CHIEF COMPLAINT: sepsis

PRESENT ILLNESS: 89yo F with COPD/emphysema, chronic back pain who presented with
sepsis. Patient's daughter called EMS on the day of admission
after she found her mother by the bed with mental status
changes. Upon EMS arrival, she was tachypneaic to 40,
tachycardic to 170s , disoriented, and hypertensive to 200s.  In
EW, code sepsis called, RIJ placed. She was given
levo/flagyl(for fever and luekocytosis). Her intial vitals were
T103, P133 BP176/50 RR23. Her initial lactate was 6.5 which
decreased to 1.6 with hydration.

MEDICAL HISTORY: emphysema/COPD
Hypertension
hyperlipidemia
Chronic low back pain
osteoarthritis
cholecystectomy [**96**] years ago
s/p TAH

MEDICATION ON ADMISSION: Dolansetron
Tylenol
Albuterol
Prednisone
Atrovent

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 103, 154/65 111, 22, 100% RA
Gen: frail
HEENT: EOMI, PERRL, poor dentition
Neck: s/p IJ placement
Chest: dimished effort, rhonchorous
CV: hyperdynamic PMI, distant S1 s2, no mrg
Abd: obese tender diffusey, no rebound
Ext: no edema
Neuro: oriented to person and place

FAMILY HISTORY: NC

SOCIAL HISTORY: Widowed with one daughter.
Denied [**Name2 (NI) **]
Denied alcohol use
Cholangitis,Subendocardial infarction, initial episode of care,Chronic airway obstruction, not elsewhere classified,Congestive heart failure, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Unspecified disorder of kidney and ureter,Anemia, unspecified
Cholangitis,Subendo infarct, initial,Chr airway obstruct NEC,CHF NOS,Hypertension NOS,Hyperlipidemia NEC/NOS,Renal & ureteral dis NOS,Anemia NOS
Admission Date:  [**2172-4-12**]              Discharge Date:   [**2172-4-23**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5644**]
Chief Complaint:
sepsis

Major Surgical or Invasive Procedure:
Central line placement
ERCP

History of Present Illness:
89yo F with COPD/emphysema, chronic back pain who presented with
sepsis. Patient's daughter called EMS on the day of admission
after she found her mother by the bed with mental status
changes. Upon EMS arrival, she was tachypneaic to 40,
tachycardic to 170s , disoriented, and hypertensive to 200s.  In
EW, code sepsis called, RIJ placed. She was given
levo/flagyl(for fever and luekocytosis). Her intial vitals were
T103, P133 BP176/50 RR23. Her initial lactate was 6.5 which
decreased to 1.6 with hydration.


Past Medical History:
emphysema/COPD
Hypertension
hyperlipidemia
Chronic low back pain
osteoarthritis
cholecystectomy [**96**] years ago
s/p TAH


Social History:
Widowed with one daughter.
Denied [**Name2 (NI) **]
Denied alcohol use

Family History:
NC

Physical Exam:
VS: T 103, 154/65 111, 22, 100% RA
Gen: frail
HEENT: EOMI, PERRL, poor dentition
Neck: s/p IJ placement
Chest: dimished effort, rhonchorous
CV: hyperdynamic PMI, distant S1 s2, no mrg
Abd: obese tender diffusey, no rebound
Ext: no edema
Neuro: oriented to person and place

Pertinent Results:
Admission labs significant for WBC of 18, AST 58, ALT 46 AP 118,
lactate 6.8.

CT abdomen: CBD dilitation

ERCP: difficult cannulation prequiring precut sphincterotomy for
CBD acces. Biliary dilation with distal CBD stricture suggestive
of neoplasm. Cytology obtained.

EKG: on third day of admission showed lateral EKG changes and
cardiac enzymes revealed NSTEMI. Troponin I peaked at 0.37. At
the time of discharge had returned to baseline.

CTA abdomen: no mass in the pancreas, but pt does have L kidney
mass and L renal vein thrombus

