CHIEF COMPLAINT: hypoxia

PRESENT ILLNESS: Ms. [**Known lastname 1256**] is an 88yo woman with metastatic lung cancer who
presents from her nursing home given concern for hypoxia per
report to 77% on RA. The family reports that the patient had
been complaining of feeling cold for the last few days. She has
a pleural catheter in place on the L that was last drained 4
days ago for 550mL of bloody drainage. She has also had some
crusting around her eyes for the last couple of days. She denies
dysuria or increased cough.
She was recently discharged from the hospital on [**2108-2-15**] for
dyspnea. It was at this time that her pulmonary nodules were
further explored and she was diagnosed with metastatic lung
cancer, pulmonary artery thrombus, malignant pleural effusion.
Shortly after discharge, Pleurex catheter was placed. She has
followed up with heme/onc and she and her family have not wanted
to pursue chemotherapy, though plan had been to test for EGFR
activating mutation to see if anti-EGFR therapy would be
helpful.
On arrival to the emergency room her VS were T 99.5 BP 103/46,
HR 84, 97% on RA (with no episodes of hypoxia). However, her BP
dropped several times to the 80s which is well below her
baseline and she received close to 6L of IVFs while there as
well as central line placement, though never on pressors. She
was treated with Vancomycin 1g IV x1 at 1am and Zosyn 4.5mgIV x
1 at midnight.
.
On the floor, she has no complaints and is resting comfortably.
.
Review of sytems:
(+) Per HPI
Denies chest pain, shortness of breath or abdominal pain.

MEDICAL HISTORY: Metastatic lung cancer
-Multiple lung masses and nodules incidentally seen in [**3-/2107**]:
pt did not wish for further oncologic workup at that time, thus
no diagnostic bronchoscopy, biopsies, or PET-CT was performed,
nor did the patient or the patient's family wish for any
treatment at that time.

MEDICATION ON ADMISSION: Colace 200mg po bid
Carvedilol 12.5mg [**Hospital1 **]
Tums
Bethanechol Chloride 5mg po tid prior to meals
Tylenol with codeine 2 tabs q4hr prn
Acetaminophen 650mg po q4hr prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Patient deceased.

FAMILY HISTORY: Son was diagnosed with lung Ca one year ago and
he is currently undergoing chemotherapy.

SOCIAL HISTORY: The patient has never smoked. NO EtOH use.Immigrated from
[**Country 3992**] in [**2094**]. Was a farmer in [**Country 3992**]. Lives with her
children and their families in [**Hospital1 392**], but in a nursing home
since recent discharge. No known environmental exposures
(second-hand smoke, asbestos, arsenic, chromium, or nickel).
Malignant neoplasm of other parts of bronchus or lung,Acute kidney failure with lesion of tubular necrosis,Pleurisy with effusion, with mention of a bacterial cause other than tuberculosis,Empyema without mention of fistula,Secondary malignant neoplasm of bone and bone marrow,Urinary tract infection, site not specified,Acidosis,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Conjunctivitis, unspecified,Hypoxemia,Osteoporosis, unspecified,Anemia, unspecified,Spinal stenosis, unspecified region,Retention of urine, unspecified,Thrombocytopenia, unspecified,Personal history of venous thrombosis and embolism
Mal neo bronch/lung NEC,Ac kidny fail, tubr necr,Bact pleur/effus not TB,Empyema w/o fistula,Secondary malig neo bone,Urin tract infection NOS,Acidosis,Klebsiella pneumoniae,Conjunctivitis NOS,Hypoxemia,Osteoporosis NOS,Anemia NOS,Spinal stenosis NOS,Retention urine NOS,Thrombocytopenia NOS,Hx-ven thrombosis/embols
Admission Date:  [**2108-4-9**]              Discharge Date:   [**2108-4-19**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2009**]
Chief Complaint:
hypoxia

Major Surgical or Invasive Procedure:
none


History of Present Illness:
Ms. [**Known lastname 1256**] is an 88yo woman with metastatic lung cancer who
presents from her nursing home given concern for hypoxia per
report to 77% on RA. The family reports that the patient had
been complaining of feeling cold for the last few days. She has
a pleural catheter in place on the L that was last drained 4
days ago for 550mL of bloody drainage. She has also had some
crusting around her eyes for the last couple of days. She denies
dysuria or increased cough.
She was recently discharged from the hospital on [**2108-2-15**] for
dyspnea. It was at this time that her pulmonary nodules were
further explored and she was diagnosed with metastatic lung
cancer, pulmonary artery thrombus, malignant pleural effusion.
Shortly after discharge, Pleurex catheter was placed. She has
followed up with heme/onc and she and her family have not wanted
to pursue chemotherapy, though plan had been to test for EGFR
activating mutation to see if anti-EGFR therapy would be
helpful.
On arrival to the emergency room her VS were T 99.5 BP 103/46,
HR 84, 97% on RA (with no episodes of hypoxia). However, her BP
dropped several times to the 80s which is well below her
baseline and she received close to 6L of IVFs while there as
well as central line placement, though never on pressors. She
was treated with Vancomycin 1g IV x1 at 1am and Zosyn 4.5mgIV x
1 at midnight.
.
On the floor, she has no complaints and is resting comfortably.
.
Review of sytems:
(+) Per HPI
Denies chest pain, shortness of breath or abdominal pain.

