diff --git "a/cohort_past_history_12072022.csv" "b/cohort_past_history_12072022.csv" --- "a/cohort_past_history_12072022.csv" +++ "b/cohort_past_history_12072022.csv" @@ -1,4 +1,4 @@ -SUBJECT_ID,INDEX_HADM_ID,INDEX_ROW_ID,INDEX_CHARTDATE,ROW_ID,HADM_ID,CHARTDATE,CATEGORY,TEXT,days_from_index,ADMITTIME,DISCHTIME,ADMISSION_TYPE,ADMISSION_LOCATION,DISCHARGE_LOCATION,DIAGNOSIS,hospital_course_processed,Diagnosis_Description +SUBJECT_ID,INDEX_HADM_ID,INDEX_ROW_ID,INDEX_CHARTDATE,ROW_ID,HADM_ID,CHARTDATE,CATEGORY,TEXT,days_from_index,ADMITTIME,DISCHTIME,ADMISSION_TYPE,ADMISSION_LOCATION,DISCHARGE_LOCATION,DIAGNOSIS,hospital_course_processed,Diagnosis_Description,BertSummarizer,t5seq2eq 109,140167.0,14802,2141-12-23,14796,139061.0,2141-09-14,Discharge summary,"Admission Date: [**2141-9-11**] Discharge Date: [**2141-9-14**] Date of Birth: [**2117-8-7**] Sex: F @@ -454,7 +454,16 @@ maintained on warfarin with inr goal 2.5 to 3.0. patients home prednisone regimen was continued. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Urinary tract infection, site not specified; Other primary cardiomyopathies; Systemic lupus erythematosus; Sciatica; Hyperpotassemia; Thrombocytopenia, unspecified; Abnormal coagulation profile; Hyperparathyroidism, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism]" +SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Urinary tract infection, site not specified; Other primary cardiomyopathies; Systemic lupus erythematosus; Sciatica; Hyperpotassemia; Thrombocytopenia, unspecified; Abnormal coagulation profile; Hyperparathyroidism, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism]","icu course: +ekg showed no change from prior, and cxr showed a suggestion of +rll/r diaphragm haziness. the renal team was consulted, and recommended +no change to home medication regimen. right leg pain: upon arrival on the floor, the patient +complained of [**2143-4-15**] pain in r buttock and posterior thigh, much +exacerbated with standing. of note, lumbar spine mri and r hip +xr on most recent admission were both negative. she was treated with a +three day course of ciprofloxacin. esrd: the patient has end-stage renal disease due to her +lupus. anemia: the patients hematocrit remained near her baseline +low 20s throughout her stay.","ekg showed no change from prior, and cxr showed a suggestion of rll/r diaphragm haziness. the patient was found to by hypocalcemic, and was started on calcium replacement therapy. she became more hypertensive, with sbps to the 170s-180s during the day. throughout her hospitalization, the patient had no symptoms/signs of hypertensive emergency." 109,140167.0,14802,2141-12-23,14797,172335.0,2141-09-24,Discharge summary,"Admission Date: [**2141-9-18**] Discharge Date: [**2141-9-24**] Date of Birth: [**2117-8-7**] Sex: F @@ -1027,7 +1036,23 @@ pivs ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [Pneumonia, organism unspecified; Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Hyperpotassemia; Sciatica; Other iatrogenic hypotension; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Anemia of other chronic disease; Hypocalcemia]" +SECONDARY: [Pneumonia, organism unspecified; Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Hyperpotassemia; Sciatica; Other iatrogenic hypotension; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Anemia of other chronic disease; Hypocalcemia]","24 yo with h/o of lupus, htn, and lupus nephropathy started on +peitoneal dialysis during this admissionwho was admitted +initially for r hip pain. micu course: on [**9-20**], the patient triggered for hypotension +(82/45), hypothermia (92.9) and altered mental status with +difficult arousability in setting of recent blood transfusion. urine culture and blood cultures are pending. patients +bp was in the 110s so hydralazine was stopped. her other bp meds +were otherwise continued. if patient has leg pain +again, may consider neurogenic source such a piriformis syndrome +as suggested by neurology. it would be good if we could arrange a pulmonary clinic follow +up for ms. [** she underwent ct head, and v/q scan which were unremarkable. her steroid dose was increased to 15mg given concern for need +for stress dose steroids. she was pan-cultured (blood, urine, +peritoneal dialysate) without obvious source of infection. source unclear at this point, but cxr with +question of retrocardiac opacity. continue home bp meds :labetalol 900 mg po tid but +difficult for patient to tolerate due to nausea, aliskiren *nf* +150 mg oral [**hospital1 **], nifedipine cr 60 mg po daily, clonidine patch, +hydralazine given hypertensive in setting of nausa. did well with pd on [**9-22**] but did +report some nause and cramping. # systemic lupus erythematosus: home prednisone dose 5mg.","lupus nephropathy patient on peitoneal dialysis with htn and lupus nephropathy. triggered for hypotension (82/45), hypothermia (92.9), altered mental status. concern was for sepsis, autonomic seizure, transfusion reaction, pulmonary embolus and/or narcosis." 109,140167.0,14802,2141-12-23,14798,126055.0,2141-11-03,Discharge summary,"Admission Date: [**2141-10-13**] Discharge Date: [**2141-11-3**] Date of Birth: [**2117-8-7**] Sex: F @@ -1725,7 +1750,41 @@ having undergone three rounds of hemodialysis, her bicarbonate was within normal limits at 28. ","PRIMARY: [Malignant essential hypertension] -SECONDARY: [Renal dialysis status; Epilepsy, unspecified, without mention of intractable epilepsy; Constipation, unspecified; Anemia in chronic kidney disease; Abnormal coagulation profile; Obstructive sleep apnea (adult)(pediatric); Other diseases of lung, not elsewhere classified; Other chest pain; Fever, unspecified; Rash and other nonspecific skin eruption; Other chronic pulmonary heart diseases; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Unspecified disease of pericardium; Other ascites; Acidosis; Hyposmolality and/or hyponatremia; Abdominal pain, other specified site; Abdominal pain, epigastric; Nausea with vomiting; Diarrhea; Systemic lupus erythematosus; Hyperparathyroidism, unspecified; Anemia, unspecified; Thrombocytopenia, unspecified; Esophageal reflux]" +SECONDARY: [Renal dialysis status; Epilepsy, unspecified, without mention of intractable epilepsy; Constipation, unspecified; Anemia in chronic kidney disease; Abnormal coagulation profile; Obstructive sleep apnea (adult)(pediatric); Other diseases of lung, not elsewhere classified; Other chest pain; Fever, unspecified; Rash and other nonspecific skin eruption; Other chronic pulmonary heart diseases; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Unspecified disease of pericardium; Other ascites; Acidosis; Hyposmolality and/or hyponatremia; Abdominal pain, other specified site; Abdominal pain, epigastric; Nausea with vomiting; Diarrhea; Systemic lupus erythematosus; Hyperparathyroidism, unspecified; Anemia, unspecified; Thrombocytopenia, unspecified; Esophageal reflux]","this is a 24 year old woman with esrd secondary to sle (started +peritoneal dialysis approximately one week prior to admission), +malignant htn, h/o svc syndrome, and multiple thrombotic events +(on warfarin) who is presenting with persistent suprapubic/lower +abdominal pain and new onset severe epigastric pain w/ nausea +and vomiting, and hypertension. however, during +the initial part of her admission, the patient remained afebrile +with an initial relative leukocytosis which trended to within +baseline limits. pericarditis +was considered, but her ekg was unchanged from prior studies and +there had been on interval increase in her pericardial effusion +since [**2141-10-13**]. the patient tolerated the procedure well and immediately +reported that both her epigastric and suprapubic pain were gone +after the surgery. multiple medication regimens +were attempted and changed throughout her hospital course. when +sbp>180, give 25 mg po hydral every 30 min until sbp<150. during her admission, the patient underwent multiple +trials of peritoneal dialysis, but was unable to tolerate it on +a consistent basis secondary to abdominal pain. upon discharge, her electrolytes were back to her +baseline. epo alfa sc was +also given on [**2141-10-17**]. the patients +hct remained stable (hovering between 25 - 27) from [**2141-10-19**] - +[**2141-10-23**]. between [**2141-10-23**] - [**2141-10-24**], the patient had a hct +drop from 26 to 20 in the setting of occult positive emesis. gi +was aware and planned to perform a non-urgent egd on [**10-25**] or +[**10-26**] as the patient was hemodynamically stable and her hct +returned to baseline. she was +also started heparin drip secondary to concern for ischemic +bowel [**2-11**] microthrombotic disease. as a result, she underwent upper +extremity venous ultrasound on [**2141-11-2**], which showed no +evidence of a dvt within the left upper extremity and the +previously noted thrombus within the left subclavian vein was +not seen as well. # sle: rheumatology was consulted several times throughout her +hospital course, but they did not think that a lupus flare was +contributing to her presentation. # obstructive sleep apnea: the patient was noted to have osa +based on clinical nocturnal exam during admission.","esrd secondary to sle, malignant htn, h/o svc syndrome, and multiple thrombotic events were considered. the patient was placed on iv flagyl, but this was discontinued when stool samples were negative for c.difficile. a heparin drip and warfarin were started for treatment of possible microthrombotic ischemia." 109,140167.0,14802,2141-12-23,14799,125288.0,2141-11-23,Discharge summary,"Admission Date: [**2141-11-18**] Discharge Date: [**2141-11-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -2094,7 +2153,15 @@ is agreeable to outpatient follow up with [**company 191**] social work, and potential cbt. these can be arranged by her pcp. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Abdominal pain, unspecified site; Anemia, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Abdominal pain, unspecified site; Anemia, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","1) hypertension: patient has history of extremely labile +hypertension on an aggressive outpatient regimen. her hydralazine was increased from 75mg to 100mg tid with mild +improvement. peritoneal fluid was obtained and contained 544 +polys. the dose was lowered to 4mg daily at +discharge to prevent overshooting the therapeutic range, but the +patient will have close follow up with coumadin clinic, with +dose titrations as needed. her nephrologist felt +this may be contributing to her recurrent pain and hypertension, +so psychiatry was consulted.","patient has history of extremely labile hypertension on aggressive outpatient regimen. overnight in the micu, patient required iv and po labetalol for sbp > 200. ct scan showed increasing ascites, but no acute pathology." 109,140167.0,14802,2141-12-23,14800,161950.0,2141-12-01,Discharge summary,"Admission Date: [**2141-11-24**] Discharge Date: [**2141-12-1**] Date of Birth: [**2117-8-7**] Sex: F @@ -2483,7 +2550,10 @@ patient succesfully switched to po meds and transferred to the floor. upon transfer to the floor, the following was her ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Other ascites; ; Systemic lupus erythematosus; Headache; Anemia in chronic kidney disease; Anxiety state, unspecified; Other chest pain; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Renal dialysis status; Acquired absence of organ, eye]" +SECONDARY: [End stage renal disease; Other ascites; ; Systemic lupus erythematosus; Headache; Anemia in chronic kidney disease; Anxiety state, unspecified; Other chest pain; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Renal dialysis status; Acquired absence of organ, eye]","24yo f with sle, esrd on hd and malignant hypertension who +presented with abdominal pain and headache and was admitted for +hypertensive urgency. the renal team was consulted, and recommended no change +to home med regimen.","a 24yo f with sle, esrd on hd and malignant hypertension presented with abdominal pain and headache. the patient was found to be hypocalcemic, and was started on calcium replacement therapy. she successfully switched to po meds and was transferred to the floor." 109,140167.0,14802,2141-12-23,14801,173633.0,2141-12-14,Discharge summary,"Admission Date: [**2141-12-8**] Discharge Date: [**2141-12-14**] Date of Birth: [**2117-8-7**] Sex: F @@ -2938,7 +3008,18 @@ transfused 1u prbc at hd on [**12-12**]. she was also given epo at hd. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Systemic lupus erythematosus; Other and unspecified noninfectious gastroenteritis and colitis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Other iatrogenic hypotension; Obstructive sleep apnea (adult)(pediatric); Hemangioma of intra-abdominal structures; Other chronic pain; Abdominal pain, unspecified site; Abnormal coagulation profile; Renal dialysis status; Personal history of venous thrombosis and embolism]" +SECONDARY: [End stage renal disease; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Systemic lupus erythematosus; Other and unspecified noninfectious gastroenteritis and colitis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Other iatrogenic hypotension; Obstructive sleep apnea (adult)(pediatric); Hemangioma of intra-abdominal structures; Other chronic pain; Abdominal pain, unspecified site; Abnormal coagulation profile; Renal dialysis status; Personal history of venous thrombosis and embolism]","24 year old woman with ckd v and severe hypertension due to sle +admitted with flare of chronic abdominal pain and hypertensive +urgency. initially her blood pressure over-corrected to +sbps in the 80s (patient was asymptomatic). the patient was +transferred to the floor on [**12-10**] after resolution of her +hypertensive urgency with a decreased blood pressure regimen due +to her hypotension in response to home doses of her medications. the patient was continuned on her +admission hypertensive regimen. a ct scan was +performed that showed bowel wall changes that are likely +secondary to recent peritoneal dialysis and unrelated to pain. ckd v from lupus nephritis: the patient was continued on hd +during her admission. she was therapetuic the same day and her heparin gtt +was stopped.",24 year old woman with ckd v and severe hypertension due to sle admitted. patient was initially maintained on a labetalol drip and hydralazine iv prn. initially her blood pressure over-corrected to sbps in the 80s (patient was asymptomatic) 109,173633.0,14801,2141-12-14,14796,139061.0,2141-09-14,Discharge summary,"Admission Date: [**2141-9-11**] Discharge Date: [**2141-9-14**] Date of Birth: [**2117-8-7**] Sex: F @@ -3394,7 +3475,16 @@ maintained on warfarin with inr goal 2.5 to 3.0. patients home prednisone regimen was continued. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Urinary tract infection, site not specified; Other primary cardiomyopathies; Systemic lupus erythematosus; Sciatica; Hyperpotassemia; Thrombocytopenia, unspecified; Abnormal coagulation profile; Hyperparathyroidism, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism]" +SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Urinary tract infection, site not specified; Other primary cardiomyopathies; Systemic lupus erythematosus; Sciatica; Hyperpotassemia; Thrombocytopenia, unspecified; Abnormal coagulation profile; Hyperparathyroidism, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism]","icu course: +ekg showed no change from prior, and cxr showed a suggestion of +rll/r diaphragm haziness. the renal team was consulted, and recommended +no change to home medication regimen. right leg pain: upon arrival on the floor, the patient +complained of [**2143-4-15**] pain in r buttock and posterior thigh, much +exacerbated with standing. of note, lumbar spine mri and r hip +xr on most recent admission were both negative. she was treated with a +three day course of ciprofloxacin. esrd: the patient has end-stage renal disease due to her +lupus. anemia: the patients hematocrit remained near her baseline +low 20s throughout her stay.","ekg showed no change from prior, and cxr showed a suggestion of rll/r diaphragm haziness. the patient was found to by hypocalcemic, and was started on calcium replacement therapy. she became more hypertensive, with sbps to the 170s-180s during the day. throughout her hospitalization, the patient had no symptoms/signs of hypertensive emergency." 109,173633.0,14801,2141-12-14,14797,172335.0,2141-09-24,Discharge summary,"Admission Date: [**2141-9-18**] Discharge Date: [**2141-9-24**] Date of Birth: [**2117-8-7**] Sex: F @@ -3967,7 +4057,23 @@ pivs ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [Pneumonia, organism unspecified; Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Hyperpotassemia; Sciatica; Other iatrogenic hypotension; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Anemia of other chronic disease; Hypocalcemia]" +SECONDARY: [Pneumonia, organism unspecified; Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Hyperpotassemia; Sciatica; Other iatrogenic hypotension; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Anemia of other chronic disease; Hypocalcemia]","24 yo with h/o of lupus, htn, and lupus nephropathy started on +peitoneal dialysis during this admissionwho was admitted +initially for r hip pain. micu course: on [**9-20**], the patient triggered for hypotension +(82/45), hypothermia (92.9) and altered mental status with +difficult arousability in setting of recent blood transfusion. urine culture and blood cultures are pending. patients +bp was in the 110s so hydralazine was stopped. her other bp meds +were otherwise continued. if patient has leg pain +again, may consider neurogenic source such a piriformis syndrome +as suggested by neurology. it would be good if we could arrange a pulmonary clinic follow +up for ms. [** she underwent ct head, and v/q scan which were unremarkable. her steroid dose was increased to 15mg given concern for need +for stress dose steroids. she was pan-cultured (blood, urine, +peritoneal dialysate) without obvious source of infection. source unclear at this point, but cxr with +question of retrocardiac opacity. continue home bp meds :labetalol 900 mg po tid but +difficult for patient to tolerate due to nausea, aliskiren *nf* +150 mg oral [**hospital1 **], nifedipine cr 60 mg po daily, clonidine patch, +hydralazine given hypertensive in setting of nausa. did well with pd on [**9-22**] but did +report some nause and cramping. # systemic lupus erythematosus: home prednisone dose 5mg.","lupus nephropathy patient on peitoneal dialysis with htn and lupus nephropathy. triggered for hypotension (82/45), hypothermia (92.9), altered mental status. concern was for sepsis, autonomic seizure, transfusion reaction, pulmonary embolus and/or narcosis." 109,173633.0,14801,2141-12-14,14798,126055.0,2141-11-03,Discharge summary,"Admission Date: [**2141-10-13**] Discharge Date: [**2141-11-3**] Date of Birth: [**2117-8-7**] Sex: F @@ -4665,7 +4771,41 @@ having undergone three rounds of hemodialysis, her bicarbonate was within normal limits at 28. ","PRIMARY: [Malignant essential hypertension] -SECONDARY: [Renal dialysis status; Epilepsy, unspecified, without mention of intractable epilepsy; Constipation, unspecified; Anemia in chronic kidney disease; Abnormal coagulation profile; Obstructive sleep apnea (adult)(pediatric); Other diseases of lung, not elsewhere classified; Other chest pain; Fever, unspecified; Rash and other nonspecific skin eruption; Other chronic pulmonary heart diseases; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Unspecified disease of pericardium; Other ascites; Acidosis; Hyposmolality and/or hyponatremia; Abdominal pain, other specified site; Abdominal pain, epigastric; Nausea with vomiting; Diarrhea; Systemic lupus erythematosus; Hyperparathyroidism, unspecified; Anemia, unspecified; Thrombocytopenia, unspecified; Esophageal reflux]" +SECONDARY: [Renal dialysis status; Epilepsy, unspecified, without mention of intractable epilepsy; Constipation, unspecified; Anemia in chronic kidney disease; Abnormal coagulation profile; Obstructive sleep apnea (adult)(pediatric); Other diseases of lung, not elsewhere classified; Other chest pain; Fever, unspecified; Rash and other nonspecific skin eruption; Other chronic pulmonary heart diseases; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Unspecified disease of pericardium; Other ascites; Acidosis; Hyposmolality and/or hyponatremia; Abdominal pain, other specified site; Abdominal pain, epigastric; Nausea with vomiting; Diarrhea; Systemic lupus erythematosus; Hyperparathyroidism, unspecified; Anemia, unspecified; Thrombocytopenia, unspecified; Esophageal reflux]","this is a 24 year old woman with esrd secondary to sle (started +peritoneal dialysis approximately one week prior to admission), +malignant htn, h/o svc syndrome, and multiple thrombotic events +(on warfarin) who is presenting with persistent suprapubic/lower +abdominal pain and new onset severe epigastric pain w/ nausea +and vomiting, and hypertension. however, during +the initial part of her admission, the patient remained afebrile +with an initial relative leukocytosis which trended to within +baseline limits. pericarditis +was considered, but her ekg was unchanged from prior studies and +there had been on interval increase in her pericardial effusion +since [**2141-10-13**]. the patient tolerated the procedure well and immediately +reported that both her epigastric and suprapubic pain were gone +after the surgery. multiple medication regimens +were attempted and changed throughout her hospital course. when +sbp>180, give 25 mg po hydral every 30 min until sbp<150. during her admission, the patient underwent multiple +trials of peritoneal dialysis, but was unable to tolerate it on +a consistent basis secondary to abdominal pain. upon discharge, her electrolytes were back to her +baseline. epo alfa sc was +also given on [**2141-10-17**]. the patients +hct remained stable (hovering between 25 - 27) from [**2141-10-19**] - +[**2141-10-23**]. between [**2141-10-23**] - [**2141-10-24**], the patient had a hct +drop from 26 to 20 in the setting of occult positive emesis. gi +was aware and planned to perform a non-urgent egd on [**10-25**] or +[**10-26**] as the patient was hemodynamically stable and her hct +returned to baseline. she was +also started heparin drip secondary to concern for ischemic +bowel [**2-11**] microthrombotic disease. as a result, she underwent upper +extremity venous ultrasound on [**2141-11-2**], which showed no +evidence of a dvt within the left upper extremity and the +previously noted thrombus within the left subclavian vein was +not seen as well. # sle: rheumatology was consulted several times throughout her +hospital course, but they did not think that a lupus flare was +contributing to her presentation. # obstructive sleep apnea: the patient was noted to have osa +based on clinical nocturnal exam during admission.","esrd secondary to sle, malignant htn, h/o svc syndrome, and multiple thrombotic events were considered. the patient was placed on iv flagyl, but this was discontinued when stool samples were negative for c.difficile. a heparin drip and warfarin were started for treatment of possible microthrombotic ischemia." 109,173633.0,14801,2141-12-14,14799,125288.0,2141-11-23,Discharge summary,"Admission Date: [**2141-11-18**] Discharge Date: [**2141-11-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -5034,7 +5174,15 @@ is agreeable to outpatient follow up with [**company 191**] social work, and potential cbt. these can be arranged by her pcp. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Abdominal pain, unspecified site; Anemia, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Abdominal pain, unspecified site; Anemia, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","1) hypertension: patient has history of extremely labile +hypertension on an aggressive outpatient regimen. her hydralazine was increased from 75mg to 100mg tid with mild +improvement. peritoneal fluid was obtained and contained 544 +polys. the dose was lowered to 4mg daily at +discharge to prevent overshooting the therapeutic range, but the +patient will have close follow up with coumadin clinic, with +dose titrations as needed. her nephrologist felt +this may be contributing to her recurrent pain and hypertension, +so psychiatry was consulted.","patient has history of extremely labile hypertension on aggressive outpatient regimen. overnight in the micu, patient required iv and po labetalol for sbp > 200. ct scan showed increasing ascites, but no acute pathology." 109,173633.0,14801,2141-12-14,14800,161950.0,2141-12-01,Discharge summary,"Admission Date: [**2141-11-24**] Discharge Date: [**2141-12-1**] Date of Birth: [**2117-8-7**] Sex: F @@ -5423,7 +5571,10 @@ patient succesfully switched to po meds and transferred to the floor. upon transfer to the floor, the following was her ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Other ascites; ; Systemic lupus erythematosus; Headache; Anemia in chronic kidney disease; Anxiety state, unspecified; Other chest pain; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Renal dialysis status; Acquired absence of organ, eye]" +SECONDARY: [End stage renal disease; Other ascites; ; Systemic lupus erythematosus; Headache; Anemia in chronic kidney disease; Anxiety state, unspecified; Other chest pain; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Renal dialysis status; Acquired absence of organ, eye]","24yo f with sle, esrd on hd and malignant hypertension who +presented with abdominal pain and headache and was admitted for +hypertensive urgency. the renal team was consulted, and recommended no change +to home med regimen.","a 24yo f with sle, esrd on hd and malignant hypertension presented with abdominal pain and headache. the patient was found to be hypocalcemic, and was started on calcium replacement therapy. she successfully switched to po meds and was transferred to the floor." 