CHIEF COMPLAINT: Abdominal pain

PRESENT ILLNESS: Mr. [**Known lastname 1007**] is a 37 year old male with history of idiopathic
pancreatitis who presents from [**Hospital 15405**] with necrotizing
pancreatitis.  He initially presented on [**12-13**] with one day
history of severe abdominal pain/LLQ pain/epigastric pain
radiating to left scrotum.  Also with nausea and dry heaves but
no emesis.  Went to ED for evaluation and found to have elevated
amylase (424 --> 681) and lipase (1245 --> 1154).  CT scan of
abdomen demonstrated significant necrotizing pancreatitis with
significant abnormal pleural fluid.  Patient was hypotensive and
was on dopamine intially but weaned off after recieving
approximately 4L of IVF's over 2 days.  He also become
tachycardic to 170's and was treated with lopressor 5mg IV,
repeated an unclear number of times.  He also had a recurrent
fever (Tm 105) and was hypoxia with O2 sats in low 90's on 6-8L
high flow.  He was seen by gastroenterology and treated with
aldactone 50 [**Hospital1 **] and lasix for ascites and to improve urine
output.  He had been receiving dilaudid 2-4 mg IV Q2H prn for
pain.  Because of the worsening CT scan on [**12-15**] and clinical
deterioration, patient transferred to [**Hospital1 18**] for further
management.

MEDICAL HISTORY: 1)Idiopathic Pancreatitis - Seen by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3315**] in [**2134**]
- First in [**2130**] after heavy ETOH, second [**2131**] after a car
accident and light ETOH, another after fatty foods (not ETOH),
another after ERCP (amylase range of 1800-[**2135**], pain relieved by
brief hospitalization).
- ERCP found a normal common bile duct and biliary system but
was unable to cannulate the pancreatic duct.
- MRCP with no pancreatic divisum ([**2134**])
- CF gene negative
2)Kidney Stones
3)GERD
4)UTI
5)Spinal stenosis s/p fusion in [**2123**]
6)HTN
7)Seasonal allergies
8)Ulnar nerve entrapment surgery in [**2132**]

MEDICATION ON ADMISSION: Atenolol 50 mg PO QD

ALLERGIES: Codeine / Zosyn

PHYSICAL EXAM: Gen: sleepy, arousable
Vitals: 101.3, 141/83, 120, 20, 98% on 50%
HEENT: PERRL, EOMI, anicteric sclera, MM dry, OP clear
Neck: supple, no LAD, no thyromegaly
Cardiac: tachy, regular, NL S1 and S2, no MRGs
Lungs: CTAB post, no crackles
Abd: distended, tense, tender in lower quadrants and epigastric,
+ascites and dullness, no caput or spiders, no asterixis, no HSM
Ext: warm, 2+ DP pulses, no C/C/E
Neuro: CN III-XII intact, MAE, alert to person, time, but
thought at [**Hospital3 **]

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: +tob, pt states no ETOH recently but told surgery that he drinks
a 6pk of beer a day and told attending 1 br/day on occasion.  no
IVDU. lives at home with wife and 18mnth old child.
Acute pancreatitis,Other and unspecified alcohol dependence, unspecified,Alcohol withdrawal,Unspecified pleural effusion,Congestive heart failure, unspecified,Acute respiratory failure,Dehydration,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of urinary calculi,Esophageal reflux,Tobacco use disorder,Long-term (current) use of insulin,Diarrhea,Tachycardia, unspecified
Acute pancreatitis,Alcoh dep NEC/NOS-unspec,Alcohol withdrawal,Pleural effusion NOS,CHF NOS,Acute respiratry failure,Dehydration,DMII wo cmp nt st uncntr,Prsnl hst urnr dsrd calc,Esophageal reflux,Tobacco use disorder,Long-term use of insulin,Diarrhea,Tachycardia NOS
Admission Date:  [**2142-12-15**]              Discharge Date:   [**2143-1-1**]

Date of Birth:  [**2105-6-2**]             Sex:   M

Service: MEDICINE

Allergies:
Codeine / Zosyn

Attending:[**First Name3 (LF) 1148**]
Chief Complaint:
Abdominal pain

Major Surgical or Invasive Procedure:
NG tube placement
PICC line placement
Central line placement
Intubation


