-30 AST(SGOT)-85* LD(LDH)-675*
CK(CPK)-106 ALK PHOS-132* AMYLASE-94 TOT BILI-0.9
[**2152-12-15**] 11:40PM   LIPASE-72*
[**2152-12-15**] 11:40PM   CK-MB-3 cTropnT-<0.01
[**2152-12-15**] 11:40PM   ALBUMIN-4.1
[**2152-12-15**] 11:40PM   WBC-10.9 RBC-3.94* HGB-11.6* HCT-35.9* MCV-91
MCH-29.4 MCHC-32.3 RDW-16.3*
[**2152-12-15**] 11:40PM   NEUTS-74.5* LYMPHS-21.9 MONOS-2.9 EOS-0.6
BASOS-0.2
[**2152-12-15**] 11:40PM   HYPOCHROM-3+ ANISOCYT-1+ POIKILOCY-1+
[**2152-12-15**] 11:40PM   PLT COUNT-264
[**2152-12-15**] 11:40PM   PLT COUNT-264
[**2152-12-15**] 11:40PM   PT-24.6* PTT-26.5 INR(PT)-2.5*
.
Micro:
Blood culture NGTD
Urine culture genital contaminated

Radiology:
CTA [**2152-12-16**]- IMPRESSION:
1.  No evidence of pulmonary embolism.
2.  Ground-glass opacities in the lung fields with smooth
interlobular septal thickening, most likely represents pulmonary
vascular congestion as well as pulmonary edema or congestive
heart failure.
3.  Stable but continued enlargement of mediastinal and hilar
lymph nodes not significantly changed.  The etiology of this
lymphadenopathy is unclear, however may be in part due to
congestive heart failure.
4.  Patchy peribronchial opacities in the right middle lobe may
be infectious or inflammatory in etiology.
5.  Atherosclerotic calcifications of the thoracic aorta and
coronary artery calcifications.
.
CXR AP [**2152-12-16**]
1.  No evidence for congestive heart failure or infiltrate.
2.  Stable right hilar and mediastinal adenopathy, better seen
on the chest CT done subsequent to this examination.

Brief Hospital Course:
Pt is a 83 yo female with severe pulmonary HTN, HTN, history of
bilateral PE and recent admissions for CHF and PNA who presents
with lightheadedness, found to be hypoxic.  Her hospital course
is as follows:
.
Hypoxia: Normally on 2 L NC likely [**2-10**] severe pulmonary HTN;
PFTs also showed a restrictive pattern.  The patient was given
levaquin, prednisone, and lasix in the ED.  Given clinical
concern, she was transferred to the MICU for observation.  In
the MICU, she was ruled out for MI and PE.  CT did demonstrate
findings concerning for possible edema, infectious pneumonia, or
COP.  She was diuresed well in the MICU, and started on
levaquin.  She improved clinically and was transferred to the
floor.  On the floor she achieved her baseline oxygenation on
2-3L NC.  Pt worked with her and cleared her for home.  Her
outpatient pulmonologist was made aware of her admission.  Given
her improvement on lasix and levaquin, we felt her symptoms were
related to fluid overload and an underlying CAP.  She was
discharged to complete a course of antibiotics, she was
maintained on her home oxygen, and she was told to follow up
closely with her pulmonologist.
.
Dizziness: Was thought to be related to her initial hypoxia.
Her old records were reviewed.  Her dizziness resolved with her
improvement in symptoms.  She experienced no additional
dizziness during her admission.
.
Renal failure: Chronic renal failure with cr baseline of 1.0.
Her renal failure was thought secondary to pre-renal azotemia.
After her CTA she was hydrated with bicarb and her cr
subsequently improved during admission and remained stable.
.
HTN: Her beta blocker and ACEI were continued with good effect.
.
history of PE: Her coumadin was initially continued.  However,
it was held when her INR was supratherapeutic.  Her INR improved
to the normal range and she was restarted on a lower dose of
coumadin at 3mg PO qHS.  She will need frequent INR checks and
adjustment of her coumadin as needed.
.
Glaucoma: continued timolol eye drops
.
Code: Patient was unable to definitively decide during
admission.  This should be addressed as an outpatient for future
potential admissions.

Medications on Admission:
Toprol XL 50 mg qday
Atrovent and albuterol nebs MDI q 6 hours
Lisinopril 5 mg qday
Coumadin - 4mg Monday and Friday nights
Coumadin- 3 mg Tuesday, Wednesday, Thursday, Saturday, and
Sundays
Timolol eye drops
Atrovent, albuterol MDI prn

Discharge Medications:
1. Toprol XL 50 mg Tablet Sustained Release 24HR Sig: One (1)
Tablet Sustained Release 24HR PO once a day.
Disp:*30 Tablet Sustained Release 24HR(s)* Refills:*0*
2. Albuterol 90 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation Q6H (every 6 hours).
Disp:*1 inhaler* Refills:*2*
3. Ipratropium Bromide 17 mcg/Actuation Aerosol Sig: Two (2)
Puff Inhalation QID (4 times a day).
Disp:*1 inhaler* Refills:*2*
4. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
5. Timolol Maleate 0.5 % Drops Sig: One (1) Drop Ophthalmic  [**Hospital1 **]
(2 times a day).
Disp:*1 vial* Refills:*2*
6. Warfarin 1 mg Tablet Sig: Three (3) Tablet PO HS (at
bedtime): Please have your INR checked on [**12-21**] and adjust your
medication according to your PCP.  [**Name10 (NameIs) 18303**] INR is [**2-11**].
Disp:*90 Tablet(s)* Refills:*0*
7. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
8. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 6 days.
Disp:*6 Tablet(s)* Refills:*0*
9. Home Oxygen
Patient's oxygen saturation less than 87% on room air.

