CHIEF COMPLAINT: extremity weakness

PRESENT ILLNESS: Pt is a 29 yo G4P2 @ 29w1d ega with [**Last Name (un) **] [**2195-1-2**] by [**Hospital **]
transferred from [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] to here for further evaluation of
progressive weakness. Pt reports that she began noticing some
weakness in her knees last Sunday and Monday (approx 6 days
ago). It then became somewhat difficult for her to walk over the
next few days. She had difficulty standing up from a chair
earlier today and also noticed weakness in her arms. She
presented to [**Hospital **] hospital as above. Pt otherwise denies
recent illness and denies cough, sore throat, fevers, chills. No
recent sick contacts. Otherwise in usual state of health till
last several days. This pregnancy has been uncomplicated. Pt
currently denies abd pain, ctxs, LOF, VB. She reports active
fetal movement.

MEDICAL HISTORY: PNC:
- EDC [**2195-1-2**] by LMP (5 wk US consistent)
- Primary Ob ([**Hospital1 **]) Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 75377**]
- Blood Type O+; prenatal labs not available
- Normal quad and FFS (per pt report)
- Nml GLT (per pt report)

MEDICATION ON ADMISSION: - advair [**Hospital1 **]
- albuterol prn
- PNV

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE: T 98.2, BP 132/92, HR 96, RR 25, O2 sat 99%RA
GEN:  NAD
Chest:  CTAB
CV:  RRR
Abd:  soft, obese, gravid, nontender
SVE:  1cm ext/closed int/ long/ high/ posterior
Ext:  tr edema, no calf-tenderness
Neuro:  (as per neurology note)
FHT:  150s / mod variability / + accels / no decels
Toco:  no ctxs noted

FAMILY HISTORY: no hx autoimmune dz, neurological dz

SOCIAL HISTORY: Pt currently lives in [**Location 246**] w/ her husband and two
children. She works as [**Last Name (un) 75378**] department store.
+tobacco use (~10 cigarettes / day), denies ETOH or illicit
drug use
Other current conditions classifiable elsewhere of mother, antepartum condition or complication,Alkalosis,Asthma, unspecified type, unspecified,Tobacco use disorder complicating pregnancy, childbirth, or the puerperium, antepartum condition or complication,Anemia, unspecified
Oth curr cond-antepartum,Alkalosis,Asthma NOS,Tobacco use dis-antepart,Anemia NOS
Admission Date:  [**2194-10-18**]              Discharge Date:   [**2194-10-21**]

Date of Birth:  [**2165-9-9**]             Sex:   F

Service: OBSTETRICS/GYNECOLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 19399**]
Chief Complaint:
extremity weakness

Major Surgical or Invasive Procedure:
none

History of Present Illness:
Pt is a 29 yo G4P2 @ 29w1d ega with [**Last Name (un) **] [**2195-1-2**] by [**Hospital **]
transferred from [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] to here for further evaluation of
progressive weakness. Pt reports that she began noticing some
weakness in her knees last Sunday and Monday (approx 6 days
ago). It then became somewhat difficult for her to walk over the
next few days. She had difficulty standing up from a chair
earlier today and also noticed weakness in her arms. She
presented to [**Hospital **] hospital as above. Pt otherwise denies
recent illness and denies cough, sore throat, fevers, chills. No
recent sick contacts. Otherwise in usual state of health till
last several days. This pregnancy has been uncomplicated. Pt
currently denies abd pain, ctxs, LOF, VB. She reports active
fetal movement.

Past Medical History:
PNC:
- EDC [**2195-1-2**] by LMP (5 wk US consistent)
- Primary Ob ([**Hospital1 **]) Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 75377**]
- Blood Type O+; prenatal labs not available
- Normal quad and FFS (per pt report)
- Nml GLT (per pt report)

PAST OBSTETRIC HISTORY
- NSVD @ 40 wks (male, 7#10, no complications)
- NSVD @ 37 wks (female, 8#2, pregnancy complicated by gHTN)
- Ectopic pregnancy tx'd w/ MTX

PAST GYNECOLOGIC HISTORY
- regular menses
- ? one abnl pap -> f/u nml (no biopsies or surgeries)
- no hx of STDs

PAST MEDICAL HISTORY
-asthma (no hx of intubations)

PAST SURGICAL HISTORY
-sinus surgery

Social History:
Pt currently lives in [**Location 246**] w/ her husband and two
children. She works as [**Last Name (un) 75378**] department store.
+tobacco use (~10 cigarettes / day), denies ETOH or illicit
drug use

