CHIEF COMPLAINT: Hypoglycemia

PRESENT ILLNESS: Ms. [**Known lastname 68459**] is a 49 year old female with history of Hep C
Cirrhosis, currently listed for transplant with history of
previous decompensation in way of encephalopathy and ascites
requiring TIPS, with additional med history pertinent for
secondary adrenal insufficiency, and DM who now presents from
her chronic care facility. The patient was found unresponsive
yesterday a.m. with fingerstick at that time of 8 and question
of seizure activity at that time. The patient was transported to
[**Hospital3 **] where a CT Head was performed without evidence of
bleed or acute intracranial pathology. The patient was
transferred to [**Hospital1 18**] for further care.
.
ED Course: In the ED vitals were 94.2 HR-81 BP- 110/55 RR: 20
O2: 100% NRB. The patient has labs performed revealing no
leukocytosis or bandemia. A CXR was performed revealing for new
RLL consolidation. A [**Name (NI) 5283**] sono and abdominal ultrasound was
performed revealing no ascites present. Fingerstick was 142. The
patient received Levo/Zosyn/Vanc and is now transferred to the
ICU for ongoing monitoring and care.
.
Patient being transferred to [**Doctor Last Name 3271**] [**Doctor Last Name **] service, upon
questioning patient is sleepy but arousable. She reports some
back pain which is her baseline but otherwise has little
complaints. On questioning she reports her breathing is
comfortable, has been coughing little more than usual green
sputum. She took 32 units of Glargine 2 nights ago per her usual
regimen, reports she ate meals that night. She does not recall
the exact events surrounding her event this a.m. and altered
mental status. She was put on vanc and unasyn for consideration
aspiration and ha-pna. Also put on stress dose steroids.
Baseline bp 100-110. Stress dose steroids initially 50 q6 and
decreased to 25 q6 currently.
.
On admit to the floor pt. near baseline mental status. Has NG
tube and getting lactulose--> stooling a lot. HD stable and
transferred to floor.

MEDICAL HISTORY: # HCV cirrhosis:
- complicated by encephalopathy, thrombocytopenia, ascites and
hydrothorax.
- s/p TIPS [**11-9**] for ascites
- currently On transplant list
#. Hyponatremia baseline 128-133
#. Secondary Adrenal insufficiency: should receive stress dosed
steroids when appropriate
- microadenoma on MRI, prolactin elevated
#. Asthma
#. DM
#. GERD
#. Anxiety
#. Recent ICU admission with intubation thought [**1-7**]
transfusion-related acute lung injury. Led to prolonged ICU stay
then rehab. Also treated for PNA
#. h/o UTIs
#. Hip fx and L4 compression fx on [**2157-11-6**] s/p ORIF of hip fx

MEDICATION ON ADMISSION: Lactulose 30 ml QID
Rifaximin 400 mg TID
Aldactone 25mg Daily
Lasix 40 mg [**Hospital1 **]
Lantus insulin 36 units qhs
Humulog sliding scale as needed
Singulair 10mg Daily
Fluticasone 1 puff [**Hospital1 **]
Albuterol 1-2 puffs q4
Combivent inhaler 2 puffs QID
Prednisone 5 mg Daily
Multivitamin 1 tab Daily
Folic acid 1 mg Daily
Protonix 40mg [**Hospital1 **]
Vitamin D 50,000 units qWk
Calcium citrate 950 mg TID
Morphine Sulfate 15 mg Daily
Oxycodone 5 mg q6h
Lidoderm 5% patch as needed

ALLERGIES: Shellfish / Flexeril / Tricyclic Compounds

PHYSICAL EXAM: VITALS: 97.1 122/56 88 18 97% on RA
GEN: Patient is a middle aged female, appears older than stated
age, jaundiced skin. Patient is lethargic but arousable, answers
questions but need to keep awakening to hold attention. Oriented
to person place and year. Knows why she is here.
HEENT: NCAT, EOMI, sclera icteric. PERRL, OP clear, NGT in place

FAMILY HISTORY: Mother w/ DM2, HTN, and hyperlipidemia.
Father w/ COPD and EtOH cirrhosis