History of Present Illness:
Mr. [**Known lastname 1007**] is a 37 year old male with history of idiopathic
pancreatitis who presents from [**Hospital 15405**] with necrotizing
pancreatitis.  He initially presented on [**12-13**] with one day
history of severe abdominal pain/LLQ pain/epigastric pain
radiating to left scrotum.  Also with nausea and dry heaves but
no emesis.  Went to ED for evaluation and found to have elevated
amylase (424 --> 681) and lipase (1245 --> 1154).  CT scan of
abdomen demonstrated significant necrotizing pancreatitis with
significant abnormal pleural fluid.  Patient was hypotensive and
was on dopamine intially but weaned off after recieving
approximately 4L of IVF's over 2 days.  He also become
tachycardic to 170's and was treated with lopressor 5mg IV,
repeated an unclear number of times.  He also had a recurrent
fever (Tm 105) and was hypoxia with O2 sats in low 90's on 6-8L
high flow.  He was seen by gastroenterology and treated with
aldactone 50 [**Hospital1 **] and lasix for ascites and to improve urine
output.  He had been receiving dilaudid 2-4 mg IV Q2H prn for
pain.  Because of the worsening CT scan on [**12-15**] and clinical
deterioration, patient transferred to [**Hospital1 18**] for further
management.

Pt arrived on floor looking comfortable and without respiratory
distress.  Related no abdominal pain d/t pain meds.  No chest
pain, SOB, or other discomforts.  + fevers, no chills.  No URI
sxs, no dysuria.

Past Medical History:
1)Idiopathic Pancreatitis - Seen by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3315**] in [**2134**]
- First in [**2130**] after heavy ETOH, second [**2131**] after a car
accident and light ETOH, another after fatty foods (not ETOH),
another after ERCP (amylase range of 1800-[**2135**], pain relieved by
brief hospitalization).
- ERCP found a normal common bile duct and biliary system but
was unable to cannulate the pancreatic duct.
- MRCP with no pancreatic divisum ([**2134**])
- CF gene negative
2)Kidney Stones
3)GERD
4)UTI
5)Spinal stenosis s/p fusion in [**2123**]
6)HTN
7)Seasonal allergies
8)Ulnar nerve entrapment surgery in [**2132**]

Social History:
+tob, pt states no ETOH recently but told surgery that he drinks
a 6pk of beer a day and told attending 1 br/day on occasion.  no
IVDU. lives at home with wife and 18mnth old child.


Family History:
Non-contributory

Physical Exam:
Gen: sleepy, arousable
Vitals: 101.3, 141/83, 120, 20, 98% on 50%
HEENT: PERRL, EOMI, anicteric sclera, MM dry, OP clear
Neck: supple, no LAD, no thyromegaly
Cardiac: tachy, regular, NL S1 and S2, no MRGs
Lungs: CTAB post, no crackles
Abd: distended, tense, tender in lower quadrants and epigastric,
+ascites and dullness, no caput or spiders, no asterixis, no HSM
Ext: warm, 2+ DP pulses, no C/C/E
Neuro: CN III-XII intact, MAE, alert to person, time, but
thought at [**Hospital3 **]


Pertinent Results:
Laboratory results:
[**2142-12-16**] 03:04AM BLOOD WBC-8.5 RBC-4.34* Hgb-13.1* Hct-38.0*
MCV-88 MCH-30.2 MCHC-34.5 RDW-14.2 Plt Ct-149*
[**2143-1-1**] 05:57AM BLOOD WBC-8.1 RBC-3.60* Hgb-10.6* Hct-31.9*
MCV-89 MCH-29.4 MCHC-33.1 RDW-13.6 Plt Ct-473*
[**2142-12-16**] 03:04AM BLOOD PT-13.5* PTT-36.1* INR(PT)-1.2*
[**2142-12-16**] 03:04AM BLOOD Glucose-153* UreaN-15 Creat-0.5 Na-142
K-4.0 Cl-111* HCO3-27 AnGap-8
[**2143-1-1**] 05:57AM BLOOD Glucose-70 UreaN-13 Creat-0.4* Na-136
K-4.1 Cl-100 HCO3-28 AnGap-12
[**2142-12-16**] 03:04AM BLOOD ALT-28 AST-53* LD(LDH)-472* AlkPhos-51
Amylase-552* TotBili-0.7
[**2143-1-1**] 05:57AM BLOOD ALT-37 AST-22 AlkPhos-244* Amylase-127*
TotBili-0.3
[**2142-12-16**] 03:04AM BLOOD Lipase-628*
[**2143-1-1**] 05:57AM BLOOD Lipase-95*
[**2142-12-16**] 03:04AM BLOOD Albumin-2.7* Calcium-7.4* Phos-1.0*
Mg-1.9
[**2143-1-1**] 05:57AM BLOOD Calcium-8.6 Phos-4.2
[**2142-12-18**] 02:30AM BLOOD VitB12-1299* Folate-11.5
[**2142-12-16**] 08:44PM BLOOD Triglyc-238*