Family History:
no hx autoimmune dz, neurological dz

Physical Exam:
PE: T 98.2, BP 132/92, HR 96, RR 25, O2 sat 99%RA
GEN:  NAD
Chest:  CTAB
CV:  RRR
Abd:  soft, obese, gravid, nontender
SVE:  1cm ext/closed int/ long/ high/ posterior
Ext:  tr edema, no calf-tenderness
Neuro:  (as per neurology note)
FHT:  150s / mod variability / + accels / no decels
Toco:  no ctxs noted

Pertinent Results:
[**2194-10-18**] WBC-16.7 RBC-3.55 Hgb-11.1 Hct-30.9 MCV-87 Plt-285
[**2194-10-20**] WBC-12.0 RBC-3.47 Hgb-11.0 Hct-30.0 MCV-86 Plt-259
[**2194-10-18**] PT-11.7 PTT-22.6 INR-1.0
[**2194-10-20**] PT-11.8 PTT-24.3 INR-1.0
[**2194-10-18**] ESR-35
[**2194-10-18**] Glu-79 BUN-4 Cre-0.4 Na-144 K-2.6 Cl-109 HCO3-24
AnGap-14
[**2194-10-21**] Glu-97 BUN-3 Creat-0.4 Na-140 K-3.7 Cl-106 HCO3-25
AnGap-13
[**2194-10-18**] ALT-59 AST-136 LD-287 CK-6175 AlkPhos-108 TBili-0.3
[**2194-10-21**] ALT-81 AST-212 CK-[**Numeric Identifier 75379**]
[**2194-10-18**] Albumin-3.1 Calcium-8.5 Phos-2.9 Mg-1.6
[**2194-10-20**] Albumin-2.8 Calcium-8.3 Phos-2.8 Mg-1.8
[**2194-10-19**] calTIBC-398 Ferritn-30 TRF-306
[**2194-10-18**] TSH-1.0 T4-10.4 calcTBG-1.45 TUptake-0.69 T4Index-7.2
[**2194-10-18**] CRP-19.3
[**2194-10-19**] ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG
         Barbitr-NEG Tricycl-NEG
[**2194-10-20**] HCV Ab-NEGATIVE
[**2194-10-18**] BLOOD Type-ART pO2-152 pCO2-29 pH-7.51 calTCO2-24 Base
XS-1

[**2194-10-21**] URINE 24Creat-1167 24Prot-660

Brief Hospital Course:
29y/o G4P2 admitted at 29+1wks with progressive ascending
weakness.
.
Mrs [**Known lastname **] was initially evaluated in the emergency department.
Her vitals were stable and she was in no distress. She had no
signs or symptoms of infection or preterm labor. Labs were
significant for a white blood cell count of 16.7 and a potassium
of 2.6. Neurology consulted and her exam was notable for UMN
pattern of weakness in the arms and legs, normal sensation,
normal tone and dropped reflexes at triceps and right
brachioradialis, which was suggestive of a cervical cord
process. It was also suggested that her hypokalemia could be
causing a periodic limb paralysis. An MRI was obtained and ruled
out an epidural abscess, hematoma, and transverse myelitis. She
was admitted to the ICU for close observation. Fetal testing was
reassuring and there were no obstetric concerns. Her ABG showed
a respiratory alkalosis which was likely physiolgic secondary to
pregnancy. Her oxygen saturation remained 97-100% on room air.
Her potassium and magnesium were repleted and serial EKGs were
performed. Additional labwork revealed an elevated CK 5683 and
an elevated ESR 35. A lumbar puncture was done and was negative
for infection. She had some mildly elevated blood pressures up
to 130-140s/80-90s and elevated LFT's. A 24 hour urine
collection was done and revealed 660mg of protein. Her
creatinine was normal (0.4) and a uric acid was ordered, but
unfortunately was not done prior to her discharge. Her blood
pressure on the day of discharge was 90/64.
.
Mrs[**Known lastname 75380**] weakness had significant improvement as her potassium
levels increased. She was tranferred from the ICU to the
antepartum floor. Neurology felt that she had periodic limb
paralysis from hypokalemia, possibly [**Doctor Last Name 65597**]-Tawill Syndrome (a
variant of hypokalemic periodic paralysis). Since this syndrome
may cause prolonged QT intervals and arrhythmias, she was seen
by cardiology. They felt that she did not have the EKG changes
or cardiologic manifestations that would go with this disorder.
However, they did recommend that she follow up with Dr [**Last Name (STitle) 75381**]
who specializes in long QT syndromes. Fetal testing remained
reassuring during this admission. She had an ultrasound on [**10-20**]
which revealed breech, BPP [**8-6**], AFI 17.8, and EFW 1433g(50%).
She was discharged to home on [**10-21**] and will have close
outpatient follow up.