SOCIAL HISTORY: The patient is single with one child, she currently lives in a
chronic care facility, [**Hospital1 **] [**Hospital1 3894**] Nursing Facility in [**Location (un) 29158**]. She is currently on disability, formerly a waitress.
Illicits: Past IV drug use with needle sharing, last use 7 years
ago. Past drug-snorting.
Alcohol: Past alcohol use, last drink at age 46.
Tobacco: Past [**Location (un) 1818**] with 10 pack-year history
Pneumonia, organism unspecified,Unspecified viral hepatitis C with hepatic coma,Other adrenal hypofunction,Hyposmolality and/or hyponatremia,Unspecified protein-calorie malnutrition,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Cirrhosis of liver without mention of alcohol,Asthma, unspecified type, unspecified,Depressive disorder, not elsewhere classified,Esophageal reflux,Awaiting organ transplant status,Other chronic pain,Backache, unspecified
Pneumonia, organism NOS,Hpt C w hepatic coma NOS,Adrenal hypofunction NEC,Hyposmolality,Protein-cal malnutr NOS,DMII oth nt st uncntrld,Long-term use of insulin,Cirrhosis of liver NOS,Asthma NOS,Depressive disorder NEC,Esophageal reflux,Await organ transplnt st,Chronic pain NEC,Backache NOS
Admission Date:  [**2158-2-27**]              Discharge Date:   [**2158-3-6**]

Date of Birth:  [**2109-1-23**]             Sex:   F

Service: MEDICINE

Allergies:
Shellfish / Flexeril / Tricyclic Compounds

Attending:[**First Name3 (LF) 12174**]
Chief Complaint:
Hypoglycemia

Major Surgical or Invasive Procedure:
none

History of Present Illness:
Ms. [**Known lastname 68459**] is a 49 year old female with history of Hep C
Cirrhosis, currently listed for transplant with history of
previous decompensation in way of encephalopathy and ascites
requiring TIPS, with additional med history pertinent for
secondary adrenal insufficiency, and DM who now presents from
her chronic care facility. The patient was found unresponsive
yesterday a.m. with fingerstick at that time of 8 and question
of seizure activity at that time. The patient was transported to
[**Hospital3 **] where a CT Head was performed without evidence of
bleed or acute intracranial pathology. The patient was
transferred to [**Hospital1 18**] for further care.
.
ED Course: In the ED vitals were 94.2 HR-81 BP- 110/55 RR: 20
O2: 100% NRB. The patient has labs performed revealing no
leukocytosis or bandemia. A CXR was performed revealing for new
RLL consolidation. A [**Name (NI) 5283**] sono and abdominal ultrasound was
performed revealing no ascites present. Fingerstick was 142. The
patient received Levo/Zosyn/Vanc and is now transferred to the
ICU for ongoing monitoring and care.
.
Patient being transferred to [**Doctor Last Name 3271**] [**Doctor Last Name **] service, upon
questioning patient is sleepy but arousable. She reports some
back pain which is her baseline but otherwise has little
complaints. On questioning she reports her breathing is
comfortable, has been coughing little more than usual green
sputum. She took 32 units of Glargine 2 nights ago per her usual
regimen, reports she ate meals that night. She does not recall
the exact events surrounding her event this a.m. and altered
mental status. She was put on vanc and unasyn for consideration
aspiration and ha-pna. Also put on stress dose steroids.
Baseline bp 100-110. Stress dose steroids initially 50 q6 and
decreased to 25 q6 currently.
.
On admit to the floor pt. near baseline mental status. Has NG
tube and getting lactulose--> stooling a lot. HD stable and
transferred to floor.


Past Medical History:
# HCV cirrhosis:
- complicated by encephalopathy, thrombocytopenia, ascites and
hydrothorax.
- s/p TIPS [**11-9**] for ascites
- currently On transplant list
#. Hyponatremia baseline 128-133
#. Secondary Adrenal insufficiency: should receive stress dosed
steroids when appropriate
- microadenoma on MRI, prolactin elevated
#. Asthma
#. DM
#. GERD
#. Anxiety
#. Recent ICU admission with intubation thought [**1-7**]
transfusion-related acute lung injury. Led to prolonged ICU stay
then rehab. Also treated for PNA
#. h/o UTIs
#. Hip fx and L4 compression fx on [**2157-11-6**] s/p ORIF of hip fx


Social History:
The patient is single with one child, she currently lives in a
chronic care facility, [**Hospital1 **] [**Hospital1 3894**] Nursing Facility in [**Location (un) 29158**]. She is currently on disability, formerly a waitress.
Illicits: Past IV drug use with needle sharing, last use 7 years
ago. Past drug-snorting.
Alcohol: Past alcohol use, last drink at age 46.
Tobacco: Past [**Location (un) 1818**] with 10 pack-year history