Brief Hospital Course:
89yo F with COPD/emphysema, chronic back pain who presented s/p
fall with altered mental status found to have cholangitis and
NSTEMI.  While hospitalized CTA of abdomen revealed L kidney
mass suspicious for renal cancer.
#ID: Cholangitis: patient underwent ERCP and sphincterotomy and
stent placement in CBD. She will complete a 21 day course of
antibiotics. At the time of discharge she has 10 additional days
of antibiotics (levofloxacin and flagyl) left.
#Renal mass: CT scan to evaluate possible pancreatic mass found
on ERCP found that pt did not have pancreatic mass, but was
found to have L renal mass and renal vein thrombus.  Pt was
started on low dose coumadin.  She should have her INR checked
on [**4-26**] with results faxed to her primary care physcian.
She has an appointment for an MRI of the kidneys [**5-6**] at
[**Hospital3 **].  She was evaluated by urology and will be seen by
them in followup.  The implications of this mass was discussed
with the patient and her daughter.
#CAD: NSTEMI: Pt ruled in for MI, enzyme peak at 0.37, EKG
diffuse lateral ST depression, cardiac enzymes have trended down
to baseline.  Pt was started on aspirin and had 48 hours of
heparin.  Echocardiogram showed EF 60%, mild-mod TR, mod PA HTN.
Pt will need outpatient p-MIBI for risk stratification,
especially if she decides to pursue treatment of renal mass.
#COPD/emphysema: Pt received stress dose steroids while in the
ICU, she was then tapered down to home dose of prednisone and
remains on her regular inhalers.
#HTN-
- Continue metoprolol and captopril
#chronic low back pain
- tylenol, morphine prn with aggressive bowel regimen


Medications on Admission:
Dolansetron
Tylenol
Albuterol
Prednisone
Atrovent

Discharge Medications:
1. Ipratropium Bromide 18 mcg/Actuation Aerosol Sig: Two (2)
Puff Inhalation QID (4 times a day).
2. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation
Q6H (every 6 hours) as needed.
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
5. Senna 8.6 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day) as needed.
6. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
7. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).

8. Heparin Sodium (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
9. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
10. Prednisone 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
11. Captopril 25 mg Tablet Sig: Two (2) Tablet PO TID (3 times a
day).
12. Metoprolol Tartrate 50 mg Tablet Sig: 1.5 Tablets PO BID (2
times a day).
13. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H
(every 24 hours) for 10 days.
14. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) for 10 days.
15. Warfarin Sodium 2 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
16. Citalopram Hydrobromide 20 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).


Discharge Disposition:
Extended Care

Facility:
[**Location (un) **] - [**Location (un) 620**]

Discharge Diagnosis:
Cholangitis
NSTEMI


Discharge Condition:
Stable

Discharge Instructions:
Return to the emergency room or call your primary care physician
if you have fevers, abdominal pain, chest pain, or shortness of
breath or any other symptom that bothers you.

Followup Instructions:
Please call your primary care physician [**Last Name (NamePattern4) **] [**Telephone/Fax (1) 17753**] to make
an appointment within the next 2 weeks.

Please return to the [**Hospital Ward Name 23**] building Wednesday [**5-6**] at
1:45p [**Location (un) **]. Please do not eat or drink anything 4 hours
before the MRI.
{'Cholangitis,Subendocardial infarction, initial episode of care,Chronic airway obstruction, not elsewhere classified,Congestive heart failure, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Unspecified disorder of kidney and ureter,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: sepsis

PRESENT ILLNESS: 89yo F with COPD/emphysema, chronic back pain who presented with
sepsis. Patient's daughter called EMS on the day of admission
after she found her mother by the bed with mental status
changes. Upon EMS arrival, she was tachypneaic to 40,
tachycardic to 170s , disoriented, and hypertensive to 200s.  In
EW, code sepsis called, RIJ placed. She was given
levo/flagyl(for fever and luekocytosis). Her intial vitals were
T103, P133 BP176/50 RR23. Her initial lactate was 6.5 which
decreased to 1.6 with hydration.

MEDICAL HISTORY: emphysema/COPD
Hypertension
hyperlipidemia
Chronic low back pain
osteoarthritis
cholecystectomy [**96**] years ago
s/p TAH

MEDICATION ON ADMISSION: Dolansetron
Tylenol
Albuterol
Prednisone
Atrovent

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 103, 154/65 111, 22, 100% RA
Gen: frail
HEENT: EOMI, PERRL, poor dentition
Neck: s/p IJ placement
Chest: dimished effort, rhonchorous
CV: hyperdynamic PMI, distant S1 s2, no mrg
Abd: obese tender diffusey, no rebound
Ext: no edema
Neuro: oriented to person and place

FAMILY HISTORY: NC

SOCIAL HISTORY: Widowed with one daughter.
Denied [**Name2 (NI) **]
Denied alcohol use 

### Response:
{'Cholangitis,Subendocardial infarction, initial episode of care,Chronic airway obstruction, not elsewhere classified,Congestive heart failure, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Unspecified disorder of kidney and ureter,Anemia, unspecified'}
