CHIEF COMPLAINT: Colitis, hypotension

PRESENT ILLNESS: 62yo F with hx of HTN, hypothyroidism, presenting with abdominal
pain since Sunday [**2140-7-17**].  She started having crampy b/l LQ
pain on Sunday night with nonbloody loose stools, which became
worse through Monday. Monday at midnight she presented to the
[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] where she received 5 IVF and Levofloxacin for
?diverticulitis. WBC 14.3, lactate 1.2 there. By report, CT scan
showed small bowel ischemia so she was sent here. She was
started on dopamine 5mg and transferred to the [**Hospital1 **] (though has
been SBPs in 90s off of it).
.
In the ED, initial vital signs were 97.4 82 111/91 18 96% while
on dopamine. Lactate 1.2, Cr 1.5. Seen by surgery who felt that
the etiology was most likely infectious and recommended
admission to medicine. Scan looks more infectious vs
inflammatory per the ED and surgery attendings. Getting Fentanyl
for pain. Getting Flagyl in ED. Also received Zofran.
.
On transfer VS: 97.3 64 96/40 15 99% 3L nc. 20 G L AC 18G L hand

MEDICAL HISTORY: - hypertension
- hypothyroidism

MEDICATION ON ADMISSION: - lisinopril 40mg daily (started in Novemenber [**2139**])
- HCTZ 25mg daily (started in [**2139-12-23**])
- levothyroxine 50mcg daily (started [**2139-12-23**])
- multivitamin
- calcium/vitamin D

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On Admission
Vitals: 97.4, 106/50, 69, 98/RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, dry MM, oropharynx clear
Neck: supple, JVP not elevated
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, mildly distended, bowel sounds
present, no rebound tenderness or guarding, no organomegaly
GU: foley in place with clear urine
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

FAMILY HISTORY: Father with [**Name2 (NI) 499**] ca at age 80 and prostate ca. Mother w/ HTN.
Brother with [**Name (NI) 2320**].

SOCIAL HISTORY: She had recent life stressor of mom dying
- [**Name2 (NI) 1139**]: never
- Alcohol: [**2-25**] glasses of wine daily, more since mother passed
away, at about 4 drinks/day the past few days. Denies history of
withdrawal.
Other and unspecified noninfectious gastroenteritis and colitis,Acute kidney failure, unspecified,Hypovolemia,Diverticulosis of colon (without mention of hemorrhage),Unspecified essential hypertension,Unspecified acquired hypothyroidism
Noninf gastroenterit NEC,Acute kidney failure NOS,Hypovolemia,Dvrtclo colon w/o hmrhg,Hypertension NOS,Hypothyroidism NOS
Admission Date:  [**2140-7-19**]              Discharge Date:   [**2140-7-21**]

Date of Birth:  [**2077-7-30**]             Sex:   F

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 348**]
Chief Complaint:
Colitis, hypotension

Major Surgical or Invasive Procedure:
None

History of Present Illness:
62yo F with hx of HTN, hypothyroidism, presenting with abdominal
pain since Sunday [**2140-7-17**].  She started having crampy b/l LQ
pain on Sunday night with nonbloody loose stools, which became
worse through Monday. Monday at midnight she presented to the
[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] where she received 5 IVF and Levofloxacin for
?diverticulitis. WBC 14.3, lactate 1.2 there. By report, CT scan
showed small bowel ischemia so she was sent here. She was
started on dopamine 5mg and transferred to the [**Hospital1 **] (though has
been SBPs in 90s off of it).
.
In the ED, initial vital signs were 97.4 82 111/91 18 96% while
on dopamine. Lactate 1.2, Cr 1.5. Seen by surgery who felt that
the etiology was most likely infectious and recommended
admission to medicine. Scan looks more infectious vs
inflammatory per the ED and surgery attendings. Getting Fentanyl
for pain. Getting Flagyl in ED. Also received Zofran.
.
On transfer VS: 97.3 64 96/40 15 99% 3L nc. 20 G L AC 18G L hand

She was on Dopamine at 5mcg/kg/hr.
.
On the floor, she states abdominal pain much improved. She
denies having a colonoscopy in the past.


Past Medical History:
- hypertension
- hypothyroidism


Social History:
She had recent life stressor of mom dying
- [**Name2 (NI) 1139**]: never
- Alcohol: [**2-25**] glasses of wine daily, more since mother passed
away, at about 4 drinks/day the past few days. Denies history of
withdrawal.

Family History:
Father with [**Name2 (NI) 499**] ca at age 80 and prostate ca. Mother w/ HTN.
Brother with [**Name (NI) 2320**].


