CHIEF COMPLAINT: Aspiration pneumonia
Sepsis

PRESENT ILLNESS: [**Age over 90 **]f with recent pna, hypothyroidism, VVI pacer for bradycardia
and AV block awoke on morning of admit with dyspnea. She'd been
increasingly dyspneic over the past 2-3d before admit. She'd had
no chest discomfort, f/c, or significant cough. In the ED, she
was found to have a WBC of 16.8 with 7%bands so was treated with
levofloxacin; her o2 sat was 87% on ra in ED but rebound to 99%
on 2L-nc. She was found to have 4+ bilateral lower extremity
edema. Chest xray in ED was unchanged from prior with densely
calcified pleura due to fibrothorax. She had one meausre of O2
sat of 99% on 2 L. Her BNP in the ED was found to be 5455 (last
BNP was >6000). She was noted to have elevated WBC of 16 with 7
bands and was given dose of levofloxacin. She was HD stable in
the ED however her UOP has been none to minimal. She was given
dose of dexamethasone in the ED for concern of adrenal
insufficiency.
.
She was admitted to the [**Hospital Unit Name 153**] where she received ceftriaxone and
azithromycin and remained stable throughout the day, so was sent
to the floor. Here, she is frustrated over being ill and having
to be in the hospital, so she'd answer few questions, though
denies pain but does say she remains dyspneic.
.
Patient was recently admitted for SOB and weakness in [**1-16**] and
felt dyspnea could be secondary to PNA. Patient did have CT
chest on prior admission that showed pleural calcifications. At
that admission patient was noted to have B/L LE edema with
negative LENI and felt edema secondary to low albumin.
.
She was doing well on the wards until [**4-2**] when she began to be
hypothermic. Though she had been hypothermic in the ICU with
temperatures in the 95 range, she was more so on the floor with
temps in the 93 axillary range with as low as 91. The team
changed her abx from levoquin to vanc/zosyn for broader coverage
on [**4-2**]. She was also given increased lasix on [**4-2**] (recieved 10
PO and 20 IV at noon). Attempts to warm her were unsuccessful.
Approximately 9:30 PM on [**4-2**], she began to become hypotensive
as well with systolics in the 70's. She was given normal saline
boluses 250 x2 with minimal effect and transferred to the ICU.

MEDICAL HISTORY: 1. Hospitalized 4 years ago for atypical chest pain, no MI
2. Hypothyroidism
3. Anemia, iron deficient
4. VVI Pacemaker [**2116**], for bradycardia and AV block
5. Query seizure disorder
6. s/p pneumothorax after pacemaker.
7. h/o falls
8. recent admission for pna

MEDICATION ON ADMISSION: Levothyroxine 150 mcg PO DAILY
Ferrous Sulfate 325 PO DAILY
Latanoprost 0.005 % Drops Ophthalmic HS
Dorzolamide-Timolol 2-0.5 % Drops One QAM
Brimonidine 0.15 % Drops Ophthalmic [**Hospital1 **]
Levetiracetam 250 mg One PO QHS
Ibuprofen 400 mg One PO Q8H prn
Aspirin 81 mg One PO DAILY (Daily).
Lasix 10 mg PO once a day

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE: t 96.7, bp 130/60, hr 76, rr 16, spo2 96%2l
Pt defers exam
Appears non-tox, in NAD
Breathing without accessory muscle use
Neurologically, she can tell me she's at [**Hospital1 **]-hospital, just came
up from the [**Location (un) **] and that she was in an ICU, and that it's
[**2118**]; she's moving all extrm.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: The patient previously owned a flower store in [**Location (un) 669**]. She
lives in [**Location (un) 9226**] [**Hospital3 **] facility. She was
never married, though has a niece and nephew in the area who are
primary supports. She denies tobacco, ETOH, drugs. Her nephew is
her HCP.
Pneumonitis due to inhalation of food or vomitus,Unspecified septicemia,Severe sepsis,Other convulsions,Hypovolemia,Diastolic heart failure, unspecified,Pleurisy without mention of effusion or current tuberculosis,Unspecified acquired hypothyroidism,Fitting and adjustment of cardiac pacemaker,Iron deficiency anemia, unspecified,Paraphrenia,Edema,Other disorders of plasma protein metabolism,Unspecified hemorrhoids without mention of complication
Food/vomit pneumonitis,Septicemia NOS,Severe sepsis,Convulsions NEC,Hypovolemia,Diastolc hrt failure NOS,Pleurisy w/o effus or TB,Hypothyroidism NOS,Ftng cardiac pacemaker,Iron defic anemia NOS,Paraphrenia,Edema,Dis plas protein met NEC,Hemorrhoids NOS
Admission Date:  [**2118-3-30**]              Discharge Date:   [**2118-4-9**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1148**]
Chief Complaint:
Aspiration pneumonia
Sepsis

