CHIEF COMPLAINT: Chest pain, SOB

PRESENT ILLNESS: 31 year old male h/o liver [**First Name3 (LF) **] age 5 [**12-27**] biliary atresia
and subsequent cirrhosis, ESRD [**12-27**] GN on HD presents with chief
complaint of left chest pain when he coughs, non productive, no
hemoptysis, no fever or chils.  He states that the pain is sharp
and pleuritic.  His CP does not radiate.  He also complains of
abdominal pain which is chronic in nature.  He denies
constipation or diarrhea.  He has SOB at rest and 2 pillow
orthopnea.  No nausea or vomiting.
.
He denies any other symptoms, at the current moment the patient
would like only to sleep, and is asking for benadryl.
.
In the ER his initial VS were: T 97.6 HR 72 BP 122/83 RR 24 O2
sat: 96% RA.  He rec'd 1 L IVF in total in the ER.  He was also
mildly hypoglycemic in the ER and rec'd 2 amps of D50.  He had a
WBC of 20 and therefore had a CT of his torso, this revealed
possible colonic thickening, possible focal enhancement of the
kidney.  He rec'd vanc/zosyn/flagyl.  His VS prior to transfer
to the ICU was HR 110, RR 23, BP 113/73 92% RA.  Access is HD
line and 18g x 1.

MEDICAL HISTORY: Biliary atresia s/p liver [**Month/Day (2) **] [**2110**]
ESRD [**12-27**] post-infectious GN on HD M/W/F
asthma, well-controlled
right hip avascular necrosis, per ortho may need THR
nephrotic syndrome (4.1g proteinuria), hypoalbuminemia
s/p small bowel resection
Seizure [**12-27**] presumed emoblic event ([**12-4**]) from hepato-pulmonary
syndrome

MEDICATION ON ADMISSION: Keppra 500 mg daily and 500 mg after each hemodialysis session
lactulose QID prn
tacrolimus 0.5 mg daily
vitamin B complex with folic acid daily
Reglan 10 mg tablet to take 0.5 tablets p.o. q.i.d.
ipratropium bromide inhalation one q.6h.
metoprolol tartrate 25 mg 0.5 tablets p.o. b.i.d.
lidocaine adhesive patch
omeprazole 40 mg daily
vitamin D3 800-unit daily
oxycodone 5 mg one tablet q.6h. p.r.n. pain
sucralfate 1 g p.o. q.i.d.

ALLERGIES: Ibuprofen

PHYSICAL EXAM: Vitals: T: 96.8 BP: 139/85 P: 114 R: 22  O2: 98% on 2L
General: somewhat drowsy, oriented x 2 (person and place, date
is [**2128**] or [**2131**]), mild respiratory distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP 10cm, no LAD
Lungs: bronchial breath sounds throughout on the L side, clear
on the Right
CV: Regular rate and rhythm, normal S1 + S2, 3/6 SEM at the USB
Abdomen: soft, non-tender, moderatley distended, bowel sounds
present, no rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, minimal edema bilaterally
Neuro: AOx2. [**3-28**] stregnth in all 4 extremities, normal sensation
to light touch, no myoclonus.  Drowsy.  + asterixis - very
prominent.

FAMILY HISTORY: NC

SOCIAL HISTORY: He lives with his parents. He has a child with a prior
girlfriend. [**Name (NI) **] does not have a job. No tobacco, alcohol, or
illegal drugs.
Other and unspecified infection due to central venous catheter,Methicillin susceptible Staphylococcus aureus septicemia,Pneumonia, organism unspecified,Empyema without mention of fistula,Severe sepsis,Acute respiratory failure,Septic shock,End stage renal disease,Hepatic encephalopathy,Other severe protein-calorie malnutrition,Acute and subacute necrosis of liver,Unspecified disease of pericardium,Unspecified pleural effusion,Complications of transplanted liver,Aseptic necrosis of head and neck of femur,Other and unspecified coagulation defects,Precipitous drop in hematocrit,Acute venous embolism and thrombosis of internal jugular veins,Glucocorticoid deficiency,Encounter for palliative care,Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Renal dialysis status,Cirrhosis of liver without mention of alcohol,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Asthma, unspecified type, unspecified
Oth/uns inf-cen ven cath,Meth susc Staph aur sept,Pneumonia, organism NOS,Empyema w/o fistula,Severe sepsis,Acute respiratry failure,Septic shock,End stage renal disease,Hepatic encephalopathy,Oth severe malnutrition,Acute necrosis of liver,Pericardial disease NOS,Pleural effusion NOS,Compl liver transplant,Aseptic necrosis femur,Coagulat defect NEC/NOS,Drop, hematocrit, precip,Ac embl internl jug vein,Glucocorticoid deficient,Encountr palliative care,Abn react-renal dialysis,Renal dialysis status,Cirrhosis of liver NOS,Abn react-org transplant,Asthma NOS
Admission Date:  [**2136-2-11**]              Discharge Date:   [**2136-3-4**]