Physical Exam:
On Admission
Vitals: 97.4, 106/50, 69, 98/RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, dry MM, oropharynx clear
Neck: supple, JVP not elevated
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, mildly distended, bowel sounds
present, no rebound tenderness or guarding, no organomegaly
GU: foley in place with clear urine
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

On Discharge
Vitals: 96, 121/63, 60, 99 RA
General: Alert, oriented, NAD
HEENT: Sclera anicteric, MMM, OP clear
Neck: supple, JVP not elevated
Lungs: CTAB, no wheezes, rales, ronchi
CV: RRR, normal S1 + S2, no murmurs, rubs, gallops
Abdomen: Soft nontender, nondistended, no R/G no HSM, BS+
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

Pertinent Results:
[**2140-7-19**] 11:20AM BLOOD WBC-10.1 RBC-3.69* Hgb-11.9* Hct-34.7*
MCV-94 MCH-32.3* MCHC-34.3 RDW-12.2 Plt Ct-353
[**2140-7-19**] 11:20AM BLOOD Neuts-82.6* Lymphs-12.2* Monos-4.0
Eos-0.8 Baso-0.3
[**2140-7-19**] 11:20AM BLOOD PT-11.7 PTT-22.5 INR(PT)-1.0
[**2140-7-19**] 11:20AM BLOOD Glucose-129* UreaN-24* Creat-1.5* Na-136
K-3.5 Cl-104 HCO3-21* AnGap-15
[**2140-7-19**] 11:20AM BLOOD ALT-13 AST-11 LD(LDH)-105 AlkPhos-43
Amylase-21 TotBili-0.4
[**2140-7-19**] 11:20AM BLOOD Lipase-15
[**2140-7-19**] 04:30PM BLOOD Albumin-3.0* Calcium-7.4* Phos-2.4*
Mg-1.9
[**2140-7-19**] 04:30PM BLOOD TSH-1.6
[**2140-7-20**] 04:24AM BLOOD Cortsol-14.2
[**2140-7-19**] 10:52AM BLOOD Lactate-1.2
[**2140-7-19**] 02:04PM URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-1.006
[**2140-7-19**] 02:04PM URINE Blood-NEG Nitrite-NEG Protein-TR
Glucose-150 Ketone-10 Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG
[**2140-7-19**] 02:04PM URINE RBC-<1 WBC-<1 Bacteri-FEW Yeast-NONE
Epi-<1
[**2140-7-19**] 02:04PM URINE CastHy-1*
[**2140-7-19**] 02:04PM URINE Hours-RANDOM Creat-48.9 Na-22

Stool:
   FECAL CULTURE (Pending):

   CAMPYLOBACTER CULTURE (Pending):

   OVA + PARASITES (Final [**2140-7-20**]):
      NO OVA AND PARASITES SEEN.
      This test does not reliably detect Cryptosporidium,
Cyclospora or
      Microsporidium. While most cases of Giardia are detected
by routine
      O+P, the Giardia antigen test may enhance detection when
organisms
      are rare.

   CLOSTRIDIUM DIFFICILE TOXIN A & B TEST (Final [**2140-7-20**]):
      Feces negative for C.difficile toxin A & B by EIA.
           (Reference Range-Negative).

CT Abdomen:
1. Diffuse mural thickening of a long segment of ileum extending
to the
ileocecal valve with sparing of the [**Month/Day/Year 499**], consistent with
enteritis, which
could be ischemic, infectious, or inflammatory. No pneumatosis
or free air
seen.
2. Small bowel proximal to the thickened loops are mildly
dilated without
evidence of obstruction and oral contrast seen into the large
bowel to the
level of the rectum.
3. No atherosclerotic calcification is seen at the origins of
the celiac,
superior mesenteric, or inferior mesenteric artiers; however,
given this is a
non-contrast study, assessment of vasculature is not otherwise
performed.
4. Mild to moderate ascites.
5. Diverticulosis without acute diverticulitis.

On discharge:

[**2140-7-19**] 3:21 pm STOOL     CONSISTENCY: NOT APPLICABLE
      Source: Stool.

                            **FINAL REPORT [**2140-7-21**]**

   FECAL CULTURE (Final [**2140-7-21**]):    NO SALMONELLA OR SHIGELLA
FOUND.

   CAMPYLOBACTER CULTURE (Final [**2140-7-21**]):    NO CAMPYLOBACTER
FOUND.

