CHIEF COMPLAINT: Abdominal pain and Hypoxia

PRESENT ILLNESS: Chief Complaint: Abdominal Pain

MEDICAL HISTORY: hypertension,
congestive heart failure, presumably diastolic
pacer dependent heart block
diverticulosis.
Colectomy in [**2161**] at [**Hospital3 **]
left hip pinning in the 40s.

MEDICATION ON ADMISSION: - Amlodipine 5 mg PO/NG DAILY
- Aluminum-Magnesium Hydrox.-Simethicone 30 mL PO/NG QID:PRN
dyspepsia
- CefePIME 2 g IV Q24H
- Furosemide 40 mg IV x 3
- Heparin 5000 UNIT SC TID
- Metoprolol Succinate XL 25 mg PO DAILY
- Omeprazole 40 mg PO DAILY
- Vancomycin 1000 mg IV Q48H

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admit Exam:
GENERAL ?????? increased work of breathing
HEENT - NC/AT, PERRL, EOMI, sclerae anicteric, MMM, OP clear
NECK - supple, distended neck veins, no carotid bruits
LUNGS - lungs with crackles, poor airation
HEART - RRR, 3/6 systolic murmer, nl S1-S2
ABDOMEN - NABS, soft/NT/ND, no masses or HSM, no
rebound/guarding
EXTREMITIES - WWP, no edema, 2+ peripheral pulses (radials, DPs)

FAMILY HISTORY: father had kidney cancer in his 60s
mother had melanoma

SOCIAL HISTORY: Ms. [**Known lastname **] lives alone in [**Hospital1 3494**] in an apartment on the 5th
Acute respiratory failure,Acute kidney failure, unspecified,Bacterial pneumonia, unspecified,Acidosis,Secondary malignant neoplasm of other specified sites,Chronic diastolic heart failure,Delirium due to conditions classified elsewhere,Malignant neoplasm of kidney, except pelvis,Mitral valve disorders,Cardiac pacemaker in situ,Diverticulosis of colon (without mention of hemorrhage),Do not resuscitate status,Abdominal pain, unspecified site
Acute respiratry failure,Acute kidney failure NOS,Bacterial pneumonia NOS,Acidosis,Secondary malig neo NEC,Chr diastolic hrt fail,Delirium d/t other cond,Malig neopl kidney,Mitral valve disorder,Status cardiac pacemaker,Dvrtclo colon w/o hmrhg,Do not resusctate status,Abdmnal pain unspcf site
Admission Date:  [**2173-6-28**]              Discharge Date:   [**2173-7-1**]


Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 594**]
Chief Complaint:
Abdominal pain and Hypoxia

Major Surgical or Invasive Procedure:
None

History of Present Illness:
Chief Complaint: Abdominal Pain

Reason for MICU transfer: Hypoxia requiring BiPAP

History of Present Illness:  [**Age over 90 **]F with h/o metastatic renal CA,
CHF, pacemaker, presented to ED yesterday ([**6-28**]) c/o of
epigastric abdominal pain and weakness, was admitted to medicine
for hypoxia, and was transferred to MICU this morning for
inability to maintain O2 sat on NRB.
.
She initially presented with abdominal pain, which is chronic in
nature and has gone on intermittently for several years. She
states that it is associated with certain foods such as
"cucumbers and tomatoes." Her Alum-Mag hydroxide-simethicone
typically helps somewhat. The pain does not radiate anywhere and
is associated with some nausea. Patient lives alone but has been
feeling weak for the past 3 days. Has no appetite and has not
been eating much. Denies fevers/chills, cough, chest pain, SOB,
pain anywhere else, dysuria, vomiting. Went to OSH and had
abdominal CT 3 days ago showing worsening right renal mass and
invasion to right renal vein and IVC. Not currently undergoing
treatment for CA.
.
Patient initially came here with complaints of abdominal pain
again, but was noted to be hypoxic in the ED. She denies
orthopnea, PND, but does complain of difficulty climbing a
flight of stairs. The family is unable to detail if these
symptoms have changed recently, but they said she has been
hypoxic before when she was seen at [**Hospital1 3494**] 3 days ago. She
was given "some liquid" which resulted in her being able to come
off o2. Other than that, her only prior O2 requirement was when
she required pacer placement in [**2169**] at the time of her RCC
diagnosis.
.
In the ED, initial vitals: 97.6 104 149/75 18 86%. Labs notable
for Na 125, K 5.4, BNP [**Numeric Identifier 81257**], WBC 12.9, diff N:93.9 L:5.1 M:0.7
E:0.1 Bas:0.1. The pt underwent a CXR PA and Lat which showed a
L sided consolidation concerning for PNA vs atelectasis, She
received nothing in the ED. Vitals prior to transfer to floor:
98.2, 149/78, 25, 94, 99%4L.
.
Initially on the floor, patient's vitals were 98.5, 146/83, 99,
20, 94%, 3L.  Were treating and working up hypoxia as PE vs. MI
vs. malignancy vs. CHF.  Also treating hyponatremia.  Became
hypoxic on floor early this morning to O2 sat 61, put on NRB,
came up to mid 80s.  ABG showed 7.28/64/63/31.  Given nebs,
started on vanc and cefepime.  Patient is DNR/DNI, but was
transferred to the floor for BiPAP.