109,173633.0,14801,2141-12-14,15330,131345.0,2141-09-08,Discharge summary,"Admission Date: [**2141-9-5**] Discharge Date: [**2141-9-8**] Date of Birth: [**2117-8-7**] Sex: F @@ -5826,7 +5977,14 @@ for 2d # dispo status: ambulating, pain free, bp in the 150/90 range ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Nausea alone; Other antihypertensive agents causing adverse effects in therapeutic use; Hip and thigh injury; Unspecified accident; Hypotension, unspecified; Anemia, unspecified; Personal history of venous thrombosis and embolism; End stage renal disease; ; Urinary tract infection, site not specified; Hyperpotassemia; Acidosis; Disorders of phosphorus metabolism; Hypocalcemia; Secondary hyperparathyroidism (of renal origin)]" +SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Nausea alone; Other antihypertensive agents causing adverse effects in therapeutic use; Hip and thigh injury; Unspecified accident; Hypotension, unspecified; Anemia, unspecified; Personal history of venous thrombosis and embolism; End stage renal disease; ; Urinary tract infection, site not specified; Hyperpotassemia; Acidosis; Disorders of phosphorus metabolism; Hypocalcemia; Secondary hyperparathyroidism (of renal origin)]","ms [**known lastname **] is a 24 year old woman with sle, ckd v, and multiple +admissions for labile hypertension who presented to the ed +complaining of about a weeks?????? we opted to discharge her on her home regimen +(without decreasing doses) since she is more often having issues +with elevated blood pressures. # right leg pain: no evidence of avascular necrosis or fracture +on plain film. also had +temp to 101 on evening prior to discharge. # systemic lupus erythematosus: cont home prednisone dose +.","ms [**known lastname **] is a 24 year old woman with sle, ckd v, and multiple admissions for labile hypertension. she presented to the ed complaining of about a weeks?????? worth of right leg pain. she was initially admitted to the micu for hypertensive urgency and then transferred to the floor after a day. she was started on her home meds and tolerated them fairly well." 109,140167.0,14802,2141-12-23,15330,131345.0,2141-09-08,Discharge summary,"Admission Date: [**2141-9-5**] Discharge Date: [**2141-9-8**] Date of Birth: [**2117-8-7**] Sex: F @@ -6229,7 +6387,14 @@ for 2d # dispo status: ambulating, pain free, bp in the 150/90 range ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Nausea alone; Other antihypertensive agents causing adverse effects in therapeutic use; Hip and thigh injury; Unspecified accident; Hypotension, unspecified; Anemia, unspecified; Personal history of venous thrombosis and embolism; End stage renal disease; ; Urinary tract infection, site not specified; Hyperpotassemia; Acidosis; Disorders of phosphorus metabolism; Hypocalcemia; Secondary hyperparathyroidism (of renal origin)]" +SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Nausea alone; Other antihypertensive agents causing adverse effects in therapeutic use; Hip and thigh injury; Unspecified accident; Hypotension, unspecified; Anemia, unspecified; Personal history of venous thrombosis and embolism; End stage renal disease; ; Urinary tract infection, site not specified; Hyperpotassemia; Acidosis; Disorders of phosphorus metabolism; Hypocalcemia; Secondary hyperparathyroidism (of renal origin)]","ms [**known lastname **] is a 24 year old woman with sle, ckd v, and multiple +admissions for labile hypertension who presented to the ed +complaining of about a weeks?????? we opted to discharge her on her home regimen +(without decreasing doses) since she is more often having issues +with elevated blood pressures. # right leg pain: no evidence of avascular necrosis or fracture +on plain film. also had +temp to 101 on evening prior to discharge. # systemic lupus erythematosus: cont home prednisone dose +.","ms [**known lastname **] is a 24 year old woman with sle, ckd v, and multiple admissions for labile hypertension. she presented to the ed complaining of about a weeks?????? worth of right leg pain. she was initially admitted to the micu for hypertensive urgency and then transferred to the floor after a day. she was started on her home meds and tolerated them fairly well." 109,124657.0,14804,2142-01-20,14797,172335.0,2141-09-24,Discharge summary,"Admission Date: [**2141-9-18**] Discharge Date: [**2141-9-24**] Date of Birth: [**2117-8-7**] Sex: F @@ -6802,7 +6967,23 @@ pivs ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [Pneumonia, organism unspecified; Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Hyperpotassemia; Sciatica; Other iatrogenic hypotension; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Anemia of other chronic disease; Hypocalcemia]" +SECONDARY: [Pneumonia, organism unspecified; Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Hyperpotassemia; Sciatica; Other iatrogenic hypotension; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Anemia of other chronic disease; Hypocalcemia]","24 yo with h/o of lupus, htn, and lupus nephropathy started on +peitoneal dialysis during this admissionwho was admitted +initially for r hip pain. micu course: on [**9-20**], the patient triggered for hypotension +(82/45), hypothermia (92.9) and altered mental status with +difficult arousability in setting of recent blood transfusion. urine culture and blood cultures are pending. patients +bp was in the 110s so hydralazine was stopped. her other bp meds +were otherwise continued. if patient has leg pain +again, may consider neurogenic source such a piriformis syndrome +as suggested by neurology. it would be good if we could arrange a pulmonary clinic follow +up for ms. [** she underwent ct head, and v/q scan which were unremarkable. her steroid dose was increased to 15mg given concern for need +for stress dose steroids. she was pan-cultured (blood, urine, +peritoneal dialysate) without obvious source of infection. source unclear at this point, but cxr with +question of retrocardiac opacity. continue home bp meds :labetalol 900 mg po tid but +difficult for patient to tolerate due to nausea, aliskiren *nf* +150 mg oral [**hospital1 **], nifedipine cr 60 mg po daily, clonidine patch, +hydralazine given hypertensive in setting of nausa. did well with pd on [**9-22**] but did +report some nause and cramping. # systemic lupus erythematosus: home prednisone dose 5mg.","lupus nephropathy patient on peitoneal dialysis with htn and lupus nephropathy. triggered for hypotension (82/45), hypothermia (92.9), altered mental status. concern was for sepsis, autonomic seizure, transfusion reaction, pulmonary embolus and/or narcosis." 109,124657.0,14804,2142-01-20,14798,126055.0,2141-11-03,Discharge summary,"Admission Date: [**2141-10-13**] Discharge Date: [**2141-11-3**] Date of Birth: [**2117-8-7**] Sex: F @@ -7500,7 +7681,41 @@ having undergone three rounds of hemodialysis, her bicarbonate was within normal limits at 28. ","PRIMARY: [Malignant essential hypertension] -SECONDARY: [Renal dialysis status; Epilepsy, unspecified, without mention of intractable epilepsy; Constipation, unspecified; Anemia in chronic kidney disease; Abnormal coagulation profile; Obstructive sleep apnea (adult)(pediatric); Other diseases of lung, not elsewhere classified; Other chest pain; Fever, unspecified; Rash and other nonspecific skin eruption; Other chronic pulmonary heart diseases; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Unspecified disease of pericardium; Other ascites; Acidosis; Hyposmolality and/or hyponatremia; Abdominal pain, other specified site; Abdominal pain, epigastric; Nausea with vomiting; Diarrhea; Systemic lupus erythematosus; Hyperparathyroidism, unspecified; Anemia, unspecified; Thrombocytopenia, unspecified; Esophageal reflux]" +SECONDARY: [Renal dialysis status; Epilepsy, unspecified, without mention of intractable epilepsy; Constipation, unspecified; Anemia in chronic kidney disease; Abnormal coagulation profile; Obstructive sleep apnea (adult)(pediatric); Other diseases of lung, not elsewhere classified; Other chest pain; Fever, unspecified; Rash and other nonspecific skin eruption; Other chronic pulmonary heart diseases; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Unspecified disease of pericardium; Other ascites; Acidosis; Hyposmolality and/or hyponatremia; Abdominal pain, other specified site; Abdominal pain, epigastric; Nausea with vomiting; Diarrhea; Systemic lupus erythematosus; Hyperparathyroidism, unspecified; Anemia, unspecified; Thrombocytopenia, unspecified; Esophageal reflux]","this is a 24 year old woman with esrd secondary to sle (started +peritoneal dialysis approximately one week prior to admission), +malignant htn, h/o svc syndrome, and multiple thrombotic events +(on warfarin) who is presenting with persistent suprapubic/lower +abdominal pain and new onset severe epigastric pain w/ nausea +and vomiting, and hypertension. however, during +the initial part of her admission, the patient remained afebrile +with an initial relative leukocytosis which trended to within +baseline limits. pericarditis +was considered, but her ekg was unchanged from prior studies and +there had been on interval increase in her pericardial effusion +since [**2141-10-13**]. the patient tolerated the procedure well and immediately +reported that both her epigastric and suprapubic pain were gone +after the surgery. multiple medication regimens +were attempted and changed throughout her hospital course. when +sbp>180, give 25 mg po hydral every 30 min until sbp<150. during her admission, the patient underwent multiple +trials of peritoneal dialysis, but was unable to tolerate it on +a consistent basis secondary to abdominal pain. upon discharge, her electrolytes were back to her +baseline. epo alfa sc was +also given on [**2141-10-17**]. the patients +hct remained stable (hovering between 25 - 27) from [**2141-10-19**] - +[**2141-10-23**]. between [**2141-10-23**] - [**2141-10-24**], the patient had a hct +drop from 26 to 20 in the setting of occult positive emesis. gi +was aware and planned to perform a non-urgent egd on [**10-25**] or +[**10-26**] as the patient was hemodynamically stable and her hct +returned to baseline. she was +also started heparin drip secondary to concern for ischemic +bowel [**2-11**] microthrombotic disease. as a result, she underwent upper +extremity venous ultrasound on [**2141-11-2**], which showed no +evidence of a dvt within the left upper extremity and the +previously noted thrombus within the left subclavian vein was +not seen as well. # sle: rheumatology was consulted several times throughout her +hospital course, but they did not think that a lupus flare was +contributing to her presentation. # obstructive sleep apnea: the patient was noted to have osa +based on clinical nocturnal exam during admission.","esrd secondary to sle, malignant htn, h/o svc syndrome, and multiple thrombotic events were considered. the patient was placed on iv flagyl, but this was discontinued when stool samples were negative for c.difficile. a heparin drip and warfarin were started for treatment of possible microthrombotic ischemia." 109,124657.0,14804,2142-01-20,14799,125288.0,2141-11-23,Discharge summary,"Admission Date: [**2141-11-18**] Discharge Date: [**2141-11-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -7869,7 +8084,15 @@ is agreeable to outpatient follow up with [**company 191**] social work, and potential cbt. these can be arranged by her pcp. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Abdominal pain, unspecified site; Anemia, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Abdominal pain, unspecified site; Anemia, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","1) hypertension: patient has history of extremely labile +hypertension on an aggressive outpatient regimen. her hydralazine was increased from 75mg to 100mg tid with mild +improvement. peritoneal fluid was obtained and contained 544 +polys. the dose was lowered to 4mg daily at +discharge to prevent overshooting the therapeutic range, but the +patient will have close follow up with coumadin clinic, with +dose titrations as needed. her nephrologist felt +this may be contributing to her recurrent pain and hypertension, +so psychiatry was consulted.","patient has history of extremely labile hypertension on aggressive outpatient regimen. overnight in the micu, patient required iv and po labetalol for sbp > 200. ct scan showed increasing ascites, but no acute pathology." 109,124657.0,14804,2142-01-20,14800,161950.0,2141-12-01,Discharge summary,"Admission Date: [**2141-11-24**] Discharge Date: [**2141-12-1**] Date of Birth: [**2117-8-7**] Sex: F @@ -8258,7 +8481,10 @@ patient succesfully switched to po meds and transferred to the floor. upon transfer to the floor, the following was her ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Other ascites; ; Systemic lupus erythematosus; Headache; Anemia in chronic kidney disease; Anxiety state, unspecified; Other chest pain; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Renal dialysis status; Acquired absence of organ, eye]" +SECONDARY: [End stage renal disease; Other ascites; ; Systemic lupus erythematosus; Headache; Anemia in chronic kidney disease; Anxiety state, unspecified; Other chest pain; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Renal dialysis status; Acquired absence of organ, eye]","24yo f with sle, esrd on hd and malignant hypertension who +presented with abdominal pain and headache and was admitted for +hypertensive urgency. the renal team was consulted, and recommended no change +to home med regimen.","a 24yo f with sle, esrd on hd and malignant hypertension presented with abdominal pain and headache. the patient was found to be hypocalcemic, and was started on calcium replacement therapy. she successfully switched to po meds and was transferred to the floor." 109,124657.0,14804,2142-01-20,14801,173633.0,2141-12-14,Discharge summary,"Admission Date: [**2141-12-8**] Discharge Date: [**2141-12-14**] Date of Birth: [**2117-8-7**] Sex: F @@ -8713,7 +8939,18 @@ transfused 1u prbc at hd on [**12-12**]. she was also given epo at hd. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Systemic lupus erythematosus; Other and unspecified noninfectious gastroenteritis and colitis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Other iatrogenic hypotension; Obstructive sleep apnea (adult)(pediatric); Hemangioma of intra-abdominal structures; Other chronic pain; Abdominal pain, unspecified site; Abnormal coagulation profile; Renal dialysis status; Personal history of venous thrombosis and embolism]" +SECONDARY: [End stage renal disease; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Systemic lupus erythematosus; Other and unspecified noninfectious gastroenteritis and colitis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Other iatrogenic hypotension; Obstructive sleep apnea (adult)(pediatric); Hemangioma of intra-abdominal structures; Other chronic pain; Abdominal pain, unspecified site; Abnormal coagulation profile; Renal dialysis status; Personal history of venous thrombosis and embolism]","24 year old woman with ckd v and severe hypertension due to sle +admitted with flare of chronic abdominal pain and hypertensive +urgency. initially her blood pressure over-corrected to +sbps in the 80s (patient was asymptomatic). the patient was +transferred to the floor on [**12-10**] after resolution of her +hypertensive urgency with a decreased blood pressure regimen due +to her hypotension in response to home doses of her medications. the patient was continuned on her +admission hypertensive regimen. a ct scan was +performed that showed bowel wall changes that are likely +secondary to recent peritoneal dialysis and unrelated to pain. ckd v from lupus nephritis: the patient was continued on hd +during her admission. she was therapetuic the same day and her heparin gtt +was stopped.",24 year old woman with ckd v and severe hypertension due to sle admitted. patient was initially maintained on a labetalol drip and hydralazine iv prn. initially her blood pressure over-corrected to sbps in the 80s (patient was asymptomatic) 109,124657.0,14804,2142-01-20,14802,140167.0,2141-12-23,Discharge summary,"Admission Date: [**2141-12-18**] Discharge Date: [**2141-12-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -9185,7 +9422,23 @@ pericarditis. she was continued on her home prednisone dose of ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Mechanical complication due to peritoneal dialysis catheter; ; Unspecified disease of pericardium; Angioneurotic edema, not elsewhere classified; Abdominal pain, other specified site; Systemic lupus erythematosus; ; Anemia in chronic kidney disease; Dysthymic disorder; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of steroids; Long-term (current) use of anticoagulants; Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation; Other antihypertensive agents causing adverse effects in therapeutic use]" +SECONDARY: [End stage renal disease; Mechanical complication due to peritoneal dialysis catheter; ; Unspecified disease of pericardium; Angioneurotic edema, not elsewhere classified; Abdominal pain, other specified site; Systemic lupus erythematosus; ; Anemia in chronic kidney disease; Dysthymic disorder; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of steroids; Long-term (current) use of anticoagulants; Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation; Other antihypertensive agents causing adverse effects in therapeutic use]","24 year old female with sle, esrd on hd and malignant +hypertension presents with abdominal pain and headache +consistent with her usual hypertensive urgency and was found to +be in hypertensive urgency in ed. she was given 10mg iv labetalol and started on a labatelol drip. nephrology was consulted and dialysis +initiated in the am. she received a total of 60 mg iv hydralazine over the course of +the morning as well as 0.1 mg po clonidine. she reports bilateral calf cramping but no +leg swelling. she took her am bp meds without difficulty. her +tekturna was discontinued for concern that it might be causing +angioedema. the patient +was maintained on her heparin drip for her svc syndrome. abdominal pain: the patient has had extensive prior workup +that has been unrevealing. the +patients tunneled dialysis catheter had a cuff that was out +and qas subsequently replaced with a temporary femoral line on +[**12-21**]. the patient was scheduled +to have dialysis on [**12-23**]. she was admitted with a +subtherpeutic inr of 1.2 she was started on a heparin drip. there was +no evidence of active, acute bleeding.","24 year old female with sle, esrd on hd presents with abdominal pain and headache consistent with her usual hypertensive urgency. she was found to be in hypertensive urgency in ed. she received hydralazine iv 10 mg once and 2 inches of nitropaste." 109,124657.0,14804,2142-01-20,14803,135923.0,2142-01-12,Discharge summary,"Admission Date: [**2142-1-8**] Discharge Date: [**2142-1-13**] Date of Birth: [**2117-8-7**] Sex: F @@ -9576,7 +9829,17 @@ clonazepam. level. follow-up with transplant surgery. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Hypoxemia; Other opiates and related narcotics causing adverse effects in therapeutic use; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Abdominal pain, other specified site; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Renal dialysis status; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Other postprocedural status]" +SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Hypoxemia; Other opiates and related narcotics causing adverse effects in therapeutic use; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Abdominal pain, other specified site; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Renal dialysis status; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Other postprocedural status]","24 yo woman with hx of sle, ersd on hd, admitted with +hypertensive urgency. # hypertension: pt with extensive history of repeated admissions +for hypertension. # sle: stable, continued prednisone at 4 mg po daily. patient was +oversedated on dilaudid and had episode of oxygen desaturation +which was reversed with narcan. first name (stitle) **] (transplant +surgery). she will be sent home with low-dose morphine ir and +tylenol prn pain. if l groin pain should become uncontrollable +on current meds, pt should return to the ed for re-evaluation. this is likely secondary to aocd +and renal failure. pt will +need an inr check in the next week at her follow-up with her +pcp.","24 yo woman with hx of sle, ersd on hd, admitted with hypertensive urgency. patient was stablized on home medicaitons, suggesting medication non-compliance. patient was oversedated on dilaudid and had episode of oxygen desaturation." 109,135923.0,14803,2142-01-12,14796,139061.0,2141-09-14,Discharge summary,"Admission Date: [**2141-9-11**] Discharge Date: [**2141-9-14**] Date of Birth: [**2117-8-7**] Sex: F @@ -10032,7 +10295,16 @@ maintained on warfarin with inr goal 2.5 to 3.0. patients home prednisone regimen was continued. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Urinary tract infection, site not specified; Other primary cardiomyopathies; Systemic lupus erythematosus; Sciatica; Hyperpotassemia; Thrombocytopenia, unspecified; Abnormal coagulation profile; Hyperparathyroidism, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism]" +SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Urinary tract infection, site not specified; Other primary cardiomyopathies; Systemic lupus erythematosus; Sciatica; Hyperpotassemia; Thrombocytopenia, unspecified; Abnormal coagulation profile; Hyperparathyroidism, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism]","icu course: +ekg showed no change from prior, and cxr showed a suggestion of +rll/r diaphragm haziness. the renal team was consulted, and recommended +no change to home medication regimen. right leg pain: upon arrival on the floor, the patient +complained of [**2143-4-15**] pain in r buttock and posterior thigh, much +exacerbated with standing. of note, lumbar spine mri and r hip +xr on most recent admission were both negative. she was treated with a +three day course of ciprofloxacin. esrd: the patient has end-stage renal disease due to her +lupus. anemia: the patients hematocrit remained near her baseline +low 20s throughout her stay.","ekg showed no change from prior, and cxr showed a suggestion of rll/r diaphragm haziness. the patient was found to by hypocalcemic, and was started on calcium replacement therapy. she became more hypertensive, with sbps to the 170s-180s during the day. throughout her hospitalization, the patient had no symptoms/signs of hypertensive emergency." 109,135923.0,14803,2142-01-12,14797,172335.0,2141-09-24,Discharge summary,"Admission Date: [**2141-9-18**] Discharge Date: [**2141-9-24**] Date of Birth: [**2117-8-7**] Sex: F @@ -10605,7 +10877,23 @@ pivs ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [Pneumonia, organism unspecified; Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Hyperpotassemia; Sciatica; Other iatrogenic hypotension; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Anemia of other chronic disease; Hypocalcemia]" +SECONDARY: [Pneumonia, organism unspecified; Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Hyperpotassemia; Sciatica; Other iatrogenic hypotension; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Anemia of other chronic disease; Hypocalcemia]","24 yo with h/o of lupus, htn, and lupus nephropathy started on +peitoneal dialysis during this admissionwho was admitted +initially for r hip pain. micu course: on [**9-20**], the patient triggered for hypotension +(82/45), hypothermia (92.9) and altered mental status with +difficult arousability in setting of recent blood transfusion. urine culture and blood cultures are pending. patients +bp was in the 110s so hydralazine was stopped. her other bp meds +were otherwise continued. if patient has leg pain +again, may consider neurogenic source such a piriformis syndrome +as suggested by neurology. it would be good if we could arrange a pulmonary clinic follow +up for ms. [** she underwent ct head, and v/q scan which were unremarkable. her steroid dose was increased to 15mg given concern for need +for stress dose steroids. she was pan-cultured (blood, urine, +peritoneal dialysate) without obvious source of infection. source unclear at this point, but cxr with +question of retrocardiac opacity. continue home bp meds :labetalol 900 mg po tid but +difficult for patient to tolerate due to nausea, aliskiren *nf* +150 mg oral [**hospital1 **], nifedipine cr 60 mg po daily, clonidine patch, +hydralazine given hypertensive in setting of nausa. did well with pd on [**9-22**] but did +report some nause and cramping. # systemic lupus erythematosus: home prednisone dose 5mg.","lupus nephropathy patient on peitoneal dialysis with htn and lupus nephropathy. triggered for hypotension (82/45), hypothermia (92.9), altered mental status. concern was for sepsis, autonomic seizure, transfusion reaction, pulmonary embolus and/or narcosis." 109,135923.0,14803,2142-01-12,14798,126055.0,2141-11-03,Discharge summary,"Admission Date: [**2141-10-13**] Discharge Date: [**2141-11-3**] Date of Birth: [**2117-8-7**] Sex: F @@ -11303,7 +11591,41 @@ having undergone three rounds of hemodialysis, her bicarbonate was within normal limits at 28. ","PRIMARY: [Malignant essential hypertension] -SECONDARY: [Renal dialysis status; Epilepsy, unspecified, without mention of intractable epilepsy; Constipation, unspecified; Anemia in chronic kidney disease; Abnormal coagulation profile; Obstructive sleep apnea (adult)(pediatric); Other diseases of lung, not elsewhere classified; Other chest pain; Fever, unspecified; Rash and other nonspecific skin eruption; Other chronic pulmonary heart diseases; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Unspecified disease of pericardium; Other ascites; Acidosis; Hyposmolality and/or hyponatremia; Abdominal pain, other specified site; Abdominal pain, epigastric; Nausea with vomiting; Diarrhea; Systemic lupus erythematosus; Hyperparathyroidism, unspecified; Anemia, unspecified; Thrombocytopenia, unspecified; Esophageal reflux]" +SECONDARY: [Renal dialysis status; Epilepsy, unspecified, without mention of intractable epilepsy; Constipation, unspecified; Anemia in chronic kidney disease; Abnormal coagulation profile; Obstructive sleep apnea (adult)(pediatric); Other diseases of lung, not elsewhere classified; Other chest pain; Fever, unspecified; Rash and other nonspecific skin eruption; Other chronic pulmonary heart diseases; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Unspecified disease of pericardium; Other ascites; Acidosis; Hyposmolality and/or hyponatremia; Abdominal pain, other specified site; Abdominal pain, epigastric; Nausea with vomiting; Diarrhea; Systemic lupus erythematosus; Hyperparathyroidism, unspecified; Anemia, unspecified; Thrombocytopenia, unspecified; Esophageal reflux]","this is a 24 year old woman with esrd secondary to sle (started +peritoneal dialysis approximately one week prior to admission), +malignant htn, h/o svc syndrome, and multiple thrombotic events +(on warfarin) who is presenting with persistent suprapubic/lower +abdominal pain and new onset severe epigastric pain w/ nausea +and vomiting, and hypertension. however, during +the initial part of her admission, the patient remained afebrile +with an initial relative leukocytosis which trended to within +baseline limits. pericarditis +was considered, but her ekg was unchanged from prior studies and +there had been on interval increase in her pericardial effusion +since [**2141-10-13**]. the patient tolerated the procedure well and immediately +reported that both her epigastric and suprapubic pain were gone +after the surgery. multiple medication regimens +were attempted and changed throughout her hospital course. when +sbp>180, give 25 mg po hydral every 30 min until sbp<150. during her admission, the patient underwent multiple +trials of peritoneal dialysis, but was unable to tolerate it on +a consistent basis secondary to abdominal pain. upon discharge, her electrolytes were back to her +baseline. epo alfa sc was +also given on [**2141-10-17**]. the patients +hct remained stable (hovering between 25 - 27) from [**2141-10-19**] - +[**2141-10-23**]. between [**2141-10-23**] - [**2141-10-24**], the patient had a hct +drop from 26 to 20 in the setting of occult positive emesis. gi +was aware and planned to perform a non-urgent egd on [**10-25**] or +[**10-26**] as the patient was hemodynamically stable and her hct +returned to baseline. she was +also started heparin drip secondary to concern for ischemic +bowel [**2-11**] microthrombotic disease. as a result, she underwent upper +extremity venous ultrasound on [**2141-11-2**], which showed no +evidence of a dvt within the left upper extremity and the +previously noted thrombus within the left subclavian vein was +not seen as well. # sle: rheumatology was consulted several times throughout her +hospital course, but they did not think that a lupus flare was +contributing to her presentation. # obstructive sleep apnea: the patient was noted to have osa +based on clinical nocturnal exam during admission.","esrd secondary to sle, malignant htn, h/o svc syndrome, and multiple thrombotic events were considered. the patient was placed on iv flagyl, but this was discontinued when stool samples were negative for c.difficile. a heparin drip and warfarin were started for treatment of possible microthrombotic ischemia." 