Major Surgical or Invasive Procedure:
none

History of Present Illness:
[**Age over 90 **]f with recent pna, hypothyroidism, VVI pacer for bradycardia
and AV block awoke on morning of admit with dyspnea. She'd been
increasingly dyspneic over the past 2-3d before admit. She'd had
no chest discomfort, f/c, or significant cough. In the ED, she
was found to have a WBC of 16.8 with 7%bands so was treated with
levofloxacin; her o2 sat was 87% on ra in ED but rebound to 99%
on 2L-nc. She was found to have 4+ bilateral lower extremity
edema. Chest xray in ED was unchanged from prior with densely
calcified pleura due to fibrothorax. She had one meausre of O2
sat of 99% on 2 L. Her BNP in the ED was found to be 5455 (last
BNP was >6000). She was noted to have elevated WBC of 16 with 7
bands and was given dose of levofloxacin. She was HD stable in
the ED however her UOP has been none to minimal. She was given
dose of dexamethasone in the ED for concern of adrenal
insufficiency.
.
She was admitted to the [**Hospital Unit Name 153**] where she received ceftriaxone and
azithromycin and remained stable throughout the day, so was sent
to the floor. Here, she is frustrated over being ill and having
to be in the hospital, so she'd answer few questions, though
denies pain but does say she remains dyspneic.
.
Patient was recently admitted for SOB and weakness in [**1-16**] and
felt dyspnea could be secondary to PNA. Patient did have CT
chest on prior admission that showed pleural calcifications. At
that admission patient was noted to have B/L LE edema with
negative LENI and felt edema secondary to low albumin.
.
She was doing well on the wards until [**4-2**] when she began to be
hypothermic. Though she had been hypothermic in the ICU with
temperatures in the 95 range, she was more so on the floor with
temps in the 93 axillary range with as low as 91. The team
changed her abx from levoquin to vanc/zosyn for broader coverage
on [**4-2**]. She was also given increased lasix on [**4-2**] (recieved 10
PO and 20 IV at noon). Attempts to warm her were unsuccessful.
Approximately 9:30 PM on [**4-2**], she began to become hypotensive
as well with systolics in the 70's. She was given normal saline
boluses 250 x2 with minimal effect and transferred to the ICU.

Past Medical History:
1. Hospitalized 4 years ago for atypical chest pain, no MI
2. Hypothyroidism
3. Anemia, iron deficient
4. VVI Pacemaker [**2116**], for bradycardia and AV block
5. Query seizure disorder
6. s/p pneumothorax after pacemaker.
7. h/o falls
8. recent admission for pna

Social History:
The patient previously owned a flower store in [**Location (un) 669**]. She
lives in [**Location (un) 9226**] [**Hospital3 **] facility. She was
never married, though has a niece and nephew in the area who are
primary supports. She denies tobacco, ETOH, drugs. Her nephew is
her HCP.

Family History:
Non-contributory

Physical Exam:
PE: t 96.7, bp 130/60, hr 76, rr 16, spo2 96%2l
Pt defers exam
Appears non-tox, in NAD
Breathing without accessory muscle use
Neurologically, she can tell me she's at [**Hospital1 **]-hospital, just came
up from the [**Location (un) **] and that she was in an ICU, and that it's
[**2118**]; she's moving all extrm.