Past Medical History:
Metastatic lung cancer
-Multiple lung masses and nodules incidentally seen in [**3-/2107**]:
pt did not wish for further oncologic workup at that time, thus
no diagnostic bronchoscopy, biopsies, or PET-CT was performed,
nor did the patient or the patient's family wish for any
treatment at that time.

Hypertension
Spinal stenosis
L3 compression fracture
Urinary retention
Anemia
Osteoporosis


Social History:
The patient has never smoked. NO EtOH use.Immigrated from
[**Country 3992**] in [**2094**]. Was a farmer in [**Country 3992**]. Lives with her
children and their families in [**Hospital1 392**], but in a nursing home
since recent discharge. No known environmental exposures
(second-hand smoke, asbestos, arsenic, chromium, or nickel).

Family History:
Son was diagnosed with lung Ca one year ago and
he is currently undergoing chemotherapy.

Physical Exam:
Patient deceased.

Pertinent Results:
[**2108-4-12**] 05:43AM BLOOD WBC-8.1 RBC-3.92* Hgb-9.7* Hct-30.2*
MCV-77* MCH-24.8* MCHC-32.3 RDW-17.5* Plt Ct-30*
[**2108-4-9**] 04:17PM BLOOD Glucose-79 UreaN-11 Creat-0.6 Na-137
K-3.6 Cl-109* HCO3-19* AnGap-13
[**2108-4-11**] 06:20AM BLOOD Glucose-66* UreaN-29* Creat-2.3*# Na-135
K-4.1 Cl-108 HCO3-16* AnGap-15
[**2108-4-12**] 05:43AM BLOOD Glucose-84 UreaN-37* Creat-3.4*# Na-133
K-4.4 Cl-108 HCO3-16* AnGap-13
[**2108-4-12**] 08:47PM URINE Blood-LG Nitrite-NEG Protein-100
Glucose-70 Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.5 Leuks-TR
[**2108-4-12**] 08:47PM URINE RBC-243* WBC-12* Bacteri-FEW Yeast-NONE
Epi-0

Micro:
[**2108-4-9**] PLEURAL FLUID GRAM STAIN-FINAL; FLUID CULTURE-FINAL
{PROBABLE MICROCOCCUS SPECIES}; ANAEROBIC CULTURE-FINAL
	INPATIENT
[**2108-4-9**] MRSA SCREEN 	MRSA SCREEN-FINAL 	INPATIENT
[**2108-4-9**] URINE CULTURE-FINAL {KLEBSIELLA PNEUMONIAE}
[**2108-4-8**] BLOOD CULTURE, Routine-FINAL
[**2108-4-8**] BLOOD CULTURE, Routine-FINAL

Brief Hospital Course:
88 yo Chinese speaking female with uncurable stage IV lung
cancer with malignant pleural effusions with Pleurex catheters,
was initially admitted to the ICU with worsening SOB which
improved with Pleurex drainage. Pt was also found to have
infected pleural effusion with GPC's, and a UTI with klebsiella.
She was initially treated with IV antibiotics. Pt also developed
ATN with anuria and progressive renal failure. Platelet count
dropped precipitously as well; PLT count was originally approx
350 but this rapidly dropped to 30. Etiology of this is unclear.
There was initially concern about possible HIT, so heparin was
d/c'd and HIT screen sent, which returned negative. DIC labs
were sent, but these were not suggestive of DIC.  The patient
had multiple organ systems failing, with multiple critical
issues, in the setting of incurable lung cancer. A long
discussion was held with her family on [**4-12**] via interpreter, and
there was concensus that pt would not want aggressive care;
comfort care only was pursued.

Antibiotics were stopped, dialysis was not considered further,
and lab draws were stopped.  The patient's symptoms were
addressed with medications to dry oral secretions for improved
respiratory comfort, her pleurex catheter was drained daily
initially, and then every other day once the drainage decreased,
and she was started on a fentanyl patch to treat her L chest
pain at the site of the pleurex.

She remained anuric, and did not take anything by mouth.  She
became increasingly somnolent, likely due to her renal failure,
and she passed away peacefully on [**4-19**].  Family was at bedside,
PCP notified, declined autopsy.