   OVA + PARASITES (Final [**2140-7-20**]):
      NO OVA AND PARASITES SEEN.
      This test does not reliably detect Cryptosporidium,
Cyclospora or
      Microsporidium. While most cases of Giardia are detected
by routine
      O+P, the Giardia antigen test may enhance detection when
organisms
      are rare.

   CLOSTRIDIUM DIFFICILE TOXIN A & B TEST (Final [**2140-7-20**]):
      Feces negative for C.difficile toxin A & B by EIA.
           (Reference Range-Negative).

[**2140-7-19**] 3:21 pm STOOL     CONSISTENCY: NOT APPLICABLE
      Source: Stool.

                            **FINAL REPORT [**2140-7-21**]**

   FECAL CULTURE (Final [**2140-7-21**]):    NO SALMONELLA OR SHIGELLA
FOUND.

   CAMPYLOBACTER CULTURE (Final [**2140-7-21**]):    NO CAMPYLOBACTER
FOUND.

   OVA + PARASITES (Final [**2140-7-20**]):
      NO OVA AND PARASITES SEEN.
      This test does not reliably detect Cryptosporidium,
Cyclospora or
      Microsporidium. While most cases of Giardia are detected
by routine
      O+P, the Giardia antigen test may enhance detection when
organisms
      are rare.

   CLOSTRIDIUM DIFFICILE TOXIN A & B TEST (Final [**2140-7-20**]):
      Feces negative for C.difficile toxin A & B by EIA.
           (Reference Range-Negative).

[**2140-7-19**]: Urine legionella neg.

[**2140-7-21**]:
WBC 4.5, Hgb 10.6, Hct 30.5, Plt 343
na 136, k 3.6, cl 103, hco3 23, BUN 7, Cr 0.8, gluc 82
TSH: 1.6
TIBC 242 (low), B12 333, folate: greater than 20 ng/ml, ferritin
349 (high), transferrin 186 (low), Fe 49


Brief Hospital Course:
62F w/ hx of HTN, hypothyroidism, abdominal pain, distal small
bowel inflammation on CT scan and hypotension, improved with
IVF.

# Abdominal pain/diarrhea:  Given hx of consuming uncooked
shellfish, refrigerated rice and other meals not typical for
pt's diet as well as the radiologic findings indicative of
enteritis, diarrhea was most likely infectious.  LFTs were
normal which suggests no intrahepatic problem in setting of EtOH
abuse, and rules out viral hepatitis.  Stools were heme neg x2
and all stool cultures were negative indicating diarrhea was
likely toxin mediated.  GI was consulted and were not concerned
that this was secondary to an underlying inflammatory disease.
After 8 L of fluid resuscitation, diarrhea resolved two days
after admission.  Pt tolerated bland diet and was having solid,
formed stools.  She was hemodynamically stable and discharged
home on BRAT diet.

# hypotension: Most likely due to hypovolemia with diarrhea
given FENA 0.5%. Was initially admitted on pressor support with
dopamine and after 7L of fluid, no longer needed pressors.
Given NL lactate and good urine output after fluid resuscitation
suggested no signs of end organ hypoperfusion.  Patient was
resuscitated with total 8L IVF. Home antihypertensives were held
in the ICU and SBP was in 100s at time of transfer to floor.  On
the floor, pt's BP improved and at time of discharge she was up
to SBPs in the 120s.  On discharge, pt was on [**1-24**] normal dose
for lisinopril and HCTZ was being held.  She will f/u with her
PCP to manage antihypertensives.

.
# [**Doctor First Name 48**]: Basline 0.8 as recently as [**7-7**] as outpatient at [**Location (un) 2274**].
FENA 0.5% suggests prerenal likely due to losses.  At time of
discharge, her  Cr was back to baseline.
.
# etoh use/ ascites: Patient drinking more in setting of her
mother recently passing away.  SW consult was ordered.  Pt was
temporarily on CIWA protocol but showed no signs of withdrawal.
Of note, the CT of her abdomen showed some ascites.  This is
concerning given history of EtOH; she will need f/u with PCP to
work up etiology of ascites.
.
# hypothyroid- continued home levothyroxine
.
# HTN- held home antihypertensives in setting of hypotension.
Restarted 1/2 dose of lisinopril on discharge.

After discharge, patient will need to f/u with her PCP to
arrange for colonoscopy.  PCP should also be aware of ascites
seen on CT.

