CHIEF COMPLAINT: mental status changes, hypercalcemia, small bowel obstruction

PRESENT ILLNESS: 68yF transferred from [**Hospital 1474**] Hospital after being found to
have slurred speech and confusion over past three days. At OSH,
patient found to be in respiratory failure, intubated. Ca++ 14
at OSH, INR 7. KUB demonstrated moderately dilated small bowel.
NGT placed with 2000cc black tarry fluid expressed.

MEDICAL HISTORY: -CAD s/p CABG x 2
-PVD s/p fem-[**Doctor Last Name **] bypass [**2145**]
-CVA

MEDICATION ON ADMISSION: calcium 600'', asa 81', calcitonin 200IU', coumadin [**3-20**]',
atenolol 50'', difluoxetine 4', oxycodone 40', namenda 5''

ALLERGIES: Penicillins / Amoxicillin

PHYSICAL EXAM: Gen elderly, thin, NAD
Heent perrl, eomi, nares patent, oropharynx without
erythema/exudate
Neck supple no masses
CV rrr, no m/r/g
Resp CTA bilaterally
Abd soft NTND with midline incision intact small opening
draining serosang fluid
Ext no LE edema
Neuro answers appropriately, aao x 3

FAMILY HISTORY: NK

SOCIAL HISTORY: -+tobacco 1ppd
-no EtOH
-Lives with husband
Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection),Acute respiratory failure,Alkalosis,Pneumonia, organism unspecified,Acute pancreatitis,Hypercalcemia,Long QT syndrome,Aortocoronary bypass status,Long-term (current) use of anticoagulants,Bed confinement status
Intestinal adhes w obstr,Acute respiratry failure,Alkalosis,Pneumonia, organism NOS,Acute pancreatitis,Hypercalcemia,Long QT syndrome,Aortocoronary bypass,Long-term use anticoagul,Bed confinement status
Admission Date:  [**2156-3-29**]              Discharge Date:   [**2156-4-7**]

Date of Birth:  [**2087-10-6**]             Sex:   F

Service: SURGERY

Allergies:
Penicillins / Amoxicillin

Attending:[**First Name3 (LF) 371**]
Chief Complaint:
mental status changes, hypercalcemia, small bowel obstruction

Major Surgical or Invasive Procedure:
exploratory laparotomy with lysis of adhesions


History of Present Illness:
68yF transferred from [**Hospital 1474**] Hospital after being found to
have slurred speech and confusion over past three days. At OSH,
patient found to be in respiratory failure, intubated. Ca++ 14
at OSH, INR 7. KUB demonstrated moderately dilated small bowel.
NGT placed with 2000cc black tarry fluid expressed.

Past Medical History:
-CAD s/p CABG x 2
-PVD s/p fem-[**Doctor Last Name **] bypass [**2145**]
-CVA


Social History:
-+tobacco 1ppd
-no EtOH
-Lives with husband

Family History:
NK

Physical Exam:
Gen elderly, thin, NAD
Heent perrl, eomi, nares patent, oropharynx without
erythema/exudate
Neck supple no masses
CV rrr, no m/r/g
Resp CTA bilaterally
Abd soft NTND with midline incision intact small opening
draining serosang fluid
Ext no LE edema
Neuro answers appropriately, aao x 3

Pertinent Results:
[**2156-4-6**] 04:03AM BLOOD WBC-12.6* RBC-2.64* Hgb-8.4* Hct-24.9*
MCV-94 MCH-32.0 MCHC-34.0 RDW-14.4 Plt Ct-160
[**2156-4-5**] 03:28AM BLOOD WBC-12.3* RBC-2.75* Hgb-8.9* Hct-25.9*
MCV-94 MCH-32.2* MCHC-34.2 RDW-13.7 Plt Ct-166
[**2156-4-4**] 01:12PM BLOOD WBC-11.1* RBC-2.93* Hgb-9.7* Hct-27.8*
MCV-95 MCH-33.3* MCHC-35.0 RDW-13.7 Plt Ct-154
[**2156-4-6**] 04:03AM BLOOD Plt Ct-160
[**2156-4-6**] 04:03AM BLOOD PT-14.3* PTT-63.9* INR(PT)-1.3*
[**2156-4-5**] 03:28AM BLOOD Plt Ct-166
[**2156-4-6**] 04:03AM BLOOD Glucose-86 UreaN-13 Creat-0.6 Na-137
K-3.7 Cl-109* HCO3-21* AnGap-11
[**2156-4-5**] 01:04PM BLOOD Glucose-136* UreaN-13 Creat-0.6 Na-136
K-3.4 Cl-107 HCO3-16* AnGap-16
[**2156-4-4**] 07:15AM BLOOD Glucose-97 UreaN-10 Creat-0.7 Na-140
K-3.2* Cl-108 HCO3-21* AnGap-14
[**2156-4-6**] 04:03AM BLOOD Calcium-7.4* Phos-2.3* Mg-2.3
[**2156-4-5**] 01:04PM BLOOD Calcium-7.5* Phos-2.0* Mg-1.6
[**2156-4-4**] 07:15AM BLOOD Albumin-2.8* Calcium-7.8* Phos-2.1*
Mg-1.6
[**2156-3-30**] 10:37AM BLOOD Calcium-11.1* Phos-0.7* Mg-2.2
[**2156-3-29**] 04:46PM BLOOD Calcium-10.4* Phos-1.1* Mg-2.0
[**2156-3-29**] 12:45PM BLOOD TotProt-4.6* Calcium-11.3* Phos-2.3*
Mg-1.5*
[**2156-3-29**] 08:00AM BLOOD Albumin-2.7* Calcium-12.9* Phos-2.8
Mg-1.5* Iron-34
[**2156-3-29**] 04:15AM BLOOD Albumin-3.8 Calcium-16.6* Phos-3.0 Mg-1.7
[**2156-3-31**] 02:25AM BLOOD TSH-0.99