Family History:
Mother w/ DM2, HTN, and hyperlipidemia.
Father w/ COPD and EtOH cirrhosis


Physical Exam:
VITALS: 97.1 122/56 88 18 97% on RA
GEN: Patient is a middle aged female, appears older than stated
age, jaundiced skin. Patient is lethargic but arousable, answers
questions but need to keep awakening to hold attention. Oriented
to person place and year. Knows why she is here.
HEENT: NCAT, EOMI, sclera icteric. PERRL, OP clear, NGT in place

NECK: JVP wnl
LUNGS: Relatively clear anteriorly, bibasilar crackles
Cor: II/VI SEM loudest at apex
ABD: Obese, soft, nt/nd, bs+, live tip palpable just below
costal margin. spleen tip not palpable
EXT: 1+ LE non pitting edema to knees, mild diffuse erythema
likely secondary to venous stasis


Pertinent Results:
[**2-27**] CXR

IMPRESSION: AP chest compared to [**2-27**] and [**2157-11-10**]:

Moderate cardiomegaly has increased since [**Month (only) 1096**]. Elevation of
the left hemidiaphragm and ipsilateral basal atelectasis are
stable. Increased opacification at the right lung base could be
dependent edema but is concerning for pneumonia, unchanged since
[**59**]:07 a.m. Small right pleural effusion is probably present.
Nasogastric tube ends in the stomach, which is distended with
air.
--------------------
[**3-3**] CXR

FINDINGS: In comparison with the study of [**2-27**], the patient has
taken a somewhat better inspiration. Continued fullness of
pulmonary vessels is consistent with overhydration and increased
pulmonary venous pressure. There is increased opacification at
both bases, consistent with pleural fluid and atelectatic
change. The nasogastric tube has been removed.
[**3-5**] u/s

LEFT UPPER EXTREMITY ULTRASOUND: Grayscale and color Doppler
son[**Name (NI) 1417**] of the left internal jugular, subclavian, axillary,
brachial, and basilic veins was performed. The cephalic vein was
not visualized. In the visualized veins there was normal flow,
augmentation, compressibility, and waveforms demonstrated. No
intraluminal thrombus was identified.

IMPRESSION: No evidence of left upper extremity deep vein
thrombosis. Cephalic vein not seen.
d/c labs

[**2158-3-6**] 04:23AM BLOOD WBC-4.6 RBC-2.94* Hgb-10.2* Hct-30.0*
MCV-102* MCH-34.6* MCHC-33.9 RDW-19.3* Plt Ct-30*
[**2158-3-6**] 04:23AM BLOOD Glucose-86 UreaN-13 Creat-0.6 Na-134
K-4.1 Cl-99 HCO3-31 AnGap-8
[**2158-3-6**] 04:23AM BLOOD ALT-36 AST-64* LD(LDH)-274* AlkPhos-214*
TotBili-6.4*
[**2158-3-6**] 04:23AM BLOOD Calcium-7.9* Phos-3.7 Mg-1.5*

Brief Hospital Course:
A/P: 49 y/o F h/o HCV cirrhosis, currently on transplant list,
who presented with unresponsive episode and ? seizure episode 2
days prior in setting of hypoglycemia to 8, found to have RLL
consolidation identified on CXR c/w pneumonia. Currently
patient's mental status back at baseline.
.
# Altered mental status

Long h/o admissions for somnolence secondary to hepatic
encephalopathy although more likely etiology this admission
would be hypoglycemia given documented low blood sugar in
combination with underlying hepatic encephalopathy. Etiology for
hypoglycemia itself not clear given no change in meds, diet,
hepatic function. Possibly related to underlying pneumonia and
adrenal insufficiency. Her mental status was back to baseline at
time of discharge, alert and oriented times three. She is to
continue with lactulose and rifaximin for hepatic
encephalopathy.
.

#. DM

Patient was previously on Lantus 36 units. She was placed on
sliding scale to determine her insulin requirements. She had no
hypoglycemic episodes as an inpatient. Her dose of Lantus was 34
units at the time of discharge and her fingersticks were running
between 70-180. Of note she has been on a strict diabetic and
low sodium diet so her Lantus requirements may need to be
increased at her rehab facility. She is on a Humalog insulin
sliding scale.
.