Pertinent Results:
[**2118-3-30**] CXR: Overall unchanged appearance of the chest with
densely calcified pleura due to fibrothorax and right upper lobe
pleural-based density. Evaluation of lung parenchyma is somewhat
limited.
.
[**2118-3-30**] ECG:
Technically difficult study
Ventricular pacing
Pacemaker rhythm - no further analysis
Probable dissociated atrial rhythm, rate 60-70 bpm
Since previous tracing, no significant change
.
[**2118-4-2**] CXR: The patient's head is slumped over resulting in
obscuration of the bilateral apices, right worse than left.
There is also significant rotation. The position of her chin
obscures the previously noted pleural-based entity in the right
apex. Of the visualized lung, most of it is obscured by the
underlying fibrothorax previously described. The aerated left
upper lung is clear.
IMPRESSION: Nearly nondiagnostic examination secondary to
multiple limitations detailed above.
.
[**2118-4-3**] CT CHEST: 1. No pulmonary embolism.
2. Extensive diffuse bilateral calcified pleural plaques and
pleural thickening/loculated pleural fluid causes marked volume
loss of both lungs, right greater than left. Again this is
consistent with exposure. There is some concern for underlying
pleural malignancy with evaluation for enhancing pleural mass
limited by the very early timing of IV contrast.
3. Increase in loculated pleural fluid of the medial right lower
chest and mildly so elsewhere.
4. Multifocal opacities of both lungs are probably mostly due to
scarring and atelectasis, slightly increased. Underlying lung
parenchymal infection cannot be excluded.
5. Moderate hiatal hernia.
.

[**2118-3-30**] 04:00AM   WBC-16.8*# RBC-3.26* HGB-9.0* HCT-28.2*
MCV-87 MCH-27.8 MCHC-32.0 RDW-18.0*
[**2118-3-30**] 04:00AM   NEUTS-72* BANDS-7* LYMPHS-11* MONOS-7 EOS-0
BASOS-0 ATYPS-3* METAS-0 MYELOS-0
[**2118-3-30**] 04:03AM   GLUCOSE-148* LACTATE-1.3 K+-6.2*
[**2118-3-30**] 05:30AM   ALBUMIN-3.1* CALCIUM-9.2 PHOSPHATE-4.1
MAGNESIUM-2.4
[**2118-3-30**] 05:30AM   GLUCOSE-138* UREA N-24* CREAT-0.8 SODIUM-126*
POTASSIUM-5.3* CHLORIDE-93* TOTAL CO2-28 ANION GAP-10
[**2118-4-4**] 04:13AM BLOOD WBC-5.4 RBC-3.14* Hgb-8.8*# Hct-27.0*
MCV-86 MCH-28.0 MCHC-32.5 RDW-18.1* Plt Ct-233
[**2118-4-4**] 04:13AM BLOOD Plt Ct-233
[**2118-4-4**] 04:13AM BLOOD Glucose-87 UreaN-19 Creat-0.8 Na-139
K-3.8 Cl-105 HCO3-27 AnGap-11
[**2118-4-4**] 04:13AM BLOOD Calcium-8.8 Phos-3.2 Mg-2.2

Brief Hospital Course:
[**Age over 90 **] y/o female admitted for shortness of breath.
Hospitalization complicated by need for ICU care for hypothermia
and sepsis.  Sepsis believed secondary to chronic aspiration
leading to pneumonia.  Covered broadly for this.  With advanced
age discussions had with patient and family of overall goals of
care.  All agreed that patient would not want prolonging
measures.  Patient stabilized in ICU with volume resucitation
but decision made not to transfer back to ICU if again became
sick.  Day after transfer to floor patient again hypothermic.
Further discussions agreed to make patient CMO.  Patient made
comfortable, visited by family.  Slowly blood pressure trended
down; antibiotics and other medications stopped and patient
given oral and IV morphine in low dose prn.  Died peacefully of
cardiac arrest.

Medications on Admission:
Levothyroxine 150 mcg PO DAILY
Ferrous Sulfate 325 PO DAILY
Latanoprost 0.005 % Drops Ophthalmic HS
Dorzolamide-Timolol 2-0.5 % Drops One QAM
Brimonidine 0.15 % Drops Ophthalmic [**Hospital1 **]
Levetiracetam 250 mg One PO QHS
Ibuprofen 400 mg One PO Q8H prn
Aspirin 81 mg One PO DAILY (Daily).
Lasix 10 mg PO once a day


Discharge Medications:
None

Discharge Disposition:
Expired

Discharge Diagnosis:
aspiration pneumonia, sepsis


Discharge Condition:
Dead


Discharge Instructions:
Diet:  Speech/swallow recommending soft solid po diet texture
with thin liquids.  Po meds to be given either whole or crushed
in purees, as tolerated.