On arrival to the MICU, patient was satting poorly on NRB.  She
seemed confused and disoriented and was switched to non-invasive
pressure support.

Review of systems:
(+) Per HPI
(-) Not able to complete full ROS due to AMS.


Past Medical History:
hypertension,
congestive heart failure, presumably diastolic
pacer dependent heart block
diverticulosis.
Colectomy in [**2161**] at [**Hospital3 **]
left hip pinning in the 40s.


Social History:
Ms. [**Known lastname **] lives alone in [**Hospital1 3494**] in an apartment on the 5th

floor. Her brother and sister-in-law live nearby. She has never

been married. She has no children. No tobacco use. Occassional
EtOH use.


Family History:
father had kidney cancer in his 60s
mother had melanoma


Physical Exam:
Admit Exam:
GENERAL ?????? increased work of breathing
HEENT - NC/AT, PERRL, EOMI, sclerae anicteric, MMM, OP clear
NECK - supple, distended neck veins, no carotid bruits
LUNGS - lungs with crackles, poor airation
HEART - RRR, 3/6 systolic murmer, nl S1-S2
ABDOMEN - NABS, soft/NT/ND, no masses or HSM, no
rebound/guarding
EXTREMITIES - WWP, no edema, 2+ peripheral pulses (radials, DPs)

SKIN - no rashes or lesions
LYMPH - no cervical LAD
NEURO ?????? disoriented, pulling at lines/mask


Pertinent Results:
[**2173-6-28**] 08:47AM BLOOD WBC-12.9* RBC-4.10* Hgb-12.0 Hct-36.3
MCV-89 MCH-29.2 MCHC-33.0 RDW-13.9 Plt Ct-256
[**2173-6-29**] 01:54AM BLOOD WBC-13.7* RBC-3.96* Hgb-12.4 Hct-35.0*
MCV-88 MCH-31.3 MCHC-35.4* RDW-14.0 Plt Ct-250
[**2173-6-29**] 05:22AM BLOOD WBC-18.6* RBC-4.48 Hgb-13.3 Hct-40.3
MCV-90 MCH-29.7 MCHC-33.1 RDW-13.9 Plt Ct-305
[**2173-6-30**] 02:43AM BLOOD WBC-19.9* RBC-4.05* Hgb-12.0 Hct-36.7
MCV-91 MCH-29.7 MCHC-32.8 RDW-14.1 Plt Ct-264
[**2173-7-1**] 04:46AM BLOOD WBC-15.4* RBC-4.17* Hgb-12.2 Hct-38.8
MCV-93 MCH-29.3 MCHC-31.5 RDW-13.9 Plt Ct-276

[**2173-6-28**] 08:47AM BLOOD Glucose-218* UreaN-25* Creat-1.1 Na-125*
K-5.4* Cl-89* HCO3-24 AnGap-17
[**2173-6-28**] 09:15PM BLOOD Na-128* K-5.6* Cl-89*
[**2173-6-29**] 01:54AM BLOOD Glucose-168* UreaN-23* Creat-0.9 Na-125*
K-5.7* Cl-88* HCO3-28 AnGap-15
[**2173-6-29**] 05:22AM BLOOD Glucose-222* UreaN-24* Creat-1.0 Na-126*
K-5.2* Cl-87* HCO3-25 AnGap-19
[**2173-6-30**] 02:43AM BLOOD Glucose-142* UreaN-33* Creat-1.3* Na-129*
K-5.1 Cl-89* HCO3-31 AnGap-14
[**2173-7-1**] 04:46AM BLOOD Glucose-110* UreaN-47* Creat-1.7* Na-134
K-5.5* Cl-95* HCO3-29 AnGap-16