109,135923.0,14803,2142-01-12,14799,125288.0,2141-11-23,Discharge summary,"Admission Date: [**2141-11-18**] Discharge Date: [**2141-11-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -11672,7 +11994,15 @@ is agreeable to outpatient follow up with [**company 191**] social work, and potential cbt. these can be arranged by her pcp. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Abdominal pain, unspecified site; Anemia, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Abdominal pain, unspecified site; Anemia, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","1) hypertension: patient has history of extremely labile +hypertension on an aggressive outpatient regimen. her hydralazine was increased from 75mg to 100mg tid with mild +improvement. peritoneal fluid was obtained and contained 544 +polys. the dose was lowered to 4mg daily at +discharge to prevent overshooting the therapeutic range, but the +patient will have close follow up with coumadin clinic, with +dose titrations as needed. her nephrologist felt +this may be contributing to her recurrent pain and hypertension, +so psychiatry was consulted.","patient has history of extremely labile hypertension on aggressive outpatient regimen. overnight in the micu, patient required iv and po labetalol for sbp > 200. ct scan showed increasing ascites, but no acute pathology." 109,135923.0,14803,2142-01-12,14800,161950.0,2141-12-01,Discharge summary,"Admission Date: [**2141-11-24**] Discharge Date: [**2141-12-1**] Date of Birth: [**2117-8-7**] Sex: F @@ -12061,7 +12391,10 @@ patient succesfully switched to po meds and transferred to the floor. upon transfer to the floor, the following was her ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Other ascites; ; Systemic lupus erythematosus; Headache; Anemia in chronic kidney disease; Anxiety state, unspecified; Other chest pain; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Renal dialysis status; Acquired absence of organ, eye]" +SECONDARY: [End stage renal disease; Other ascites; ; Systemic lupus erythematosus; Headache; Anemia in chronic kidney disease; Anxiety state, unspecified; Other chest pain; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Renal dialysis status; Acquired absence of organ, eye]","24yo f with sle, esrd on hd and malignant hypertension who +presented with abdominal pain and headache and was admitted for +hypertensive urgency. the renal team was consulted, and recommended no change +to home med regimen.","a 24yo f with sle, esrd on hd and malignant hypertension presented with abdominal pain and headache. the patient was found to be hypocalcemic, and was started on calcium replacement therapy. she successfully switched to po meds and was transferred to the floor." 109,135923.0,14803,2142-01-12,14801,173633.0,2141-12-14,Discharge summary,"Admission Date: [**2141-12-8**] Discharge Date: [**2141-12-14**] Date of Birth: [**2117-8-7**] Sex: F @@ -12516,7 +12849,18 @@ transfused 1u prbc at hd on [**12-12**]. she was also given epo at hd. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Systemic lupus erythematosus; Other and unspecified noninfectious gastroenteritis and colitis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Other iatrogenic hypotension; Obstructive sleep apnea (adult)(pediatric); Hemangioma of intra-abdominal structures; Other chronic pain; Abdominal pain, unspecified site; Abnormal coagulation profile; Renal dialysis status; Personal history of venous thrombosis and embolism]" +SECONDARY: [End stage renal disease; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Systemic lupus erythematosus; Other and unspecified noninfectious gastroenteritis and colitis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Other iatrogenic hypotension; Obstructive sleep apnea (adult)(pediatric); Hemangioma of intra-abdominal structures; Other chronic pain; Abdominal pain, unspecified site; Abnormal coagulation profile; Renal dialysis status; Personal history of venous thrombosis and embolism]","24 year old woman with ckd v and severe hypertension due to sle +admitted with flare of chronic abdominal pain and hypertensive +urgency. initially her blood pressure over-corrected to +sbps in the 80s (patient was asymptomatic). the patient was +transferred to the floor on [**12-10**] after resolution of her +hypertensive urgency with a decreased blood pressure regimen due +to her hypotension in response to home doses of her medications. the patient was continuned on her +admission hypertensive regimen. a ct scan was +performed that showed bowel wall changes that are likely +secondary to recent peritoneal dialysis and unrelated to pain. ckd v from lupus nephritis: the patient was continued on hd +during her admission. she was therapetuic the same day and her heparin gtt +was stopped.",24 year old woman with ckd v and severe hypertension due to sle admitted. patient was initially maintained on a labetalol drip and hydralazine iv prn. initially her blood pressure over-corrected to sbps in the 80s (patient was asymptomatic) 109,135923.0,14803,2142-01-12,14802,140167.0,2141-12-23,Discharge summary,"Admission Date: [**2141-12-18**] Discharge Date: [**2141-12-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -12988,7 +13332,23 @@ pericarditis. she was continued on her home prednisone dose of ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Mechanical complication due to peritoneal dialysis catheter; ; Unspecified disease of pericardium; Angioneurotic edema, not elsewhere classified; Abdominal pain, other specified site; Systemic lupus erythematosus; ; Anemia in chronic kidney disease; Dysthymic disorder; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of steroids; Long-term (current) use of anticoagulants; Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation; Other antihypertensive agents causing adverse effects in therapeutic use]" +SECONDARY: [End stage renal disease; Mechanical complication due to peritoneal dialysis catheter; ; Unspecified disease of pericardium; Angioneurotic edema, not elsewhere classified; Abdominal pain, other specified site; Systemic lupus erythematosus; ; Anemia in chronic kidney disease; Dysthymic disorder; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of steroids; Long-term (current) use of anticoagulants; Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation; Other antihypertensive agents causing adverse effects in therapeutic use]","24 year old female with sle, esrd on hd and malignant +hypertension presents with abdominal pain and headache +consistent with her usual hypertensive urgency and was found to +be in hypertensive urgency in ed. she was given 10mg iv labetalol and started on a labatelol drip. nephrology was consulted and dialysis +initiated in the am. she received a total of 60 mg iv hydralazine over the course of +the morning as well as 0.1 mg po clonidine. she reports bilateral calf cramping but no +leg swelling. she took her am bp meds without difficulty. her +tekturna was discontinued for concern that it might be causing +angioedema. the patient +was maintained on her heparin drip for her svc syndrome. abdominal pain: the patient has had extensive prior workup +that has been unrevealing. the +patients tunneled dialysis catheter had a cuff that was out +and qas subsequently replaced with a temporary femoral line on +[**12-21**]. the patient was scheduled +to have dialysis on [**12-23**]. she was admitted with a +subtherpeutic inr of 1.2 she was started on a heparin drip. there was +no evidence of active, acute bleeding.","24 year old female with sle, esrd on hd presents with abdominal pain and headache consistent with her usual hypertensive urgency. she was found to be in hypertensive urgency in ed. she received hydralazine iv 10 mg once and 2 inches of nitropaste." 109,135923.0,14803,2142-01-12,15330,131345.0,2141-09-08,Discharge summary,"Admission Date: [**2141-9-5**] Discharge Date: [**2141-9-8**] Date of Birth: [**2117-8-7**] Sex: F @@ -13391,7 +13751,14 @@ for 2d # dispo status: ambulating, pain free, bp in the 150/90 range ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Nausea alone; Other antihypertensive agents causing adverse effects in therapeutic use; Hip and thigh injury; Unspecified accident; Hypotension, unspecified; Anemia, unspecified; Personal history of venous thrombosis and embolism; End stage renal disease; ; Urinary tract infection, site not specified; Hyperpotassemia; Acidosis; Disorders of phosphorus metabolism; Hypocalcemia; Secondary hyperparathyroidism (of renal origin)]" +SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Nausea alone; Other antihypertensive agents causing adverse effects in therapeutic use; Hip and thigh injury; Unspecified accident; Hypotension, unspecified; Anemia, unspecified; Personal history of venous thrombosis and embolism; End stage renal disease; ; Urinary tract infection, site not specified; Hyperpotassemia; Acidosis; Disorders of phosphorus metabolism; Hypocalcemia; Secondary hyperparathyroidism (of renal origin)]","ms [**known lastname **] is a 24 year old woman with sle, ckd v, and multiple +admissions for labile hypertension who presented to the ed +complaining of about a weeks?????? we opted to discharge her on her home regimen +(without decreasing doses) since she is more often having issues +with elevated blood pressures. # right leg pain: no evidence of avascular necrosis or fracture +on plain film. also had +temp to 101 on evening prior to discharge. # systemic lupus erythematosus: cont home prednisone dose +.","ms [**known lastname **] is a 24 year old woman with sle, ckd v, and multiple admissions for labile hypertension. she presented to the ed complaining of about a weeks?????? worth of right leg pain. she was initially admitted to the micu for hypertensive urgency and then transferred to the floor after a day. she was started on her home meds and tolerated them fairly well." 109,124657.0,14804,2142-01-20,15330,131345.0,2141-09-08,Discharge summary,"Admission Date: [**2141-9-5**] Discharge Date: [**2141-9-8**] Date of Birth: [**2117-8-7**] Sex: F @@ -13794,7 +14161,14 @@ for 2d # dispo status: ambulating, pain free, bp in the 150/90 range ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Nausea alone; Other antihypertensive agents causing adverse effects in therapeutic use; Hip and thigh injury; Unspecified accident; Hypotension, unspecified; Anemia, unspecified; Personal history of venous thrombosis and embolism; End stage renal disease; ; Urinary tract infection, site not specified; Hyperpotassemia; Acidosis; Disorders of phosphorus metabolism; Hypocalcemia; Secondary hyperparathyroidism (of renal origin)]" +SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Nausea alone; Other antihypertensive agents causing adverse effects in therapeutic use; Hip and thigh injury; Unspecified accident; Hypotension, unspecified; Anemia, unspecified; Personal history of venous thrombosis and embolism; End stage renal disease; ; Urinary tract infection, site not specified; Hyperpotassemia; Acidosis; Disorders of phosphorus metabolism; Hypocalcemia; Secondary hyperparathyroidism (of renal origin)]","ms [**known lastname **] is a 24 year old woman with sle, ckd v, and multiple +admissions for labile hypertension who presented to the ed +complaining of about a weeks?????? we opted to discharge her on her home regimen +(without decreasing doses) since she is more often having issues +with elevated blood pressures. # right leg pain: no evidence of avascular necrosis or fracture +on plain film. also had +temp to 101 on evening prior to discharge. # systemic lupus erythematosus: cont home prednisone dose +.","ms [**known lastname **] is a 24 year old woman with sle, ckd v, and multiple admissions for labile hypertension. she presented to the ed complaining of about a weeks?????? worth of right leg pain. she was initially admitted to the micu for hypertensive urgency and then transferred to the floor after a day. she was started on her home meds and tolerated them fairly well." 109,161950.0,14800,2141-12-01,15329,147469.0,2141-06-17,Discharge summary,"Admission Date: [**2141-6-11**] Discharge Date: [**2141-6-17**] Date of Birth: [**2117-8-7**] Sex: F @@ -14296,7 +14670,15 @@ continued on prednisone 10mg (dropped from 15mg 2 weeks ago) ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Other encephalopathy; Chronic glomerulonephritis in diseases classified elsewhere; Urinary tract infection, site not specified; Acidosis; Unspecified iridocyclitis; Acquired hemolytic anemia, unspecified; Systemic lupus erythematosus; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Swelling, mass, or lump in head and neck; Hyperpotassemia; Lump or mass in breast; Thrombocytopenia, unspecified; Hypocalcemia; Disorders of phosphorus metabolism]" +SECONDARY: [End stage renal disease; Other encephalopathy; Chronic glomerulonephritis in diseases classified elsewhere; Urinary tract infection, site not specified; Acidosis; Unspecified iridocyclitis; Acquired hemolytic anemia, unspecified; Systemic lupus erythematosus; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Swelling, mass, or lump in head and neck; Hyperpotassemia; Lump or mass in breast; Thrombocytopenia, unspecified; Hypocalcemia; Disorders of phosphorus metabolism]","a/p: 23 f with sle, esrd not on hd, chronic vte with rue and +facial swelling p/w hypertensive emergency and delta ms +initially admitted to the [**hospital unit name 153**]. she was evaluated by neurology who +considered pres, though she did not seize. aliskiren was not covered by masshealth, and a prior auth was +faxed over. also likely component of osa although this seems +chronic. inr +2.1 coumadin was held in [**hospital unit name 153**] for anticipation of procedures. avoided +fluid overload with lasix, patient currently making urine. # metabolic acidosis/electrolytes abnormalities. # ppx: systemically anticoagulated, getting kayexalate, ppi +# fen: electrolytes as above, no standing fluids i/os goal even.","delta ms was evaluated by neurology who considered pres, though she did not seize. she was started on keppra as she has had seizures before, and will follow up with them. her bp remained between 120-170 before discharge, she no longer had headaches, or nausea." 