CT scan abd/pelvis ([**2141-12-15**]): Severe pancreatitis, prominent
areas of nonengancement are seen involving the pancreas
suggestion possible necrotic changes (enhancement of head,
protion of tail, patchy through body).  No interval change in
the extensive amount of fluid within the abdomen and pelvis.
Increased amount of pleural fluid.  Liver with fatty
infiltration.  Some minmal fatty sparing surrounding the
gallbladder and gallbladder is minimally dilated.  Low density
foci throughout the spleen.  One or two small stones in left
kidney and rounded hyperdensity in right kidney d/t small cyst.

Brief Hospital Course:
Mr. [**Known lastname 1007**] is a 37 year old male with h/o pancreatitis who
presents with necrotizing pancreatitis, now with delirium
suspected [**1-11**] alcohol withdrawal, although pt and family deny
alcohol use.

1)Necrotizing pancreatitis - 40% necrotized on admission CT scan
to our institution, with preservation of pancreatic head and
tail.  Possible etiologies include ETOH, gallstones (none seen
on admission CT scan), obstruction (ruled-out with RUQ u/s),
hypertriglyceridemia (triglycerides only mildly elevated in
200s), hypercalcemia, drugs (unlikely; pt only taking atenolol
at home), infection, and trauma (no history of trauma). Most
likely ETOH, although patient and his family adamantly deny EtOH
other than a drink at [**Holiday **]. Repeat CT showed overall
improved appearance of pancreas although there is some
organization of pancreatic inflammation.  He was initially kept
NPO with NGT to suction.  He subsequently received post-pyloric
tube feeds while intubated, but pulled out his NGT following
extubation.  As pancreatic enzymes trended downwards and his
clinical status improved, his diet was advanced. He also
completed a 7d course of Meropenem for necrotizing pancreatitis.
Surgery followed him closely throughout his hospital stay.

2)Fevers: Patient presented with persistent fevers throughout
his hospital stay. Daily blood and urine cultures were
unrevealing. Both pancreatitis and withdrawal can cause fever.
Ruled out acalculous cholecystitis with RUQ US. Patient also
presented with diarrhea, but c.diff was negative. He was
empirically started on Flagyl and Zosyn but the latter was
stopped due to development of a rash.

3)Delirium/? ETOH withdrawal:  Per psychiatric evaluation and
high benzodiazepine requirement, acute mental status changes
likely secondary to EtOH withdrawal.  Constellation of symptoms
includes tachycardia, tremulousness, agitation, coupled with a
history of recurrent pancreatitis.  Head CT without intracranial
abnormalities. He was placed on empiric thiamine, folate, and
B12. The patient was intubated electively for airway protection
since he required large doses of sedatives. At time of discharge
his mental status had returned to baseline.

4)Respiratory: On admission, patient was tachypneic despite
large doses of BZDs for withdrawal and as a result, was
electively intubated. He was successfull extubated once his
clinical status improved and his BZD requirement was decreased.
Cxray showed large L pleural effusion, likely secondary to
pancreatitis.

5)Hyperglycemia: Likely new onset diabetes secondary to necrosis
of his pancreatic beta cells.  Now with new insulin requirement
> 100 units per day while on TPN.  He was initially maintained
on insulin gtt with increasing requirements but was transitioned
to a sliding scale as his clinical status improved. He no longer
required insulin at time of discharge.

6)HTN: Patient was started on low dose beta-blocker and was
discharged on Atenolol.

7)FEN: Patient was initially maintained on TPN and tube feeds.
Once he self d/c'ed his NGT his diet was slowly advanced with
help of nutrition. At time of discharge patient was able to
tolerate regular diet without any complications.

Medications on Admission:
Atenolol 50 mg PO QD

Discharge Medications:
1. Atenolol 25 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Necrotizing pancreatitis
Altered mental status
Respiratory failure
Hypertension
Hyperglycemia

Discharge Condition:
Stable


Discharge Instructions:
1)You are scheduled for an appointment with a
gastroenterologist, Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 174**], for follow-up care for
your pancreatitis: [**2143-1-14**] 8:20am

2)Please schedule a follow-up appointment with your PCP [**Name Initial (PRE) 176**] 1
week of your discharge from the hospital.