Date of Birth:  [**2104-8-11**]             Sex:   M

Service: MEDICINE

Allergies:
Ibuprofen

Attending:[**First Name3 (LF) 943**]
Chief Complaint:
Chest pain, SOB

Major Surgical or Invasive Procedure:
Thoracentesis
Chest tube placement
Pericardial window and drain
Dobhoff placement by IR
HD temporary line placement
HD tunnelled line placement

History of Present Illness:
31 year old male h/o liver [**First Name3 (LF) **] age 5 [**12-27**] biliary atresia
and subsequent cirrhosis, ESRD [**12-27**] GN on HD presents with chief
complaint of left chest pain when he coughs, non productive, no
hemoptysis, no fever or chils.  He states that the pain is sharp
and pleuritic.  His CP does not radiate.  He also complains of
abdominal pain which is chronic in nature.  He denies
constipation or diarrhea.  He has SOB at rest and 2 pillow
orthopnea.  No nausea or vomiting.
.
He denies any other symptoms, at the current moment the patient
would like only to sleep, and is asking for benadryl.
.
In the ER his initial VS were: T 97.6 HR 72 BP 122/83 RR 24 O2
sat: 96% RA.  He rec'd 1 L IVF in total in the ER.  He was also
mildly hypoglycemic in the ER and rec'd 2 amps of D50.  He had a
WBC of 20 and therefore had a CT of his torso, this revealed
possible colonic thickening, possible focal enhancement of the
kidney.  He rec'd vanc/zosyn/flagyl.  His VS prior to transfer
to the ICU was HR 110, RR 23, BP 113/73 92% RA.  Access is HD
line and 18g x 1.


Past Medical History:
Biliary atresia s/p liver [**Month/Day (2) **] [**2110**]
ESRD [**12-27**] post-infectious GN on HD M/W/F
asthma, well-controlled
right hip avascular necrosis, per ortho may need THR
nephrotic syndrome (4.1g proteinuria), hypoalbuminemia
s/p small bowel resection
Seizure [**12-27**] presumed emoblic event ([**12-4**]) from hepato-pulmonary
syndrome

Social History:
He lives with his parents. He has a child with a prior
girlfriend. [**Name (NI) **] does not have a job. No tobacco, alcohol, or
illegal drugs.


Family History:
NC

Physical Exam:
Vitals: T: 96.8 BP: 139/85 P: 114 R: 22  O2: 98% on 2L
General: somewhat drowsy, oriented x 2 (person and place, date
is [**2128**] or [**2131**]), mild respiratory distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP 10cm, no LAD
Lungs: bronchial breath sounds throughout on the L side, clear
on the Right
CV: Regular rate and rhythm, normal S1 + S2, 3/6 SEM at the USB
Abdomen: soft, non-tender, moderatley distended, bowel sounds
present, no rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, minimal edema bilaterally
Neuro: AOx2. [**3-28**] stregnth in all 4 extremities, normal sensation
to light touch, no myoclonus.  Drowsy.  + asterixis - very
prominent.

Pertinent Results:
ADMISSION LABS:
.
134 94 43 AGap=18
------------<67
4.0 26 5.6
ALT: 19 AP: 338 Tbili: 2.6 Alb: 1.0
AST: 43 Lip: 11
K:4.0
Glu:67
Lactate:4.1
MCV 85 WBC 20.8 HGB 12.8 PLTs 206 HCT 40.0
N:92.7 L:2.4 M:4.3 E:0.4 Bas:0.2
PT: 18.9 PTT: 50.0 INR: 1.7
.
MICRO:
.
[**2136-2-22**] CMV Viral Load: Not detected
.
[**2136-2-13**] Strongyloides Antibody, IgG ([**Doctor First Name **]): Positive
.
[**2136-2-11**] Blood Culture, Routine (Final [**2136-2-14**]):
      STAPH AUREUS COAG +.