Followup Instructions:
None
{'Pneumonitis due to inhalation of food or vomitus,Unspecified septicemia,Severe sepsis,Other convulsions,Hypovolemia,Diastolic heart failure, unspecified,Pleurisy without mention of effusion or current tuberculosis,Unspecified acquired hypothyroidism,Fitting and adjustment of cardiac pacemaker,Iron deficiency anemia, unspecified,Paraphrenia,Edema,Other disorders of plasma protein metabolism,Unspecified hemorrhoids without mention of complication'}


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: Aspiration pneumonia
Sepsis

PRESENT ILLNESS: [**Age over 90 **]f with recent pna, hypothyroidism, VVI pacer for bradycardia
and AV block awoke on morning of admit with dyspnea. She'd been
increasingly dyspneic over the past 2-3d before admit. She'd had
no chest discomfort, f/c, or significant cough. In the ED, she
was found to have a WBC of 16.8 with 7%bands so was treated with
levofloxacin; her o2 sat was 87% on ra in ED but rebound to 99%
on 2L-nc. She was found to have 4+ bilateral lower extremity
edema. Chest xray in ED was unchanged from prior with densely
calcified pleura due to fibrothorax. She had one meausre of O2
sat of 99% on 2 L. Her BNP in the ED was found to be 5455 (last
BNP was >6000). She was noted to have elevated WBC of 16 with 7
bands and was given dose of levofloxacin. She was HD stable in
the ED however her UOP has been none to minimal. She was given
dose of dexamethasone in the ED for concern of adrenal
insufficiency.
.
She was admitted to the [**Hospital Unit Name 153**] where she received ceftriaxone and
azithromycin and remained stable throughout the day, so was sent
to the floor. Here, she is frustrated over being ill and having
to be in the hospital, so she'd answer few questions, though
denies pain but does say she remains dyspneic.
.
Patient was recently admitted for SOB and weakness in [**1-16**] and
felt dyspnea could be secondary to PNA. Patient did have CT
chest on prior admission that showed pleural calcifications. At
that admission patient was noted to have B/L LE edema with
negative LENI and felt edema secondary to low albumin.
.
She was doing well on the wards until [**4-2**] when she began to be
hypothermic. Though she had been hypothermic in the ICU with
temperatures in the 95 range, she was more so on the floor with
temps in the 93 axillary range with as low as 91. The team
changed her abx from levoquin to vanc/zosyn for broader coverage
on [**4-2**]. She was also given increased lasix on [**4-2**] (recieved 10
PO and 20 IV at noon). Attempts to warm her were unsuccessful.
Approximately 9:30 PM on [**4-2**], she began to become hypotensive
as well with systolics in the 70's. She was given normal saline
boluses 250 x2 with minimal effect and transferred to the ICU.

MEDICAL HISTORY: 1. Hospitalized 4 years ago for atypical chest pain, no MI
2. Hypothyroidism
3. Anemia, iron deficient
4. VVI Pacemaker [**2116**], for bradycardia and AV block
5. Query seizure disorder
6. s/p pneumothorax after pacemaker.
7. h/o falls
8. recent admission for pna

MEDICATION ON ADMISSION: Levothyroxine 150 mcg PO DAILY
Ferrous Sulfate 325 PO DAILY
Latanoprost 0.005 % Drops Ophthalmic HS
Dorzolamide-Timolol 2-0.5 % Drops One QAM
Brimonidine 0.15 % Drops Ophthalmic [**Hospital1 **]
Levetiracetam 250 mg One PO QHS
Ibuprofen 400 mg One PO Q8H prn
Aspirin 81 mg One PO DAILY (Daily).
Lasix 10 mg PO once a day

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE: t 96.7, bp 130/60, hr 76, rr 16, spo2 96%2l
Pt defers exam
Appears non-tox, in NAD
Breathing without accessory muscle use
Neurologically, she can tell me she's at [**Hospital1 **]-hospital, just came
up from the [**Location (un) **] and that she was in an ICU, and that it's
[**2118**]; she's moving all extrm.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: The patient previously owned a flower store in [**Location (un) 669**]. She
lives in [**Location (un) 9226**] [**Hospital3 **] facility. She was
never married, though has a niece and nephew in the area who are
primary supports. She denies tobacco, ETOH, drugs. Her nephew is
her HCP. 

### Response:
{'Pneumonitis due to inhalation of food or vomitus,Unspecified septicemia,Severe sepsis,Other convulsions,Hypovolemia,Diastolic heart failure, unspecified,Pleurisy without mention of effusion or current tuberculosis,Unspecified acquired hypothyroidism,Fitting and adjustment of cardiac pacemaker,Iron deficiency anemia, unspecified,Paraphrenia,Edema,Other disorders of plasma protein metabolism,Unspecified hemorrhoids without mention of complication'}