109,126055.0,14798,2141-11-03,14796,139061.0,2141-09-14,Discharge summary,"Admission Date: [**2141-9-11**] Discharge Date: [**2141-9-14**] Date of Birth: [**2117-8-7**] Sex: F @@ -14752,7 +15134,16 @@ maintained on warfarin with inr goal 2.5 to 3.0. patients home prednisone regimen was continued. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Urinary tract infection, site not specified; Other primary cardiomyopathies; Systemic lupus erythematosus; Sciatica; Hyperpotassemia; Thrombocytopenia, unspecified; Abnormal coagulation profile; Hyperparathyroidism, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism]" +SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Urinary tract infection, site not specified; Other primary cardiomyopathies; Systemic lupus erythematosus; Sciatica; Hyperpotassemia; Thrombocytopenia, unspecified; Abnormal coagulation profile; Hyperparathyroidism, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism]","icu course: +ekg showed no change from prior, and cxr showed a suggestion of +rll/r diaphragm haziness. the renal team was consulted, and recommended +no change to home medication regimen. right leg pain: upon arrival on the floor, the patient +complained of [**2143-4-15**] pain in r buttock and posterior thigh, much +exacerbated with standing. of note, lumbar spine mri and r hip +xr on most recent admission were both negative. she was treated with a +three day course of ciprofloxacin. esrd: the patient has end-stage renal disease due to her +lupus. anemia: the patients hematocrit remained near her baseline +low 20s throughout her stay.","ekg showed no change from prior, and cxr showed a suggestion of rll/r diaphragm haziness. the patient was found to by hypocalcemic, and was started on calcium replacement therapy. she became more hypertensive, with sbps to the 170s-180s during the day. throughout her hospitalization, the patient had no symptoms/signs of hypertensive emergency." 109,126055.0,14798,2141-11-03,14797,172335.0,2141-09-24,Discharge summary,"Admission Date: [**2141-9-18**] Discharge Date: [**2141-9-24**] Date of Birth: [**2117-8-7**] Sex: F @@ -15325,7 +15716,23 @@ pivs ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [Pneumonia, organism unspecified; Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Hyperpotassemia; Sciatica; Other iatrogenic hypotension; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Anemia of other chronic disease; Hypocalcemia]" +SECONDARY: [Pneumonia, organism unspecified; Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Hyperpotassemia; Sciatica; Other iatrogenic hypotension; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Anemia of other chronic disease; Hypocalcemia]","24 yo with h/o of lupus, htn, and lupus nephropathy started on +peitoneal dialysis during this admissionwho was admitted +initially for r hip pain. micu course: on [**9-20**], the patient triggered for hypotension +(82/45), hypothermia (92.9) and altered mental status with +difficult arousability in setting of recent blood transfusion. urine culture and blood cultures are pending. patients +bp was in the 110s so hydralazine was stopped. her other bp meds +were otherwise continued. if patient has leg pain +again, may consider neurogenic source such a piriformis syndrome +as suggested by neurology. it would be good if we could arrange a pulmonary clinic follow +up for ms. [** she underwent ct head, and v/q scan which were unremarkable. her steroid dose was increased to 15mg given concern for need +for stress dose steroids. she was pan-cultured (blood, urine, +peritoneal dialysate) without obvious source of infection. source unclear at this point, but cxr with +question of retrocardiac opacity. continue home bp meds :labetalol 900 mg po tid but +difficult for patient to tolerate due to nausea, aliskiren *nf* +150 mg oral [**hospital1 **], nifedipine cr 60 mg po daily, clonidine patch, +hydralazine given hypertensive in setting of nausa. did well with pd on [**9-22**] but did +report some nause and cramping. # systemic lupus erythematosus: home prednisone dose 5mg.","lupus nephropathy patient on peitoneal dialysis with htn and lupus nephropathy. triggered for hypotension (82/45), hypothermia (92.9), altered mental status. concern was for sepsis, autonomic seizure, transfusion reaction, pulmonary embolus and/or narcosis." 109,126055.0,14798,2141-11-03,15328,170149.0,2141-06-06,Discharge summary,"Admission Date: [**2141-5-24**] Discharge Date: [**2141-6-6**] Date of Birth: [**2117-8-7**] Sex: F @@ -15968,7 +16375,21 @@ her mother extensively. [**name2 (ni) **] medication hcanges were also extensively reviewed. ","PRIMARY: [] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Compression of vein; Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; ; Systemic lupus erythematosus; Anemia in chronic kidney disease; Hyperpotassemia; Hyperparathyroidism, unspecified; Other iatrogenic hypotension; Nausea with vomiting; ; Abnormal glandular Papanicolaou smear of cervix; Abdominal pain, other specified site; Other specified disorders of pancreatic internal secretion; Adrenal cortical steroids causing adverse effects in therapeutic use]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Compression of vein; Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; ; Systemic lupus erythematosus; Anemia in chronic kidney disease; Hyperpotassemia; Hyperparathyroidism, unspecified; Other iatrogenic hypotension; Nausea with vomiting; ; Abnormal glandular Papanicolaou smear of cervix; Abdominal pain, other specified site; Other specified disorders of pancreatic internal secretion; Adrenal cortical steroids causing adverse effects in therapeutic use]","known lastname **] is a 23yo woman with a history of sle, esrd and htn +who presented with acute onset bilateral facial swelling and +hypertensive urgency, which developed into l sided facial, l arm +and l breast swelling throughout her stay. mra could not +visualize the l brachiocephalic vein. it +remains unclear why her blood pressure is so chronically labile. we stopped her ace and [**last name (un) **] as above. the importance of bp control, especially +in the setting of new anticoagulation, was discussed extensively +with the patient. # esrd: the patient has esrd due to lupus nephritis. the renal team followed her +closely throughout her stay. she +will call [**doctor first name 3040**] the pd nurse tomorrow to set up an appointment +to have her catheter flushed and to start pd. we discussed the importance of +following this up with the patient, and at her request scheduled +her for an ob/gyn appointment as an outpatient shortly after +discharge. the above plan and appoitnments were reviewed with the pt and +her mother extensively. [**","a 23yo woman with a history of sle, esrd and htn presented with bilateral facial swelling. she developed l sided facial, l arm and l breast swelling throughout her stay. most likely etiology of her swelling is an acute-on-chronic (now occlusive) thrombus of l brachiocephalic vein." 109,126055.0,14798,2141-11-03,15329,147469.0,2141-06-17,Discharge summary,"Admission Date: [**2141-6-11**] Discharge Date: [**2141-6-17**] Date of Birth: [**2117-8-7**] Sex: F @@ -16470,7 +16891,15 @@ continued on prednisone 10mg (dropped from 15mg 2 weeks ago) ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Other encephalopathy; Chronic glomerulonephritis in diseases classified elsewhere; Urinary tract infection, site not specified; Acidosis; Unspecified iridocyclitis; Acquired hemolytic anemia, unspecified; Systemic lupus erythematosus; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Swelling, mass, or lump in head and neck; Hyperpotassemia; Lump or mass in breast; Thrombocytopenia, unspecified; Hypocalcemia; Disorders of phosphorus metabolism]" +SECONDARY: [End stage renal disease; Other encephalopathy; Chronic glomerulonephritis in diseases classified elsewhere; Urinary tract infection, site not specified; Acidosis; Unspecified iridocyclitis; Acquired hemolytic anemia, unspecified; Systemic lupus erythematosus; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Swelling, mass, or lump in head and neck; Hyperpotassemia; Lump or mass in breast; Thrombocytopenia, unspecified; Hypocalcemia; Disorders of phosphorus metabolism]","a/p: 23 f with sle, esrd not on hd, chronic vte with rue and +facial swelling p/w hypertensive emergency and delta ms +initially admitted to the [**hospital unit name 153**]. she was evaluated by neurology who +considered pres, though she did not seize. aliskiren was not covered by masshealth, and a prior auth was +faxed over. also likely component of osa although this seems +chronic. inr +2.1 coumadin was held in [**hospital unit name 153**] for anticipation of procedures. avoided +fluid overload with lasix, patient currently making urine. # metabolic acidosis/electrolytes abnormalities. # ppx: systemically anticoagulated, getting kayexalate, ppi +# fen: electrolytes as above, no standing fluids i/os goal even.","delta ms was evaluated by neurology who considered pres, though she did not seize. she was started on keppra as she has had seizures before, and will follow up with them. her bp remained between 120-170 before discharge, she no longer had headaches, or nausea." 109,172335.0,14797,2141-09-24,15329,147469.0,2141-06-17,Discharge summary,"Admission Date: [**2141-6-11**] Discharge Date: [**2141-6-17**] Date of Birth: [**2117-8-7**] Sex: F @@ -16972,7 +17401,15 @@ continued on prednisone 10mg (dropped from 15mg 2 weeks ago) ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Other encephalopathy; Chronic glomerulonephritis in diseases classified elsewhere; Urinary tract infection, site not specified; Acidosis; Unspecified iridocyclitis; Acquired hemolytic anemia, unspecified; Systemic lupus erythematosus; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Swelling, mass, or lump in head and neck; Hyperpotassemia; Lump or mass in breast; Thrombocytopenia, unspecified; Hypocalcemia; Disorders of phosphorus metabolism]" +SECONDARY: [End stage renal disease; Other encephalopathy; Chronic glomerulonephritis in diseases classified elsewhere; Urinary tract infection, site not specified; Acidosis; Unspecified iridocyclitis; Acquired hemolytic anemia, unspecified; Systemic lupus erythematosus; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Swelling, mass, or lump in head and neck; Hyperpotassemia; Lump or mass in breast; Thrombocytopenia, unspecified; Hypocalcemia; Disorders of phosphorus metabolism]","a/p: 23 f with sle, esrd not on hd, chronic vte with rue and +facial swelling p/w hypertensive emergency and delta ms +initially admitted to the [**hospital unit name 153**]. she was evaluated by neurology who +considered pres, though she did not seize. aliskiren was not covered by masshealth, and a prior auth was +faxed over. also likely component of osa although this seems +chronic. inr +2.1 coumadin was held in [**hospital unit name 153**] for anticipation of procedures. avoided +fluid overload with lasix, patient currently making urine. # metabolic acidosis/electrolytes abnormalities. # ppx: systemically anticoagulated, getting kayexalate, ppi +# fen: electrolytes as above, no standing fluids i/os goal even.","delta ms was evaluated by neurology who considered pres, though she did not seize. she was started on keppra as she has had seizures before, and will follow up with them. her bp remained between 120-170 before discharge, she no longer had headaches, or nausea." 109,172335.0,14797,2141-09-24,14796,139061.0,2141-09-14,Discharge summary,"Admission Date: [**2141-9-11**] Discharge Date: [**2141-9-14**] Date of Birth: [**2117-8-7**] Sex: F @@ -17428,7 +17865,16 @@ maintained on warfarin with inr goal 2.5 to 3.0. patients home prednisone regimen was continued. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Urinary tract infection, site not specified; Other primary cardiomyopathies; Systemic lupus erythematosus; Sciatica; Hyperpotassemia; Thrombocytopenia, unspecified; Abnormal coagulation profile; Hyperparathyroidism, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism]" +SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Urinary tract infection, site not specified; Other primary cardiomyopathies; Systemic lupus erythematosus; Sciatica; Hyperpotassemia; Thrombocytopenia, unspecified; Abnormal coagulation profile; Hyperparathyroidism, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism]","icu course: +ekg showed no change from prior, and cxr showed a suggestion of +rll/r diaphragm haziness. the renal team was consulted, and recommended +no change to home medication regimen. right leg pain: upon arrival on the floor, the patient +complained of [**2143-4-15**] pain in r buttock and posterior thigh, much +exacerbated with standing. of note, lumbar spine mri and r hip +xr on most recent admission were both negative. she was treated with a +three day course of ciprofloxacin. esrd: the patient has end-stage renal disease due to her +lupus. anemia: the patients hematocrit remained near her baseline +low 20s throughout her stay.","ekg showed no change from prior, and cxr showed a suggestion of rll/r diaphragm haziness. the patient was found to by hypocalcemic, and was started on calcium replacement therapy. she became more hypertensive, with sbps to the 170s-180s during the day. throughout her hospitalization, the patient had no symptoms/signs of hypertensive emergency." 109,172335.0,14797,2141-09-24,15330,131345.0,2141-09-08,Discharge summary,"Admission Date: [**2141-9-5**] Discharge Date: [**2141-9-8**] Date of Birth: [**2117-8-7**] Sex: F @@ -17831,7 +18277,14 @@ for 2d # dispo status: ambulating, pain free, bp in the 150/90 range ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Nausea alone; Other antihypertensive agents causing adverse effects in therapeutic use; Hip and thigh injury; Unspecified accident; Hypotension, unspecified; Anemia, unspecified; Personal history of venous thrombosis and embolism; End stage renal disease; ; Urinary tract infection, site not specified; Hyperpotassemia; Acidosis; Disorders of phosphorus metabolism; Hypocalcemia; Secondary hyperparathyroidism (of renal origin)]" +SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Nausea alone; Other antihypertensive agents causing adverse effects in therapeutic use; Hip and thigh injury; Unspecified accident; Hypotension, unspecified; Anemia, unspecified; Personal history of venous thrombosis and embolism; End stage renal disease; ; Urinary tract infection, site not specified; Hyperpotassemia; Acidosis; Disorders of phosphorus metabolism; Hypocalcemia; Secondary hyperparathyroidism (of renal origin)]","ms [**known lastname **] is a 24 year old woman with sle, ckd v, and multiple +admissions for labile hypertension who presented to the ed +complaining of about a weeks?????? we opted to discharge her on her home regimen +(without decreasing doses) since she is more often having issues +with elevated blood pressures. # right leg pain: no evidence of avascular necrosis or fracture +on plain film. also had +temp to 101 on evening prior to discharge. # systemic lupus erythematosus: cont home prednisone dose +.","ms [**known lastname **] is a 24 year old woman with sle, ckd v, and multiple admissions for labile hypertension. she presented to the ed complaining of about a weeks?????? worth of right leg pain. she was initially admitted to the micu for hypertensive urgency and then transferred to the floor after a day. she was started on her home meds and tolerated them fairly well." 109,172335.0,14797,2141-09-24,15328,170149.0,2141-06-06,Discharge summary,"Admission Date: [**2141-5-24**] Discharge Date: [**2141-6-6**] Date of Birth: [**2117-8-7**] Sex: F @@ -18474,7 +18927,21 @@ her mother extensively. [**name2 (ni) **] medication hcanges were also extensively reviewed. ","PRIMARY: [] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Compression of vein; Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; ; Systemic lupus erythematosus; Anemia in chronic kidney disease; Hyperpotassemia; Hyperparathyroidism, unspecified; Other iatrogenic hypotension; Nausea with vomiting; ; Abnormal glandular Papanicolaou smear of cervix; Abdominal pain, other specified site; Other specified disorders of pancreatic internal secretion; Adrenal cortical steroids causing adverse effects in therapeutic use]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Compression of vein; Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; ; Systemic lupus erythematosus; Anemia in chronic kidney disease; Hyperpotassemia; Hyperparathyroidism, unspecified; Other iatrogenic hypotension; Nausea with vomiting; ; Abnormal glandular Papanicolaou smear of cervix; Abdominal pain, other specified site; Other specified disorders of pancreatic internal secretion; Adrenal cortical steroids causing adverse effects in therapeutic use]","known lastname **] is a 23yo woman with a history of sle, esrd and htn +who presented with acute onset bilateral facial swelling and +hypertensive urgency, which developed into l sided facial, l arm +and l breast swelling throughout her stay. mra could not +visualize the l brachiocephalic vein. it +remains unclear why her blood pressure is so chronically labile. we stopped her ace and [**last name (un) **] as above. the importance of bp control, especially +in the setting of new anticoagulation, was discussed extensively +with the patient. # esrd: the patient has esrd due to lupus nephritis. the renal team followed her +closely throughout her stay. she +will call [**doctor first name 3040**] the pd nurse tomorrow to set up an appointment +to have her catheter flushed and to start pd. we discussed the importance of +following this up with the patient, and at her request scheduled +her for an ob/gyn appointment as an outpatient shortly after +discharge. the above plan and appoitnments were reviewed with the pt and +her mother extensively. [**","a 23yo woman with a history of sle, esrd and htn presented with bilateral facial swelling. she developed l sided facial, l arm and l breast swelling throughout her stay. most likely etiology of her swelling is an acute-on-chronic (now occlusive) thrombus of l brachiocephalic vein." 109,161950.0,14800,2141-12-01,15330,131345.0,2141-09-08,Discharge summary,"Admission Date: [**2141-9-5**] Discharge Date: [**2141-9-8**] Date of Birth: [**2117-8-7**] Sex: F @@ -18877,7 +19344,14 @@ for 2d # dispo status: ambulating, pain free, bp in the 150/90 range ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Nausea alone; Other antihypertensive agents causing adverse effects in therapeutic use; Hip and thigh injury; Unspecified accident; Hypotension, unspecified; Anemia, unspecified; Personal history of venous thrombosis and embolism; End stage renal disease; ; Urinary tract infection, site not specified; Hyperpotassemia; Acidosis; Disorders of phosphorus metabolism; Hypocalcemia; Secondary hyperparathyroidism (of renal origin)]" +SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Nausea alone; Other antihypertensive agents causing adverse effects in therapeutic use; Hip and thigh injury; Unspecified accident; Hypotension, unspecified; Anemia, unspecified; Personal history of venous thrombosis and embolism; End stage renal disease; ; Urinary tract infection, site not specified; Hyperpotassemia; Acidosis; Disorders of phosphorus metabolism; Hypocalcemia; Secondary hyperparathyroidism (of renal origin)]","ms [**known lastname **] is a 24 year old woman with sle, ckd v, and multiple +admissions for labile hypertension who presented to the ed +complaining of about a weeks?????? we opted to discharge her on her home regimen +(without decreasing doses) since she is more often having issues +with elevated blood pressures. # right leg pain: no evidence of avascular necrosis or fracture +on plain film. also had +temp to 101 on evening prior to discharge. # systemic lupus erythematosus: cont home prednisone dose +.","ms [**known lastname **] is a 24 year old woman with sle, ckd v, and multiple admissions for labile hypertension. she presented to the ed complaining of about a weeks?????? worth of right leg pain. she was initially admitted to the micu for hypertensive urgency and then transferred to the floor after a day. she was started on her home meds and tolerated them fairly well." 109,126055.0,14798,2141-11-03,15330,131345.0,2141-09-08,Discharge summary,"Admission Date: [**2141-9-5**] Discharge Date: [**2141-9-8**] Date of Birth: [**2117-8-7**] Sex: F @@ -19280,7 +19754,14 @@ for 2d # dispo status: ambulating, pain free, bp in the 150/90 range ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Nausea alone; Other antihypertensive agents causing adverse effects in therapeutic use; Hip and thigh injury; Unspecified accident; Hypotension, unspecified; Anemia, unspecified; Personal history of venous thrombosis and embolism; End stage renal disease; ; Urinary tract infection, site not specified; Hyperpotassemia; Acidosis; Disorders of phosphorus metabolism; Hypocalcemia; Secondary hyperparathyroidism (of renal origin)]" +SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Nausea alone; Other antihypertensive agents causing adverse effects in therapeutic use; Hip and thigh injury; Unspecified accident; Hypotension, unspecified; Anemia, unspecified; Personal history of venous thrombosis and embolism; End stage renal disease; ; Urinary tract infection, site not specified; Hyperpotassemia; Acidosis; Disorders of phosphorus metabolism; Hypocalcemia; Secondary hyperparathyroidism (of renal origin)]","ms [**known lastname **] is a 24 year old woman with sle, ckd v, and multiple +admissions for labile hypertension who presented to the ed +complaining of about a weeks?????? we opted to discharge her on her home regimen +(without decreasing doses) since she is more often having issues +with elevated blood pressures. # right leg pain: no evidence of avascular necrosis or fracture +on plain film. also had +temp to 101 on evening prior to discharge. # systemic lupus erythematosus: cont home prednisone dose +.","ms [**known lastname **] is a 24 year old woman with sle, ckd v, and multiple admissions for labile hypertension. she presented to the ed complaining of about a weeks?????? worth of right leg pain. she was initially admitted to the micu for hypertensive urgency and then transferred to the floor after a day. she was started on her home meds and tolerated them fairly well." 109,161950.0,14800,2141-12-01,14796,139061.0,2141-09-14,Discharge summary,"Admission Date: [**2141-9-11**] Discharge Date: [**2141-9-14**] Date of Birth: [**2117-8-7**] Sex: F @@ -19736,7 +20217,16 @@ maintained on warfarin with inr goal 2.5 to 3.0. patients home prednisone regimen was continued. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Urinary tract infection, site not specified; Other primary cardiomyopathies; Systemic lupus erythematosus; Sciatica; Hyperpotassemia; Thrombocytopenia, unspecified; Abnormal coagulation profile; Hyperparathyroidism, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism]" +SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Urinary tract infection, site not specified; Other primary cardiomyopathies; Systemic lupus erythematosus; Sciatica; Hyperpotassemia; Thrombocytopenia, unspecified; Abnormal coagulation profile; Hyperparathyroidism, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism]","icu course: +ekg showed no change from prior, and cxr showed a suggestion of +rll/r diaphragm haziness. the renal team was consulted, and recommended +no change to home medication regimen. right leg pain: upon arrival on the floor, the patient +complained of [**2143-4-15**] pain in r buttock and posterior thigh, much +exacerbated with standing. of note, lumbar spine mri and r hip +xr on most recent admission were both negative. she was treated with a +three day course of ciprofloxacin. esrd: the patient has end-stage renal disease due to her +lupus. anemia: the patients hematocrit remained near her baseline +low 20s throughout her stay.","ekg showed no change from prior, and cxr showed a suggestion of rll/r diaphragm haziness. the patient was found to by hypocalcemic, and was started on calcium replacement therapy. she became more hypertensive, with sbps to the 170s-180s during the day. throughout her hospitalization, the patient had no symptoms/signs of hypertensive emergency." 109,161950.0,14800,2141-12-01,14797,172335.0,2141-09-24,Discharge summary,"Admission Date: [**2141-9-18**] Discharge Date: [**2141-9-24**] Date of Birth: [**2117-8-7**] Sex: F @@ -20309,7 +20799,23 @@ pivs ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [Pneumonia, organism unspecified; Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Hyperpotassemia; Sciatica; Other iatrogenic hypotension; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Anemia of other chronic disease; Hypocalcemia]" +SECONDARY: [Pneumonia, organism unspecified; Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Hyperpotassemia; Sciatica; Other iatrogenic hypotension; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Anemia of other chronic disease; Hypocalcemia]","24 yo with h/o of lupus, htn, and lupus nephropathy started on +peitoneal dialysis during this admissionwho was admitted +initially for r hip pain. micu course: on [**9-20**], the patient triggered for hypotension +(82/45), hypothermia (92.9) and altered mental status with +difficult arousability in setting of recent blood transfusion. urine culture and blood cultures are pending. patients +bp was in the 110s so hydralazine was stopped. her other bp meds +were otherwise continued. if patient has leg pain +again, may consider neurogenic source such a piriformis syndrome +as suggested by neurology. it would be good if we could arrange a pulmonary clinic follow +up for ms. [** she underwent ct head, and v/q scan which were unremarkable. her steroid dose was increased to 15mg given concern for need +for stress dose steroids. she was pan-cultured (blood, urine, +peritoneal dialysate) without obvious source of infection. source unclear at this point, but cxr with +question of retrocardiac opacity. continue home bp meds :labetalol 900 mg po tid but +difficult for patient to tolerate due to nausea, aliskiren *nf* +150 mg oral [**hospital1 **], nifedipine cr 60 mg po daily, clonidine patch, +hydralazine given hypertensive in setting of nausa. did well with pd on [**9-22**] but did +report some nause and cramping. # systemic lupus erythematosus: home prednisone dose 5mg.","lupus nephropathy patient on peitoneal dialysis with htn and lupus nephropathy. triggered for hypotension (82/45), hypothermia (92.9), altered mental status. concern was for sepsis, autonomic seizure, transfusion reaction, pulmonary embolus and/or narcosis." 