Medications on Admission:
Colace 200mg po bid
Carvedilol 12.5mg [**Hospital1 **]
Tums
Bethanechol Chloride 5mg po tid prior to meals
Tylenol with codeine 2 tabs q4hr prn
Acetaminophen 650mg po q4hr prn

Discharge Medications:
None

Discharge Disposition:
Expired

Discharge Diagnosis:
# Stage IV lung cancer with malignant pleural effusions
# Infected pleural effusion
# Acute renal failure, ATN, anuria
# Thrombocytopenia, NOS
# Urinary tract infection


Discharge Condition:
deceased


Discharge Instructions:
Patient was admitted with increased shortness of breath from her
terminal lung cancer.  Her pleurex catheter was drained with
improvement in her symptoms, but she was found to be very ill
with multiple serious medical problems with very little chance
of surviving.  After discussion with the family, it was decided
that the patient would would not want aggressive care, and
treatment was focused on comfort.  She passed away peacefully on
[**4-19**].

Followup Instructions:
deceased
{"Malignant neoplasm of other parts of bronchus or lung,Acute kidney failure with lesion of tubular necrosis,Pleurisy with effusion, with mention of a bacterial cause other than tuberculosis,Empyema without mention of fistula,Secondary malignant neoplasm of bone and bone marrow,Urinary tract infection, site not specified,Acidosis,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Conjunctivitis, unspecified,Hypoxemia,Osteoporosis, unspecified,Anemia, unspecified,Spinal stenosis, unspecified region,Retention of urine, unspecified,Thrombocytopenia, unspecified,Personal history of venous thrombosis and embolism"}


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: hypoxia

PRESENT ILLNESS: Ms. [**Known lastname 1256**] is an 88yo woman with metastatic lung cancer who
presents from her nursing home given concern for hypoxia per
report to 77% on RA. The family reports that the patient had
been complaining of feeling cold for the last few days. She has
a pleural catheter in place on the L that was last drained 4
days ago for 550mL of bloody drainage. She has also had some
crusting around her eyes for the last couple of days. She denies
dysuria or increased cough.
She was recently discharged from the hospital on [**2108-2-15**] for
dyspnea. It was at this time that her pulmonary nodules were
further explored and she was diagnosed with metastatic lung
cancer, pulmonary artery thrombus, malignant pleural effusion.
Shortly after discharge, Pleurex catheter was placed. She has
followed up with heme/onc and she and her family have not wanted
to pursue chemotherapy, though plan had been to test for EGFR
activating mutation to see if anti-EGFR therapy would be
helpful.
On arrival to the emergency room her VS were T 99.5 BP 103/46,
HR 84, 97% on RA (with no episodes of hypoxia). However, her BP
dropped several times to the 80s which is well below her
baseline and she received close to 6L of IVFs while there as
well as central line placement, though never on pressors. She
was treated with Vancomycin 1g IV x1 at 1am and Zosyn 4.5mgIV x
1 at midnight.
.
On the floor, she has no complaints and is resting comfortably.
.
Review of sytems:
(+) Per HPI
Denies chest pain, shortness of breath or abdominal pain.

MEDICAL HISTORY: Metastatic lung cancer
-Multiple lung masses and nodules incidentally seen in [**3-/2107**]:
pt did not wish for further oncologic workup at that time, thus
no diagnostic bronchoscopy, biopsies, or PET-CT was performed,
nor did the patient or the patient's family wish for any
treatment at that time.

MEDICATION ON ADMISSION: Colace 200mg po bid
Carvedilol 12.5mg [**Hospital1 **]
Tums
Bethanechol Chloride 5mg po tid prior to meals
Tylenol with codeine 2 tabs q4hr prn
Acetaminophen 650mg po q4hr prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Patient deceased.

FAMILY HISTORY: Son was diagnosed with lung Ca one year ago and
he is currently undergoing chemotherapy.

SOCIAL HISTORY: The patient has never smoked. NO EtOH use.Immigrated from
[**Country 3992**] in [**2094**]. Was a farmer in [**Country 3992**]. Lives with her
children and their families in [**Hospital1 392**], but in a nursing home
since recent discharge. No known environmental exposures
(second-hand smoke, asbestos, arsenic, chromium, or nickel). 

### Response:
{"Malignant neoplasm of other parts of bronchus or lung,Acute kidney failure with lesion of tubular necrosis,Pleurisy with effusion, with mention of a bacterial cause other than tuberculosis,Empyema without mention of fistula,Secondary malignant neoplasm of bone and bone marrow,Urinary tract infection, site not specified,Acidosis,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Conjunctivitis, unspecified,Hypoxemia,Osteoporosis, unspecified,Anemia, unspecified,Spinal stenosis, unspecified region,Retention of urine, unspecified,Thrombocytopenia, unspecified,Personal history of venous thrombosis and embolism"}