[**2173-6-28**] 08:47AM BLOOD proBNP-[**Numeric Identifier 81257**]*
[**2173-6-28**] 08:47AM BLOOD cTropnT-0.07*
[**2173-6-28**] 09:15PM BLOOD CK-MB-6 cTropnT-0.08*
[**2173-6-29**] 01:54AM BLOOD CK-MB-6 cTropnT-0.09*
[**2173-6-28**] 05:24PM BLOOD Type-ART pO2-54* pCO2-46* pH-7.43
calTCO2-32* Base XS-4 Intubat-NOT INTUBA
[**2173-6-29**] 04:09AM BLOOD Type-ART pO2-63* pCO2-64* pH-7.28*
calTCO2-31* Base XS-0 Comment-NON-REBREA
[**2173-6-29**] 05:36AM BLOOD Type-[**Last Name (un) **] pO2-65* pCO2-102* pH-7.13*
calTCO2-36* Base XS-0
[**2173-6-29**] 05:38AM BLOOD Type-ART Temp-36.7 FiO2-100 pO2-76*
pCO2-98* pH-7.14* calTCO2-35* Base XS-0 AADO2-545 REQ O2-90
Intubat-NOT INTUBA
[**2173-6-29**] 07:30AM BLOOD Type-ART pO2-65* pCO2-78* pH-7.22*
calTCO2-34* Base XS-0 Intubat-NOT INTUBA Comment-NON-REBREA
[**2173-6-29**] 06:38PM BLOOD Type-[**Last Name (un) **] Temp-36.4 pO2-182* pCO2-68*
pH-7.27* calTCO2-33* Base XS-2 Intubat-NOT INTUBA
[**2173-6-30**] 02:58AM BLOOD Type-[**Last Name (un) **] Temp-36.5 pO2-47* pCO2-79*
pH-7.24* calTCO2-36* Base XS-2 Intubat-NOT INTUBA

Brief Hospital Course:
Ms. [**Known lastname **] is a [**Age over 90 **] yo female with a hx of CHF, RCC, and HTN
presenting with abdominal pain, now resolved, but noted to be
hypoxic on admission to 86%. Given vacomycin and cefepime.
Hypoxemia progressed despite ABX and patient developed [**Last Name (un) **].
Worsening hypoxemia and [**Last Name (un) **] in the setting of metastatic RCC and
DNR/DNI prompted decision to transition to CMO. Ms. [**Known lastname **]
passed while in the MICU on [**2173-7-1**].



Medications on Admission:
- Amlodipine 5 mg PO/NG DAILY
- Aluminum-Magnesium Hydrox.-Simethicone 30 mL PO/NG QID:PRN
dyspepsia
- CefePIME 2 g IV Q24H
- Furosemide 40 mg IV x 3
- Heparin 5000 UNIT SC TID
- Metoprolol Succinate XL 25 mg PO DAILY
- Omeprazole 40 mg PO DAILY
- Vancomycin 1000 mg IV Q48H


Discharge Disposition:
Expired

Discharge Diagnosis:
Expired

Discharge Condition:
Expired
{'Acute respiratory failure,Acute kidney failure, unspecified,Bacterial pneumonia, unspecified,Acidosis,Secondary malignant neoplasm of other specified sites,Chronic diastolic heart failure,Delirium due to conditions classified elsewhere,Malignant neoplasm of kidney, except pelvis,Mitral valve disorders,Cardiac pacemaker in situ,Diverticulosis of colon (without mention of hemorrhage),Do not resuscitate status,Abdominal pain, unspecified site'}


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: Abdominal pain and Hypoxia

PRESENT ILLNESS: Chief Complaint: Abdominal Pain

MEDICAL HISTORY: hypertension,
congestive heart failure, presumably diastolic
pacer dependent heart block
diverticulosis.
Colectomy in [**2161**] at [**Hospital3 **]
left hip pinning in the 40s.

MEDICATION ON ADMISSION: - Amlodipine 5 mg PO/NG DAILY
- Aluminum-Magnesium Hydrox.-Simethicone 30 mL PO/NG QID:PRN
dyspepsia
- CefePIME 2 g IV Q24H
- Furosemide 40 mg IV x 3
- Heparin 5000 UNIT SC TID
- Metoprolol Succinate XL 25 mg PO DAILY
- Omeprazole 40 mg PO DAILY
- Vancomycin 1000 mg IV Q48H

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admit Exam:
GENERAL ?????? increased work of breathing
HEENT - NC/AT, PERRL, EOMI, sclerae anicteric, MMM, OP clear
NECK - supple, distended neck veins, no carotid bruits
LUNGS - lungs with crackles, poor airation
HEART - RRR, 3/6 systolic murmer, nl S1-S2
ABDOMEN - NABS, soft/NT/ND, no masses or HSM, no
rebound/guarding
EXTREMITIES - WWP, no edema, 2+ peripheral pulses (radials, DPs)

FAMILY HISTORY: father had kidney cancer in his 60s
mother had melanoma

SOCIAL HISTORY: Ms. [**Known lastname **] lives alone in [**Hospital1 3494**] in an apartment on the 5th 

### Response:
{'Acute respiratory failure,Acute kidney failure, unspecified,Bacterial pneumonia, unspecified,Acidosis,Secondary malignant neoplasm of other specified sites,Chronic diastolic heart failure,Delirium due to conditions classified elsewhere,Malignant neoplasm of kidney, except pelvis,Mitral valve disorders,Cardiac pacemaker in situ,Diverticulosis of colon (without mention of hemorrhage),Do not resuscitate status,Abdominal pain, unspecified site'}