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             STAPH AUREUS COAG +
                             |
CLINDAMYCIN-----------<=0.25 S
ERYTHROMYCIN----------<=0.25 S
GENTAMICIN------------ <=0.5 S
LEVOFLOXACIN----------<=0.12 S
OXACILLIN-------------   0.5 S
TRIMETHOPRIM/SULFA---- <=0.5 S

   Aerobic Bottle Gram Stain (Final [**2136-2-12**]):
      GRAM POSITIVE COCCI IN CLUSTERS.
   Anaerobic Bottle Gram Stain (Final [**2136-2-12**]):
      GRAM POSITIVE COCCI IN CLUSTERS.
.
[**2136-2-12**] 11:37 am PLEURAL FLUID

   GRAM STAIN (Final [**2136-2-12**]):
      3+  (5-10 per 1000X FIELD):   POLYMORPHONUCLEAR
LEUKOCYTES.
      NO MICROORGANISMS SEEN.

   FLUID CULTURE (Final [**2136-2-16**]):
      STAPH AUREUS COAG +.    SPARSE GROWTH.
      STAPHYLOCOCCUS, COAGULASE NEGATIVE.    RARE GROWTH.


                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             STAPH AUREUS COAG +
                             |          STAPHYLOCOCCUS,
COAGULASE NEGATIVE
                             |          |
CLINDAMYCIN-----------<=0.25 S   <=0.25 S
ERYTHROMYCIN----------<=0.25 S   <=0.25 S
GENTAMICIN------------ <=0.5 S    <=0.5 S
LEVOFLOXACIN----------<=0.12 S   <=0.12 S
OXACILLIN-------------   0.5 S   <=0.25 S
TETRACYCLINE----------             =>16 R
TRIMETHOPRIM/SULFA---- <=0.5 S
VANCOMYCIN------------                1 S

   ANAEROBIC CULTURE (Final [**2136-2-16**]):    NO ANAEROBES ISOLATED.


   FUNGAL CULTURE (Preliminary):    NO FUNGUS ISOLATED.

.
[**2136-2-13**] HD Catheter tip cx: MSSA
.
IMAGING:
.
[**2136-2-11**] CT head: No acute intracranial process. Consider MRI
given the patient's history of prior infarcts if clinically
warranted.
.
[**2136-2-11**] CXR: Congestive heart failure, large left pleural
effusion. Follow up post-diuresis is recommended
.
[**2136-2-11**] CT abdomen:
1. Large left pleural effusion which is incompletely imaged with
complete
collapse of the left lower lobe and visualized lingula. Right
lower lobe
probable early pneumonia and/or fluid overload.
2. Apparent wall thickening of collapsed descending colon,
sigmoid and rectum may represent mild colitis; however, this may
also be secondary to
underdistension.
3. Interval decrease in ascites. Persistent body wall and
mesenteric edema, likely secondary to underlying liver disease.

4. Cirrhosis with stigmata of portal hypertension.
5. L5 spondylolysis.
.
[**2136-2-16**] TEE: No mass or thrombus is seen in the right atrium or
right atrial appendage. No atrial septal defect is seen by 2D or
color Doppler. Overall left ventricular systolic function is
normal (LVEF>55%). Right ventricular chamber size and free wall
motion are normal. The aortic valve leaflets (3) appear
structurally normal with good leaflet excursion. No masses or
vegetations are seen on the aortic valve. There is no aortic
valve stenosis. No aortic regurgitation is seen. The mitral
valve leaflets are structurally normal. No mass or vegetation is
seen on the mitral valve. Mild (1+) mitral regurgitation is
seen. No vegetation/mass is seen on the pulmonic valve. There is
a small pericardial effusion. No right atrial or right
ventricular diastolic collapse is seen.

IMPRESSION: No valvular vegetations seen. No evidence of
vegetation on right atrial line. Small pericardial effusion with
no evidence of right atrial or right ventricular collapse.
.
[**2136-2-19**] TTE: The left atrium is normal in size. Left ventricular
wall thicknesses and cavity size are normal. Due to suboptimal
technical quality, a focal wall motion abnormality cannot be
fully excluded. Overall left ventricular systolic function is
normal (LVEF>55%). Right ventricular chamber size and free wall
motion are normal. The aortic valve leaflets (3) appear
structurally normal with good leaflet excursion. No aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. No masses or vegetations are seen on the mitral
valve, but cannot be fully excluded due to suboptimal image
quality. Mild to moderate ([**11-26**]+) mitral regurgitation is seen.
There is a moderate sized pericardial effusion. The pericardium
may be thickened. There is right ventricular diastolic collapse,
consistent with impaired fillling/tamponade physiology.
.
[**2136-2-21**] TTE: Regional left ventricular wall motion is normal.
Overall left ventricular systolic function is normal (LVEF>55%).
Right ventricular chamber size and free wall motion are normal.
The aortic valve leaflets (?#) appear structurally normal with
good leaflet excursion. The mitral valve leaflets are
structurally normal. There is no mitral valve prolapse. Trivial
mitral regurgitation is seen. There is a very small pericardial
effusion.