Medications on Admission:
- lisinopril 40mg daily (started in Novemenber [**2139**])
- HCTZ 25mg daily (started in [**2139-12-23**])
- levothyroxine 50mcg daily (started [**2139-12-23**])
- multivitamin
- calcium/vitamin D


Discharge Medications:
1. levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. multivitamin     Tablet Sig: One (1) Tablet PO once a day.
4. calcium carbonate  Oral
5. cholecalciferol (vitamin D3)  Oral


Discharge Disposition:
Home

Discharge Diagnosis:
Gastroenteritis
hypotension
Acute kidney injury


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Dear Ms. [**Known lastname **],

You were admitted to the hospital because you were having
profuse diarrhea- we believe this was related to an infection.
Your condition improved dramatically with IV fluids and bowel
rest. You were having less frequent, semi-formed stools by the
time of discharge.

Because you received a lot of fluids you developed some
collection in your abdomen and lungs. Please continue to breath
deeply and use the incentive spirometer. You will need an
abdominal ultrasound in a couple of weeks to assess improvement
of this fluid collection- your primary care physician can help
arrange this. You will also need to arrange for a screening
colonoscopy given your family history of [**Known lastname 499**] cancer.

As you are recovering from the infection, please avoid dairy
products and follow a BRAT diet (bland simple foods like toast,
bread, rice).

We have made the following changes to your medications:
- CHANGE your dose of lisinopril to 20 mg daily ([**1-24**] of your
normal dose) since your blood pressures were low to normal while
you were in the hospital
- STOP taking your hydrochlorthiazide until otherwise instructed
by your primary care physician

It was a pleasure taking care of you. We wish you a speedy
recovery.

Followup Instructions:
Please follow up at the following appointment:

Name: [**Last Name (LF) **],[**First Name3 (LF) 2295**] J.
Location: [**Location (un) 2274**]-[**Location (un) **]
Address: 111 [**Doctor Last Name **] DR, [**Location (un) **],[**Numeric Identifier 17464**]
Phone: [**Telephone/Fax (1) 17465**]
Appt:  [**7-28**] at 3pm
{'Other and unspecified noninfectious gastroenteritis and colitis,Acute kidney failure, unspecified,Hypovolemia,Diverticulosis of colon (without mention of hemorrhage),Unspecified essential hypertension,Unspecified acquired hypothyroidism'}


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: Colitis, hypotension

PRESENT ILLNESS: 62yo F with hx of HTN, hypothyroidism, presenting with abdominal
pain since Sunday [**2140-7-17**].  She started having crampy b/l LQ
pain on Sunday night with nonbloody loose stools, which became
worse through Monday. Monday at midnight she presented to the
[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] where she received 5 IVF and Levofloxacin for
?diverticulitis. WBC 14.3, lactate 1.2 there. By report, CT scan
showed small bowel ischemia so she was sent here. She was
started on dopamine 5mg and transferred to the [**Hospital1 **] (though has
been SBPs in 90s off of it).
.
In the ED, initial vital signs were 97.4 82 111/91 18 96% while
on dopamine. Lactate 1.2, Cr 1.5. Seen by surgery who felt that
the etiology was most likely infectious and recommended
admission to medicine. Scan looks more infectious vs
inflammatory per the ED and surgery attendings. Getting Fentanyl
for pain. Getting Flagyl in ED. Also received Zofran.
.
On transfer VS: 97.3 64 96/40 15 99% 3L nc. 20 G L AC 18G L hand

MEDICAL HISTORY: - hypertension
- hypothyroidism

MEDICATION ON ADMISSION: - lisinopril 40mg daily (started in Novemenber [**2139**])
- HCTZ 25mg daily (started in [**2139-12-23**])
- levothyroxine 50mcg daily (started [**2139-12-23**])
- multivitamin
- calcium/vitamin D

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On Admission
Vitals: 97.4, 106/50, 69, 98/RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, dry MM, oropharynx clear
Neck: supple, JVP not elevated
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, mildly distended, bowel sounds
present, no rebound tenderness or guarding, no organomegaly
GU: foley in place with clear urine
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

FAMILY HISTORY: Father with [**Name2 (NI) 499**] ca at age 80 and prostate ca. Mother w/ HTN.
Brother with [**Name (NI) 2320**].

SOCIAL HISTORY: She had recent life stressor of mom dying
- [**Name2 (NI) 1139**]: never
- Alcohol: [**2-25**] glasses of wine daily, more since mother passed
away, at about 4 drinks/day the past few days. Denies history of
withdrawal. 

### Response:
{'Other and unspecified noninfectious gastroenteritis and colitis,Acute kidney failure, unspecified,Hypovolemia,Diverticulosis of colon (without mention of hemorrhage),Unspecified essential hypertension,Unspecified acquired hypothyroidism'}