Medications on Admission:
- advair [**Hospital1 **]
- albuterol prn
- PNV

Discharge Medications:
1. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation
Q4H (every 4 hours) as needed.

Discharge Disposition:
Home

Discharge Diagnosis:
pregnancy at 29weeks 4days
extremity weakness

Discharge Condition:
stable

Discharge Instructions:
Labor precautions.  Bleeding precautions.

Call if you get short of breath, have difficulty walking, your
muscles become stiff or sore, or you have any of the similar
symptoms that your had prior to this admission.

Try not to eat large high carbohydrate meals as this may lead to
low potassium levels and weakness.

Followup Instructions:
F/u in [**Hospital1 18**] neurology clinic:  Provider: [**Name Initial (NameIs) 1220**]. [**Name5 (PTitle) **] & [**Doctor Last Name **]
Phone:[**Telephone/Fax (1) 44**] Date/Time:[**2194-10-30**] 8:00

F/u in 2 days for labs.  You will need to have a potassium level
drawn.

f/u with your primary obstetrician

F/u in [**Hospital1 18**] cardiology clinic:  Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1008**],
M.D. Phone:[**Telephone/Fax (1) 285**] Date/Time:[**2194-11-11**] 3:00

F/u in genetics clinic if you would like to:  [**Telephone/Fax (1) 75382**]


                             [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 19401**]

Completed by:[**2194-10-28**]
{'Other current conditions classifiable elsewhere of mother, antepartum condition or complication,Alkalosis,Asthma, unspecified type, unspecified,Tobacco use disorder complicating pregnancy, childbirth, or the puerperium, antepartum condition or complication,Anemia, unspecified'}


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: extremity weakness

PRESENT ILLNESS: Pt is a 29 yo G4P2 @ 29w1d ega with [**Last Name (un) **] [**2195-1-2**] by [**Hospital **]
transferred from [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] to here for further evaluation of
progressive weakness. Pt reports that she began noticing some
weakness in her knees last Sunday and Monday (approx 6 days
ago). It then became somewhat difficult for her to walk over the
next few days. She had difficulty standing up from a chair
earlier today and also noticed weakness in her arms. She
presented to [**Hospital **] hospital as above. Pt otherwise denies
recent illness and denies cough, sore throat, fevers, chills. No
recent sick contacts. Otherwise in usual state of health till
last several days. This pregnancy has been uncomplicated. Pt
currently denies abd pain, ctxs, LOF, VB. She reports active
fetal movement.

MEDICAL HISTORY: PNC:
- EDC [**2195-1-2**] by LMP (5 wk US consistent)
- Primary Ob ([**Hospital1 **]) Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 75377**]
- Blood Type O+; prenatal labs not available
- Normal quad and FFS (per pt report)
- Nml GLT (per pt report)

MEDICATION ON ADMISSION: - advair [**Hospital1 **]
- albuterol prn
- PNV

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE: T 98.2, BP 132/92, HR 96, RR 25, O2 sat 99%RA
GEN:  NAD
Chest:  CTAB
CV:  RRR
Abd:  soft, obese, gravid, nontender
SVE:  1cm ext/closed int/ long/ high/ posterior
Ext:  tr edema, no calf-tenderness
Neuro:  (as per neurology note)
FHT:  150s / mod variability / + accels / no decels
Toco:  no ctxs noted

FAMILY HISTORY: no hx autoimmune dz, neurological dz

SOCIAL HISTORY: Pt currently lives in [**Location 246**] w/ her husband and two
children. She works as [**Last Name (un) 75378**] department store.
+tobacco use (~10 cigarettes / day), denies ETOH or illicit
drug use 

### Response:
{'Other current conditions classifiable elsewhere of mother, antepartum condition or complication,Alkalosis,Asthma, unspecified type, unspecified,Tobacco use disorder complicating pregnancy, childbirth, or the puerperium, antepartum condition or complication,Anemia, unspecified'}