IMPRESSION: Very small pericardial effusion primarily located
anteriorly and posterior to the atria (0.7 maximum dimension).
Preserved left ventricular function.
.
[**2136-2-21**] Hip x-ray: Unchanged right femoral head avascular
necrosis.
.
[**2-26**] CT abd & pelvis:
1)A new pericardiocentesis window has been placed and the
pericardial effusion
is now small.

2)Unchanged atelectasis in the left lower lobe and lingula
suggesting a
trapped lung with adjacent locules of gas within a
hydropneumothorax. The
right pleural effusion has slightly increased and is now
moderate.

3)Colitis with pericolonic stranding which has increased since
the previous
study. Appearances are consistent with a colitis which may be
infectious or
inflammatory in origin.

4)Right femoral head AVN.
.
[**2-29**] RUQ u/s:
1. No evidence of intra- or extra-hepatic biliary dilatation.

2. Stable right-sided pleural effusion since CT from [**2136-2-26**].

3. Stable appearance of the liver with known cirrhosis. No new
focal liver
lesions.

4. Stable appearance with reversed low flow demonstrated within
the main
portal vein, left portal and anterior right portal branches and
splenic vein.
Splenomegaly and extensive splenic varices.

5. No appreciable ascites.

.
[**3-1**] CXR:
Mild pulmonary edema has changed in distribution but not in
overall severity.
Left lower lobe remains consolidated, and the moderate
multiloculated air and
fluid collection in the persistent left pleural space at the
base of the left
hemithorax is stable. Moderate cardiomegaly is longstanding. A
hemodialysis
catheter ends in the region of the superior cavoatrial junction
and upper
right atrium, obscuring the tip of the left PIC line. No right
pneumothorax.
Stable small right pleural effusion.


Brief Hospital Course:
31 yo M w/ biliary atresia s/p liver [**Month/Day (4) **], cirrhosis, ESRD
on HD presents w/ one week of left chest pain, cough, and
generalized malaise.
.
Patient died on [**2136-3-4**].
.
Goals of care: patient initially full code on admission and
during much of hospitalization. While in the ICU for the second
time, family meeting occurred and given his severely ill state
he was changed to DNR, DNI, and the focus shifted to comfort.
Patient made CMO, family at bedside, was monitored in the ICU
and then transferred to the floor. Patient died.
.
# MSSA Bacteremia/Pneumonia/Empyema: Patient presented with
symptoms of chest pain, shortness of breath and malaise. Found
to have MSSA bacteremia, pneumonia and left sided pleural
effusion.  Most likely source of infection is HD catheter.  HD
catheter was removed on presentation. Chest tube was placed to
drain empyema diagnosed on thoracentesis. Serial blood cultures
were negative after [**2136-2-11**]. TTE and TEE found no evidence of
vegetations. Due to low cortisol levels (3.9 random cortisol)
and persistently low blood pressures he was started on stress
dose steroids, these were tapered down with po prednisone.
Tapered to hydrocort 50mg IV BID [**2-25**], to prednisone 20mg daily
on [**2-27**]. Slow taper of steroids, course set as: 15mg pred [**2-29**],
10mg on [**3-1**].5mg on [**3-2**], 5mg daily thereafter continuous.
Was initially on vanc/cefepime for VAP, then changed to
nafcillin given MSSA. Then, per ID, was changed to cefazolin
with HD dosing. On [**2-29**], increased RR, leukocytosis, and
low-grade fever prompted broadening to vanc/cefepime again. ID
was directing antibiotic course. Micro data from thoracentesis
(pleural fluid) demonstrated enterococcus (VRE) on [**2136-3-1**].
.
# Respiratory Failure: During initial evaluation he underwent
bronchoscopy to attain sputum samples and to assess cause of
collapsed left lower lobe.  After bronchoscopy, patient became
increasingly tachypneic and his altered mental status
progressed.  He was electively intubated for concern that he
would not be able to protect his airway. After extubation, he
was brething well on room air. His altered mental status
resolved. Treated for VAP with vanco/cefepime for 7 days, course
completed. On the floor, breathing well on room air with SpO2 in
mid/high 90s on room air. On [**2-29**], patient had increasing
tachypnea but still maintaining SpO2; had thoracentesis by
Interventional Pulmonary team on [**3-1**] to look for
infection/empyema (prior to [**Female First Name (un) 576**], given ddAVP and FFP). At that
procedure, patient had 40 cc hemorrhagic fluid removed, pH 6.72,
continued oozing at site prompted transfer from floor to ICU.
Ordered for pRBC and FFP upon transfer to unit. Patient still
oozing in unit, required blood transfusions. Pleural fluid
results from thoracentesis demonstrate VRE.