Brief Hospital Course:
Patient admitted to the medical service intubated. She was
started on broad spectrum antibiotics and stabilized with fluid
resuscitation and supportive care. A general surgery and
endocrinology consult were obtained for her hypercalcemia and
presumed SBO, respectively. She was taken to the operating room
for an exlap with lysis of adhesions and was transferred
intubated to the PACU. She was transferred to the surgical ICU
and cardiology was consulted postoperatively due to prolonged QT
interval and T wave inversions noted on her postop EKG. Her
cardiac enzymes were negative for ischemia and she was stable
overnight. She was maintained on parenteral nutrition
immediately postop. She was extubated POD2 and remained afebrile
and stable. She continued to be followed by endocrinology and
her hypercalcemia slowly resolved with iv fluids and pamidronate
treatment. POD4 she regained bowel function and was started on a
liquid diet which she tolerated. She continued to do well and
was restarted on her home medications and transferred to the
floor. Her diet was advanced to a regular low residue diet. She
did have an episode of emesis on POD5, however, and an NGT was
placed revealing a large amount of gastric output. She remained
NPO with an NGT placed for approximately 2 days where she
tolerated an NGT clamping trial and her NGT was d/c'ed without
complication. Her diet was again advanced which she tolerated
without difficulty. Endocrinology requested a torso CT scan to
r/o malignancy as a cause of the patient's hypercalcemia which
was negative. At the time of discharge, no clear cause of the
patient's initial hypercalcemia was found. She continued to do
well. Her abdominal wound was opened on POD8 revealing brown
sanguinous fluid which was lightly packed. She remained afebrile
and was discharged on POD9 in good condition to rehab.
Endocrinology recommended treatment with Ca++ and vit D upon
discharge. She was instructed to follow up with Dr. [**Last Name (STitle) **].

Medications on Admission:
calcium 600'', asa 81', calcitonin 200IU', coumadin [**3-20**]',
atenolol 50'', difluoxetine 4', oxycodone 40', namenda 5''

Discharge Medications:
1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
2. Memantine 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
3. Atenolol 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
4. Duloxetine 30 mg Capsule, Delayed Release(E.C.) Sig: Two (2)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
Disp:*60 Capsule, Delayed Release(E.C.)(s)* Refills:*2*
5. Trazodone 50 mg Tablet Sig: Three (3) Tablet PO HS (at
bedtime).
Disp:*90 Tablet(s)* Refills:*2*
6. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. Warfarin 2 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).
Disp:*30 Tablet(s)* Refills:*2*
8. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO BID (2 times a day).
Disp:*60 Tablet, Chewable(s)* Refills:*2*
9. Tolterodine 2 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
10. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
11. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed.
Disp:*40 Tablet(s)* Refills:*0*


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 700**] - [**Location (un) 701**]

Discharge Diagnosis:
hypercalcemia
small bowel obstruction


Discharge Condition:
good


Discharge Instructions:
-please come to the emergency room if you have fever >101.4F,
nausea or vomiting, persistent redness or oozing from your
surgical incision, dizziness or weakness or shortness of breath.
-no lifting anything heavier than a telephone book for three
weeks
-you may shower normally but no tub bathing or swimming for six
weeks
-do not drive while taking pain medications
-keep your incision clean and dry, the bandage strips on your
abdominal wound will fall off on their own, do not remove them

Followup Instructions:
Please follow up with Dr. [**Last Name (STitle) **] in [**2-20**] weeks. Call
[**Telephone/Fax (1) 1864**] for an appointment.

Please make an appointment with the dermatology clinic for your
abdominal lesion. Call [**Telephone/Fax (1) 1971**] for an appointment.
{'Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection),Acute respiratory failure,Alkalosis,Pneumonia, organism unspecified,Acute pancreatitis,Hypercalcemia,Long QT syndrome,Aortocoronary bypass status,Long-term (current) use of anticoagulants,Bed confinement status'}


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: mental status changes, hypercalcemia, small bowel obstruction

PRESENT ILLNESS: 68yF transferred from [**Hospital 1474**] Hospital after being found to
have slurred speech and confusion over past three days. At OSH,
patient found to be in respiratory failure, intubated. Ca++ 14
at OSH, INR 7. KUB demonstrated moderately dilated small bowel.
NGT placed with 2000cc black tarry fluid expressed.

MEDICAL HISTORY: -CAD s/p CABG x 2
-PVD s/p fem-[**Doctor Last Name **] bypass [**2145**]
-CVA

MEDICATION ON ADMISSION: calcium 600'', asa 81', calcitonin 200IU', coumadin [**3-20**]',
atenolol 50'', difluoxetine 4', oxycodone 40', namenda 5''

ALLERGIES: Penicillins / Amoxicillin

PHYSICAL EXAM: Gen elderly, thin, NAD
Heent perrl, eomi, nares patent, oropharynx without
erythema/exudate
Neck supple no masses
CV rrr, no m/r/g
Resp CTA bilaterally
Abd soft NTND with midline incision intact small opening
draining serosang fluid
Ext no LE edema
Neuro answers appropriately, aao x 3

FAMILY HISTORY: NK

SOCIAL HISTORY: -+tobacco 1ppd
-no EtOH
-Lives with husband 

### Response:
{'Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection),Acute respiratory failure,Alkalosis,Pneumonia, organism unspecified,Acute pancreatitis,Hypercalcemia,Long QT syndrome,Aortocoronary bypass status,Long-term (current) use of anticoagulants,Bed confinement status'}