Home oxygen via nasal cannula at 2.5 Liters


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 **] Family & [**Hospital1 1926**] Services

Discharge Diagnosis:
Primary Diagnosis:
Pneumonia
.
Secondary Diagnoses:
Restrictive Lung Disease
Hypertension
s/p Pulmonary Embolus
Glaucoma


Discharge Condition:
Good, afebrile, hemodynamically stable


Discharge Instructions:
Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs.
Adhere to 2 gm sodium diet
Fluid Restriction: 1.5 liters per day
.
Please take all medications as prescribed.  Please keep all
follow up appointments.  Please return to the hospital if you
experience chest pain, worsening shortness of breath or any
other symptoms that concern you.
.
Please have your INR checked in 2 days, and then thereafter
according to your primary physician.
.
Please follow up with your primary physician and call your
pulmonologist Dr. [**Last Name (STitle) **] to schedule a follow up appointment
with him.

Followup Instructions:
Please have your INR checked on [**12-21**].  You can go to Dr. [**First Name (STitle) **]
office or have your visiting nurse check and send the results to
Dr. [**First Name (STitle) **].
.
A follow up appointment has been made with Dr. [**First Name (STitle) **] on [**12-26**] at
2:45PM.  Please have your INR checked at that time.
.
Please schedule a follow up appointment with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]
of pulmonology in 4 weeks. ([**Telephone/Fax (1) 513**]
{'Pneumonia, organism unspecified,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Chronic kidney disease, unspecified,Other chronic pulmonary heart diseases,Hypoxemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other diseases of lung, not elsewhere classified,Unspecified glaucoma,Anemia, unspecified,Personal history of venous thrombosis and embolism'}


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: Hypoxia

PRESENT ILLNESS: Pt is a 83 yo female with history of bilateral PEs, HTN,
pulmonary HTN on 2 L home O2 who presents with SOB/vomiting and
found to be hypoxic. Pt states that yesterday she felt short of
breath and lightheaded ("dizzy"- which was not the room
spinning) when standing up. She vomited x 1 and her family
called 911. Pt denies recent F/C/N. No cough. No dysuria. Stable
2 pillow orthopnea. No PND.
Pt states that she has been taking her medication and partakes
in a low salt diet.  No CP. Of note, per ED note, pt states that
she did have chest pain.
.
In the ED, VS on arrival were: T: 95.7; HR: 90; BP: 155/79; RR:
18; O2: 91 2L NC. She was given 500 mg IV levaquin x 1,
prednisone 60 mg po x 1, combivent x 2, sodium bicarb in D5w and
furosemide 40 mg IV x 1.
.
Now, pt states that she feels much better. She denies CP/SOB/
feeling lightheaded or dizzy.
.
Last admission was in [**Month (only) 216**] of this year when pt came in with
SOB. She was diuresed and it was thought to be [**2-10**] increased BPs
leading to pulmonary edema in setting of other pulmonary
problems.

MEDICAL HISTORY: s/p THR 22 years ago complicated by clot in leg
s/p cataract surgery
Back pain s/p corticosteroid injections
PFTs [**8-13**]- FEv1- 52; FVC- 54%, FEV1/FVC 104.
  Spirometry is consistent with a restrictive ventilatory defect
as
  demonstrated by the reduced TLC measured on [**2152-8-29**].
Echo [**8-13**]-Left ventricular wall thicknesses and cavity size are

MEDICATION ON ADMISSION: Toprol XL 50 mg qday
Atrovent and albuterol nebs MDI q 6 hours
Lisinopril 5 mg qday
Coumadin - 4mg Monday and Friday nights
Coumadin- 3 mg Tuesday, Wednesday, Thursday, Saturday, and
Sundays
Timolol eye drops
Atrovent, albuterol MDI prn

ALLERGIES: Clindamycin / Vancomycin

PHYSICAL EXAM: VS: T: 97.7; BP: 134/117; HR: 121; RR: 17; O2: 94 50% venti
mask.
Gen: SPeaking in full sentences in accent in NAD
HEENT: Right surgical pupil. Left RRLA. EOMI; sclera anicteric;
OP clear without exudate.
Neck: JVD difficult to tell. ? 9 cm. No LAD
CV: Distant S1S2.
Lungs: Scant crackles at right base, otherwise clear with good
air movement
Abd: NABS. soft, nt, nd
Back: No spinal, paraspinal, CVA tenderness
Ext: Trace edema b/l.
Neuro: CN II-XII tested and intact. MS [**5-12**] throughout. Biceps,
brachio, patellar reflexes [**2-10**].

FAMILY HISTORY: No heart or lung disease in family.

SOCIAL HISTORY: Originally from [**Country 3399**]. Came to the US in [**2106**]. Widowed, lives
by self. Family involved in care. No smoking. No EtOH. 

### Response:
{'Pneumonia, organism unspecified,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Chronic kidney disease, unspecified,Other chronic pulmonary heart diseases,Hypoxemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other diseases of lung, not elsewhere classified,Unspecified glaucoma,Anemia, unspecified,Personal history of venous thrombosis and embolism'}