# Leukocytosis: Patient with abdominal pain, CT abdomen/pelvis
demonstrated colitis. Started with empiric c.diff coverage with
PO vancomycin, even though c.diff negative x3. Sent off c.diff
cytotoxin B assay - pending. Abdominal pain also could have been
d/t agressive lactulose which has been tapered back and
abdominal pain improved.

# Cardiac Tamponade: Enlarging pericardial effusion was
identified on CT scan.  Transthoracic echo showed tamponade
physiology. Effusion was not accessible anteriorly for
pericardiocentesis by Cardiology. Patient's tachycardia and
hypotension were managed overnight with IVF boluses.  He
underwent pericardial window and drain placement by Thoracic
Surgery. Drain was them removed, no further evidence of
tamponade while on the floor.

# ESRD: [**Female First Name (un) **] per renal team, MWF. Low K and phos were issues
that were managed through [**Female First Name (un) 2286**] and electrolyte replacement.
Tunnelled HD line was placed in left chest [**2-27**]. Ordered vitamin
D to start vitamin D replacement given severely low level.

# ESLD: Rising bilirubin in particular prompted RUQ u/s on [**2-29**]:
[**2-29**] RUQ u/s: 1. No evidence of intra- or extra-hepatic biliary
dilatation. 2. Stable right-sided pleural effusion since CT from
[**2136-2-26**]. 3. Stable appearance of the liver with known
cirrhosis. No new focal liver lesions. 4. Stable appearance with
reversed low flow demonstrated within the main portal vein, left
portal and anterior right portal branches and splenic vein.
Splenomegaly and extensive splenic varices. 5. No appreciable
ascites.
Patient on lactulose, tacrolimus, rifaximin. Concern for
worsening liver failure; not a [**Year (4 digits) **] candidate due to
infection (above).

# Strongyloides antibody positive - no need to further monitor
O&P. Already got one dose of ivermectin - treatment done per ID.

# Nutrition: Tubefeeds via Dobhoff.

# Tachycardia: Reviewing records, present through most of
hospitalization, likely d/t pain, infection, dehydration.

# Headache - resolved. Unclear cause, however very high risk for
infection, bleeding; ordered head CT - negative for acute
process.

EMERGENCY CONTACT: [**Name (NI) 71**] [**Name (NI) 40167**] (Father) [**Telephone/Fax (1) 78901**]

Medications on Admission:
Keppra 500 mg daily and 500 mg after each hemodialysis session
lactulose QID prn
tacrolimus 0.5 mg daily
vitamin B complex with folic acid daily
Reglan 10 mg tablet to take 0.5 tablets p.o. q.i.d.
ipratropium bromide inhalation one q.6h.
metoprolol tartrate 25 mg 0.5 tablets p.o. b.i.d.
lidocaine adhesive patch
omeprazole 40 mg daily
vitamin D3 800-unit daily
oxycodone 5 mg one tablet q.6h. p.r.n. pain
sucralfate 1 g p.o. q.i.d.

Discharge Medications:
n/a

Discharge Disposition:
Expired

Discharge Diagnosis:
death

Discharge Condition:
died

Discharge Instructions:
n/a

Followup Instructions:
n/a


Completed by:[**2136-3-6**]
{'Other and unspecified infection due to central venous catheter,Methicillin susceptible Staphylococcus aureus septicemia,Pneumonia, organism unspecified,Empyema without mention of fistula,Severe sepsis,Acute respiratory failure,Septic shock,End stage renal disease,Hepatic encephalopathy,Other severe protein-calorie malnutrition,Acute and subacute necrosis of liver,Unspecified disease of pericardium,Unspecified pleural effusion,Complications of transplanted liver,Aseptic necrosis of head and neck of femur,Other and unspecified coagulation defects,Precipitous drop in hematocrit,Acute venous embolism and thrombosis of internal jugular veins,Glucocorticoid deficiency,Encounter for palliative care,Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Renal dialysis status,Cirrhosis of liver without mention of alcohol,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Asthma, unspecified type, 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: Chest pain, SOB