# PNA

RLL consolidation, clinically afebrile without leukocytosis.
Given chronic illness and aspiration risk was treated with
Unasyn and Vancomycin given she came from a chronic care
facility. PICC line placed for full 10 day course. Urine
legionella negative, unable to provide sputum, blood cx NGTD.
She will need to complete 2 more days of antibiotics at rehab.
She should have a follow up CXR in 4 weeks to document
resolution.
.

# Depression and Chronic back pain

Psychiatry consulted to manage her depression related to
component of pain and long wait for her liver transplant. She
was started on venlafaxine. Chronic pain service evaluated her
and continued her oxycodone, started Neurontin 300 mg QHS
increase as tolerated every 5-7 days to 300mg TID. Continued
Lidoderm patches to low back area. PT for core strength and
endurance. Tizanidine for sleep and spasm Start at 1 mg po QHS.
Would benefit from Pain Psychologist/ Psychiatry follow up to
address depression and further psychological treatment options
as CBT and Biofeedback.
.

# HCV Cirrhosis

s/p TIPS [**11-9**] c/b hydrothorax, encephalopathy, ascites,
thrombocytopenia. On transplant list, placed back on diuretics
which were initally held. She was discharged on furosemide 40mg
[**Hospital1 **] and spironolactone 100mg daily.  Her lactulose and rifaximin
were continued. Electrolytes should be checked in 3 days given
spironolactone was increased to 100mg daily at the time of
discharge. Weekly labs are to be drawn and faxed to [**First Name8 (NamePattern2) 1022**] [**Last Name (NamePattern1) **]
at [**Telephone/Fax (1) 697**] and should include CBC, [**Name (NI) 53324**], PT/INR, CHEM 7.

.
# Adrenal insufficiency

Received stress dose steroids and was tapered back to prednisone
5mg daily.
.

# Osteoporosis

Continued vitamin D and calcium citrate. History of fractures.
.


# Asthma

Continued Singulair, Albuterol/Ipratropium
.

# Code: Full, HCP Mother [**Name (NI) 2048**] [**Name (NI) 68659**] [**Telephone/Fax (1) 68660**]


Medications on Admission:
Lactulose 30 ml QID
Rifaximin 400 mg TID
Aldactone 25mg Daily
Lasix 40 mg [**Hospital1 **]
Lantus insulin 36 units qhs
Humulog sliding scale as needed
Singulair 10mg Daily
Fluticasone 1 puff [**Hospital1 **]
Albuterol 1-2 puffs q4
Combivent inhaler 2 puffs QID
Prednisone 5 mg Daily
Multivitamin 1 tab Daily
Folic acid 1 mg Daily
Protonix 40mg [**Hospital1 **]
Vitamin D 50,000 units qWk
Calcium citrate 950 mg TID
Morphine Sulfate 15 mg Daily
Oxycodone 5 mg q6h
Lidoderm 5% patch as needed


Discharge Medications:
1. Lactulose 10 gram/15 mL Syrup [**Hospital1 **]: Thirty (30) ML PO QID (4
times a day): titrate to 4 bm daily.
2. Rifaximin 200 mg Tablet [**Hospital1 **]: Two (2) Tablet PO TID (3 times a
day).
3. Furosemide 40 mg Tablet [**Hospital1 **]: One (1) Tablet PO BID (2 times a
day).
4. Insulin Glargine 100 unit/mL Cartridge [**Hospital1 **]: Twenty Four (24)
units Subcutaneous at bedtime.
5. Humalog 100 unit/mL Cartridge [**Hospital1 **]: One (1)  Subcutaneous as
directed: sliding scale.
6. Montelukast 10 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY
(Daily).
7. Fluticasone 110 mcg/Actuation Aerosol [**Hospital1 **]: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
8. Albuterol Sulfate 2.5 mg/3 mL Solution for Nebulization [**Hospital1 **]:
One (1)  Inhalation Q6H (every 6 hours) as needed.
9. Combivent 18-103 mcg/Actuation Aerosol [**Hospital1 **]: Two (2) puffs
Inhalation four times a day.
10. Prednisone 5 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY (Daily).

11. Hexavitamin     Tablet [**Hospital1 **]: One (1) Cap PO DAILY (Daily).
12. Folic Acid 1 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY (Daily).

13. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) [**Hospital1 **]: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
14. Ergocalciferol (Vitamin D2) 50,000 unit Capsule [**Hospital1 **]: One (1)
Capsule PO MONDAY AND WEDNESDAY ().
15. Calcium Citrate 950 mg Tablet [**Hospital1 **]: One (1) Tablet PO three
times a day.
16. Oxycodone 5 mg Tablet [**Hospital1 **]: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
17. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated [**Hospital1 **]:
One (1) Adhesive Patch, Medicated Topical DAILY (Daily).
18. Venlafaxine 37.5 mg Capsule, Sust. Release 24 hr [**Hospital1 **]: One
(1) Capsule, Sust. Release 24 hr PO DAILY (Daily).
19. Gabapentin 300 mg Capsule [**Hospital1 **]: One (1) Capsule PO HS (at
bedtime).
20. Tizanidine 2 mg Tablet [**Hospital1 **]: 0.5 Tablet PO QHS (once a day
(at bedtime)).
21. Spironolactone 100 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY
(Daily).
22. Vancomycin in Dextrose 1 gram/200 mL Piggyback [**Hospital1 **]: One (1)
Intravenous Q 12H (Every 12 Hours) for 2 days.
23. Ampicillin-Sulbactam 3 gram Recon Soln [**Hospital1 **]: One (1) Recon
Soln Injection Q8H (every 8 hours) for 2 days.


Discharge Disposition:
Extended Care

Facility:
[**Hospital 5503**] Rehabilitation

Discharge Diagnosis:
[**Hospital **]
Hospital acquired pneumonia
HCV cirrhosis
Hepatic encephalopathy
Diabetes mellitus type II


Discharge Condition:
Stable, alert and oriented times 3

Discharge Instructions:
You were admitted with low sugar causing you to be confused. You
were treated for pneumonia. You were seen by psychiatry and the
pain service to help manage your pain and depression. You were
started on new medications to help with your depression and pain
(venlafaxine, gabapentine, tizanidine). You are neing discharged
to a rehab facility to regain your strength by working with
physical therapy.

You have follow up scheduled with Dr. [**Last Name (STitle) 497**].

You will need to have follow up with psychiatry and pain center.
The numbers to the clinics are in your discharge paper work.

Followup Instructions:
Provider: [**Name10 (NameIs) **] [**Name8 (MD) **], MD Phone:[**Telephone/Fax (1) 673**]
Date/Time:[**2158-3-22**] 9:00

Provider: [**Name10 (NameIs) **] [**Name8 (MD) **], MD Phone:[**Telephone/Fax (1) 673**]
Date/Time:[**2158-4-11**] 3:30

Provider: [**Name10 (NameIs) 21503**] [**Name11 (NameIs) **], MD Phone:[**Telephone/Fax (1) 1803**]
Date/Time:[**2158-4-11**] 2:40

Provider: [**Name10 (NameIs) 706**] Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2158-4-20**] 1:00

Call ([**Telephone/Fax (1) 24780**] to schedule a follow up appointment with
psychiatry, you were seen by Dr. [**Last Name (STitle) 16293**].

Call ([**Telephone/Fax (1) 30702**] to schedule a follow up with [**Doctor First Name **] P.
[**First Name4 (NamePattern1) 1193**] [**Last Name (NamePattern1) 1194**] Management Center
{'Pneumonia, organism unspecified,Unspecified viral hepatitis C with hepatic coma,Other adrenal hypofunction,Hyposmolality and/or hyponatremia,Unspecified protein-calorie malnutrition,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Cirrhosis of liver without mention of alcohol,Asthma, unspecified type, unspecified,Depressive disorder, not elsewhere classified,Esophageal reflux,Awaiting organ transplant status,Other chronic pain,Backache, 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: Hypoglycemia