3)Please take all medications as listed in your discharge
instructions. Your dose of Atenolol has been changed to 25mg
once daily.

4)Please avoid high contents of fat and carbohydrates in your
diet.

5)If you experience fevers, chills, sweats, abdominal pain,
nausea, vomiting, chest pain, shortness of breath or any other
concerning symptoms, please go to the Emergency Room or contact
your PCP [**Name Initial (PRE) 2227**].

Followup Instructions:
Provider: [**First Name4 (NamePattern1) 1386**] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 463**]
Date/Time:[**2143-1-14**] 8:20
{'Acute pancreatitis,Other and unspecified alcohol dependence, unspecified,Alcohol withdrawal,Unspecified pleural effusion,Congestive heart failure, unspecified,Acute respiratory failure,Dehydration,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of urinary calculi,Esophageal reflux,Tobacco use disorder,Long-term (current) use of insulin,Diarrhea,Tachycardia, 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: Abdominal pain

PRESENT ILLNESS: Mr. [**Known lastname 1007**] is a 37 year old male with history of idiopathic
pancreatitis who presents from [**Hospital 15405**] with necrotizing
pancreatitis.  He initially presented on [**12-13**] with one day
history of severe abdominal pain/LLQ pain/epigastric pain
radiating to left scrotum.  Also with nausea and dry heaves but
no emesis.  Went to ED for evaluation and found to have elevated
amylase (424 --> 681) and lipase (1245 --> 1154).  CT scan of
abdomen demonstrated significant necrotizing pancreatitis with
significant abnormal pleural fluid.  Patient was hypotensive and
was on dopamine intially but weaned off after recieving
approximately 4L of IVF's over 2 days.  He also become
tachycardic to 170's and was treated with lopressor 5mg IV,
repeated an unclear number of times.  He also had a recurrent
fever (Tm 105) and was hypoxia with O2 sats in low 90's on 6-8L
high flow.  He was seen by gastroenterology and treated with
aldactone 50 [**Hospital1 **] and lasix for ascites and to improve urine
output.  He had been receiving dilaudid 2-4 mg IV Q2H prn for
pain.  Because of the worsening CT scan on [**12-15**] and clinical
deterioration, patient transferred to [**Hospital1 18**] for further
management.

MEDICAL HISTORY: 1)Idiopathic Pancreatitis - Seen by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3315**] in [**2134**]
- First in [**2130**] after heavy ETOH, second [**2131**] after a car
accident and light ETOH, another after fatty foods (not ETOH),
another after ERCP (amylase range of 1800-[**2135**], pain relieved by
brief hospitalization).
- ERCP found a normal common bile duct and biliary system but
was unable to cannulate the pancreatic duct.
- MRCP with no pancreatic divisum ([**2134**])
- CF gene negative
2)Kidney Stones
3)GERD
4)UTI
5)Spinal stenosis s/p fusion in [**2123**]
6)HTN
7)Seasonal allergies
8)Ulnar nerve entrapment surgery in [**2132**]

MEDICATION ON ADMISSION: Atenolol 50 mg PO QD

ALLERGIES: Codeine / Zosyn

PHYSICAL EXAM: Gen: sleepy, arousable
Vitals: 101.3, 141/83, 120, 20, 98% on 50%
HEENT: PERRL, EOMI, anicteric sclera, MM dry, OP clear
Neck: supple, no LAD, no thyromegaly
Cardiac: tachy, regular, NL S1 and S2, no MRGs
Lungs: CTAB post, no crackles
Abd: distended, tense, tender in lower quadrants and epigastric,
+ascites and dullness, no caput or spiders, no asterixis, no HSM
Ext: warm, 2+ DP pulses, no C/C/E
Neuro: CN III-XII intact, MAE, alert to person, time, but
thought at [**Hospital3 **]

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: +tob, pt states no ETOH recently but told surgery that he drinks
a 6pk of beer a day and told attending 1 br/day on occasion.  no
IVDU. lives at home with wife and 18mnth old child. 

### Response:
{'Acute pancreatitis,Other and unspecified alcohol dependence, unspecified,Alcohol withdrawal,Unspecified pleural effusion,Congestive heart failure, unspecified,Acute respiratory failure,Dehydration,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of urinary calculi,Esophageal reflux,Tobacco use disorder,Long-term (current) use of insulin,Diarrhea,Tachycardia, unspecified'}