PRESENT ILLNESS: 31 year old male h/o liver [**First Name3 (LF) **] age 5 [**12-27**] biliary atresia
and subsequent cirrhosis, ESRD [**12-27**] GN on HD presents with chief
complaint of left chest pain when he coughs, non productive, no
hemoptysis, no fever or chils.  He states that the pain is sharp
and pleuritic.  His CP does not radiate.  He also complains of
abdominal pain which is chronic in nature.  He denies
constipation or diarrhea.  He has SOB at rest and 2 pillow
orthopnea.  No nausea or vomiting.
.
He denies any other symptoms, at the current moment the patient
would like only to sleep, and is asking for benadryl.
.
In the ER his initial VS were: T 97.6 HR 72 BP 122/83 RR 24 O2
sat: 96% RA.  He rec'd 1 L IVF in total in the ER.  He was also
mildly hypoglycemic in the ER and rec'd 2 amps of D50.  He had a
WBC of 20 and therefore had a CT of his torso, this revealed
possible colonic thickening, possible focal enhancement of the
kidney.  He rec'd vanc/zosyn/flagyl.  His VS prior to transfer
to the ICU was HR 110, RR 23, BP 113/73 92% RA.  Access is HD
line and 18g x 1.

MEDICAL HISTORY: Biliary atresia s/p liver [**Month/Day (2) **] [**2110**]
ESRD [**12-27**] post-infectious GN on HD M/W/F
asthma, well-controlled
right hip avascular necrosis, per ortho may need THR
nephrotic syndrome (4.1g proteinuria), hypoalbuminemia
s/p small bowel resection
Seizure [**12-27**] presumed emoblic event ([**12-4**]) from hepato-pulmonary
syndrome

MEDICATION ON ADMISSION: Keppra 500 mg daily and 500 mg after each hemodialysis session
lactulose QID prn
tacrolimus 0.5 mg daily
vitamin B complex with folic acid daily
Reglan 10 mg tablet to take 0.5 tablets p.o. q.i.d.
ipratropium bromide inhalation one q.6h.
metoprolol tartrate 25 mg 0.5 tablets p.o. b.i.d.
lidocaine adhesive patch
omeprazole 40 mg daily
vitamin D3 800-unit daily
oxycodone 5 mg one tablet q.6h. p.r.n. pain
sucralfate 1 g p.o. q.i.d.

ALLERGIES: Ibuprofen

PHYSICAL EXAM: Vitals: T: 96.8 BP: 139/85 P: 114 R: 22  O2: 98% on 2L
General: somewhat drowsy, oriented x 2 (person and place, date
is [**2128**] or [**2131**]), mild respiratory distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP 10cm, no LAD
Lungs: bronchial breath sounds throughout on the L side, clear
on the Right
CV: Regular rate and rhythm, normal S1 + S2, 3/6 SEM at the USB
Abdomen: soft, non-tender, moderatley distended, bowel sounds
present, no rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, minimal edema bilaterally
Neuro: AOx2. [**3-28**] stregnth in all 4 extremities, normal sensation
to light touch, no myoclonus.  Drowsy.  + asterixis - very
prominent.

FAMILY HISTORY: NC

SOCIAL HISTORY: He lives with his parents. He has a child with a prior
girlfriend. [**Name (NI) **] does not have a job. No tobacco, alcohol, or
illegal drugs. 

### Response:
{'Other and unspecified infection due to central venous catheter,Methicillin susceptible Staphylococcus aureus septicemia,Pneumonia, organism unspecified,Empyema without mention of fistula,Severe sepsis,Acute respiratory failure,Septic shock,End stage renal disease,Hepatic encephalopathy,Other severe protein-calorie malnutrition,Acute and subacute necrosis of liver,Unspecified disease of pericardium,Unspecified pleural effusion,Complications of transplanted liver,Aseptic necrosis of head and neck of femur,Other and unspecified coagulation defects,Precipitous drop in hematocrit,Acute venous embolism and thrombosis of internal jugular veins,Glucocorticoid deficiency,Encounter for palliative care,Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Renal dialysis status,Cirrhosis of liver without mention of alcohol,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Asthma, unspecified type, unspecified'}