PRESENT ILLNESS: Ms. [**Known lastname 68459**] is a 49 year old female with history of Hep C
Cirrhosis, currently listed for transplant with history of
previous decompensation in way of encephalopathy and ascites
requiring TIPS, with additional med history pertinent for
secondary adrenal insufficiency, and DM who now presents from
her chronic care facility. The patient was found unresponsive
yesterday a.m. with fingerstick at that time of 8 and question
of seizure activity at that time. The patient was transported to
[**Hospital3 **] where a CT Head was performed without evidence of
bleed or acute intracranial pathology. The patient was
transferred to [**Hospital1 18**] for further care.
.
ED Course: In the ED vitals were 94.2 HR-81 BP- 110/55 RR: 20
O2: 100% NRB. The patient has labs performed revealing no
leukocytosis or bandemia. A CXR was performed revealing for new
RLL consolidation. A [**Name (NI) 5283**] sono and abdominal ultrasound was
performed revealing no ascites present. Fingerstick was 142. The
patient received Levo/Zosyn/Vanc and is now transferred to the
ICU for ongoing monitoring and care.
.
Patient being transferred to [**Doctor Last Name 3271**] [**Doctor Last Name **] service, upon
questioning patient is sleepy but arousable. She reports some
back pain which is her baseline but otherwise has little
complaints. On questioning she reports her breathing is
comfortable, has been coughing little more than usual green
sputum. She took 32 units of Glargine 2 nights ago per her usual
regimen, reports she ate meals that night. She does not recall
the exact events surrounding her event this a.m. and altered
mental status. She was put on vanc and unasyn for consideration
aspiration and ha-pna. Also put on stress dose steroids.
Baseline bp 100-110. Stress dose steroids initially 50 q6 and
decreased to 25 q6 currently.
.
On admit to the floor pt. near baseline mental status. Has NG
tube and getting lactulose--> stooling a lot. HD stable and
transferred to floor.

MEDICAL HISTORY: # HCV cirrhosis:
- complicated by encephalopathy, thrombocytopenia, ascites and
hydrothorax.
- s/p TIPS [**11-9**] for ascites
- currently On transplant list
#. Hyponatremia baseline 128-133
#. Secondary Adrenal insufficiency: should receive stress dosed
steroids when appropriate
- microadenoma on MRI, prolactin elevated
#. Asthma
#. DM
#. GERD
#. Anxiety
#. Recent ICU admission with intubation thought [**1-7**]
transfusion-related acute lung injury. Led to prolonged ICU stay
then rehab. Also treated for PNA
#. h/o UTIs
#. Hip fx and L4 compression fx on [**2157-11-6**] s/p ORIF of hip fx

MEDICATION ON ADMISSION: Lactulose 30 ml QID
Rifaximin 400 mg TID
Aldactone 25mg Daily
Lasix 40 mg [**Hospital1 **]
Lantus insulin 36 units qhs
Humulog sliding scale as needed
Singulair 10mg Daily
Fluticasone 1 puff [**Hospital1 **]
Albuterol 1-2 puffs q4
Combivent inhaler 2 puffs QID
Prednisone 5 mg Daily
Multivitamin 1 tab Daily
Folic acid 1 mg Daily
Protonix 40mg [**Hospital1 **]
Vitamin D 50,000 units qWk
Calcium citrate 950 mg TID
Morphine Sulfate 15 mg Daily
Oxycodone 5 mg q6h
Lidoderm 5% patch as needed

ALLERGIES: Shellfish / Flexeril / Tricyclic Compounds

PHYSICAL EXAM: VITALS: 97.1 122/56 88 18 97% on RA
GEN: Patient is a middle aged female, appears older than stated
age, jaundiced skin. Patient is lethargic but arousable, answers
questions but need to keep awakening to hold attention. Oriented
to person place and year. Knows why she is here.
HEENT: NCAT, EOMI, sclera icteric. PERRL, OP clear, NGT in place

FAMILY HISTORY: Mother w/ DM2, HTN, and hyperlipidemia.
Father w/ COPD and EtOH cirrhosis

SOCIAL HISTORY: The patient is single with one child, she currently lives in a
chronic care facility, [**Hospital1 **] [**Hospital1 3894**] Nursing Facility in [**Location (un) 29158**]. She is currently on disability, formerly a waitress.
Illicits: Past IV drug use with needle sharing, last use 7 years
ago. Past drug-snorting.
Alcohol: Past alcohol use, last drink at age 46.
Tobacco: Past [**Location (un) 1818**] with 10 pack-year history 

### Response:
{'Pneumonia, organism unspecified,Unspecified viral hepatitis C with hepatic coma,Other adrenal hypofunction,Hyposmolality and/or hyponatremia,Unspecified protein-calorie malnutrition,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Cirrhosis of liver without mention of alcohol,Asthma, unspecified type, unspecified,Depressive disorder, not elsewhere classified,Esophageal reflux,Awaiting organ transplant status,Other chronic pain,Backache, unspecified'}