109,161950.0,14800,2141-12-01,14798,126055.0,2141-11-03,Discharge summary,"Admission Date: [**2141-10-13**] Discharge Date: [**2141-11-3**] Date of Birth: [**2117-8-7**] Sex: F @@ -21007,7 +21513,41 @@ having undergone three rounds of hemodialysis, her bicarbonate was within normal limits at 28. ","PRIMARY: [Malignant essential hypertension] -SECONDARY: [Renal dialysis status; Epilepsy, unspecified, without mention of intractable epilepsy; Constipation, unspecified; Anemia in chronic kidney disease; Abnormal coagulation profile; Obstructive sleep apnea (adult)(pediatric); Other diseases of lung, not elsewhere classified; Other chest pain; Fever, unspecified; Rash and other nonspecific skin eruption; Other chronic pulmonary heart diseases; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Unspecified disease of pericardium; Other ascites; Acidosis; Hyposmolality and/or hyponatremia; Abdominal pain, other specified site; Abdominal pain, epigastric; Nausea with vomiting; Diarrhea; Systemic lupus erythematosus; Hyperparathyroidism, unspecified; Anemia, unspecified; Thrombocytopenia, unspecified; Esophageal reflux]" +SECONDARY: [Renal dialysis status; Epilepsy, unspecified, without mention of intractable epilepsy; Constipation, unspecified; Anemia in chronic kidney disease; Abnormal coagulation profile; Obstructive sleep apnea (adult)(pediatric); Other diseases of lung, not elsewhere classified; Other chest pain; Fever, unspecified; Rash and other nonspecific skin eruption; Other chronic pulmonary heart diseases; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Unspecified disease of pericardium; Other ascites; Acidosis; Hyposmolality and/or hyponatremia; Abdominal pain, other specified site; Abdominal pain, epigastric; Nausea with vomiting; Diarrhea; Systemic lupus erythematosus; Hyperparathyroidism, unspecified; Anemia, unspecified; Thrombocytopenia, unspecified; Esophageal reflux]","this is a 24 year old woman with esrd secondary to sle (started +peritoneal dialysis approximately one week prior to admission), +malignant htn, h/o svc syndrome, and multiple thrombotic events +(on warfarin) who is presenting with persistent suprapubic/lower +abdominal pain and new onset severe epigastric pain w/ nausea +and vomiting, and hypertension. however, during +the initial part of her admission, the patient remained afebrile +with an initial relative leukocytosis which trended to within +baseline limits. pericarditis +was considered, but her ekg was unchanged from prior studies and +there had been on interval increase in her pericardial effusion +since [**2141-10-13**]. the patient tolerated the procedure well and immediately +reported that both her epigastric and suprapubic pain were gone +after the surgery. multiple medication regimens +were attempted and changed throughout her hospital course. when +sbp>180, give 25 mg po hydral every 30 min until sbp<150. during her admission, the patient underwent multiple +trials of peritoneal dialysis, but was unable to tolerate it on +a consistent basis secondary to abdominal pain. upon discharge, her electrolytes were back to her +baseline. epo alfa sc was +also given on [**2141-10-17**]. the patients +hct remained stable (hovering between 25 - 27) from [**2141-10-19**] - +[**2141-10-23**]. between [**2141-10-23**] - [**2141-10-24**], the patient had a hct +drop from 26 to 20 in the setting of occult positive emesis. gi +was aware and planned to perform a non-urgent egd on [**10-25**] or +[**10-26**] as the patient was hemodynamically stable and her hct +returned to baseline. she was +also started heparin drip secondary to concern for ischemic +bowel [**2-11**] microthrombotic disease. as a result, she underwent upper +extremity venous ultrasound on [**2141-11-2**], which showed no +evidence of a dvt within the left upper extremity and the +previously noted thrombus within the left subclavian vein was +not seen as well. # sle: rheumatology was consulted several times throughout her +hospital course, but they did not think that a lupus flare was +contributing to her presentation. # obstructive sleep apnea: the patient was noted to have osa +based on clinical nocturnal exam during admission.","esrd secondary to sle, malignant htn, h/o svc syndrome, and multiple thrombotic events were considered. the patient was placed on iv flagyl, but this was discontinued when stool samples were negative for c.difficile. a heparin drip and warfarin were started for treatment of possible microthrombotic ischemia." 109,161950.0,14800,2141-12-01,14799,125288.0,2141-11-23,Discharge summary,"Admission Date: [**2141-11-18**] Discharge Date: [**2141-11-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -21376,7 +21916,15 @@ is agreeable to outpatient follow up with [**company 191**] social work, and potential cbt. these can be arranged by her pcp. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Abdominal pain, unspecified site; Anemia, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Abdominal pain, unspecified site; Anemia, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","1) hypertension: patient has history of extremely labile +hypertension on an aggressive outpatient regimen. her hydralazine was increased from 75mg to 100mg tid with mild +improvement. peritoneal fluid was obtained and contained 544 +polys. the dose was lowered to 4mg daily at +discharge to prevent overshooting the therapeutic range, but the +patient will have close follow up with coumadin clinic, with +dose titrations as needed. her nephrologist felt +this may be contributing to her recurrent pain and hypertension, +so psychiatry was consulted.","patient has history of extremely labile hypertension on aggressive outpatient regimen. overnight in the micu, patient required iv and po labetalol for sbp > 200. ct scan showed increasing ascites, but no acute pathology." 109,161950.0,14800,2141-12-01,15328,170149.0,2141-06-06,Discharge summary,"Admission Date: [**2141-5-24**] Discharge Date: [**2141-6-6**] Date of Birth: [**2117-8-7**] Sex: F @@ -22019,7 +22567,21 @@ her mother extensively. [**name2 (ni) **] medication hcanges were also extensively reviewed. ","PRIMARY: [] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Compression of vein; Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; ; Systemic lupus erythematosus; Anemia in chronic kidney disease; Hyperpotassemia; Hyperparathyroidism, unspecified; Other iatrogenic hypotension; Nausea with vomiting; ; Abnormal glandular Papanicolaou smear of cervix; Abdominal pain, other specified site; Other specified disorders of pancreatic internal secretion; Adrenal cortical steroids causing adverse effects in therapeutic use]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Compression of vein; Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; ; Systemic lupus erythematosus; Anemia in chronic kidney disease; Hyperpotassemia; Hyperparathyroidism, unspecified; Other iatrogenic hypotension; Nausea with vomiting; ; Abnormal glandular Papanicolaou smear of cervix; Abdominal pain, other specified site; Other specified disorders of pancreatic internal secretion; Adrenal cortical steroids causing adverse effects in therapeutic use]","known lastname **] is a 23yo woman with a history of sle, esrd and htn +who presented with acute onset bilateral facial swelling and +hypertensive urgency, which developed into l sided facial, l arm +and l breast swelling throughout her stay. mra could not +visualize the l brachiocephalic vein. it +remains unclear why her blood pressure is so chronically labile. we stopped her ace and [**last name (un) **] as above. the importance of bp control, especially +in the setting of new anticoagulation, was discussed extensively +with the patient. # esrd: the patient has esrd due to lupus nephritis. the renal team followed her +closely throughout her stay. she +will call [**doctor first name 3040**] the pd nurse tomorrow to set up an appointment +to have her catheter flushed and to start pd. we discussed the importance of +following this up with the patient, and at her request scheduled +her for an ob/gyn appointment as an outpatient shortly after +discharge. the above plan and appoitnments were reviewed with the pt and +her mother extensively. [**","a 23yo woman with a history of sle, esrd and htn presented with bilateral facial swelling. she developed l sided facial, l arm and l breast swelling throughout her stay. most likely etiology of her swelling is an acute-on-chronic (now occlusive) thrombus of l brachiocephalic vein." 109,125288.0,14799,2141-11-23,15329,147469.0,2141-06-17,Discharge summary,"Admission Date: [**2141-6-11**] Discharge Date: [**2141-6-17**] Date of Birth: [**2117-8-7**] Sex: F @@ -22521,7 +23083,15 @@ continued on prednisone 10mg (dropped from 15mg 2 weeks ago) ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Other encephalopathy; Chronic glomerulonephritis in diseases classified elsewhere; Urinary tract infection, site not specified; Acidosis; Unspecified iridocyclitis; Acquired hemolytic anemia, unspecified; Systemic lupus erythematosus; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Swelling, mass, or lump in head and neck; Hyperpotassemia; Lump or mass in breast; Thrombocytopenia, unspecified; Hypocalcemia; Disorders of phosphorus metabolism]" +SECONDARY: [End stage renal disease; Other encephalopathy; Chronic glomerulonephritis in diseases classified elsewhere; Urinary tract infection, site not specified; Acidosis; Unspecified iridocyclitis; Acquired hemolytic anemia, unspecified; Systemic lupus erythematosus; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Swelling, mass, or lump in head and neck; Hyperpotassemia; Lump or mass in breast; Thrombocytopenia, unspecified; Hypocalcemia; Disorders of phosphorus metabolism]","a/p: 23 f with sle, esrd not on hd, chronic vte with rue and +facial swelling p/w hypertensive emergency and delta ms +initially admitted to the [**hospital unit name 153**]. she was evaluated by neurology who +considered pres, though she did not seize. aliskiren was not covered by masshealth, and a prior auth was +faxed over. also likely component of osa although this seems +chronic. inr +2.1 coumadin was held in [**hospital unit name 153**] for anticipation of procedures. avoided +fluid overload with lasix, patient currently making urine. # metabolic acidosis/electrolytes abnormalities. # ppx: systemically anticoagulated, getting kayexalate, ppi +# fen: electrolytes as above, no standing fluids i/os goal even.","delta ms was evaluated by neurology who considered pres, though she did not seize. she was started on keppra as she has had seizures before, and will follow up with them. her bp remained between 120-170 before discharge, she no longer had headaches, or nausea." 109,125288.0,14799,2141-11-23,14796,139061.0,2141-09-14,Discharge summary,"Admission Date: [**2141-9-11**] Discharge Date: [**2141-9-14**] Date of Birth: [**2117-8-7**] Sex: F @@ -22977,7 +23547,16 @@ maintained on warfarin with inr goal 2.5 to 3.0. patients home prednisone regimen was continued. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Urinary tract infection, site not specified; Other primary cardiomyopathies; Systemic lupus erythematosus; Sciatica; Hyperpotassemia; Thrombocytopenia, unspecified; Abnormal coagulation profile; Hyperparathyroidism, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism]" +SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Urinary tract infection, site not specified; Other primary cardiomyopathies; Systemic lupus erythematosus; Sciatica; Hyperpotassemia; Thrombocytopenia, unspecified; Abnormal coagulation profile; Hyperparathyroidism, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism]","icu course: +ekg showed no change from prior, and cxr showed a suggestion of +rll/r diaphragm haziness. the renal team was consulted, and recommended +no change to home medication regimen. right leg pain: upon arrival on the floor, the patient +complained of [**2143-4-15**] pain in r buttock and posterior thigh, much +exacerbated with standing. of note, lumbar spine mri and r hip +xr on most recent admission were both negative. she was treated with a +three day course of ciprofloxacin. esrd: the patient has end-stage renal disease due to her +lupus. anemia: the patients hematocrit remained near her baseline +low 20s throughout her stay.","ekg showed no change from prior, and cxr showed a suggestion of rll/r diaphragm haziness. the patient was found to by hypocalcemic, and was started on calcium replacement therapy. she became more hypertensive, with sbps to the 170s-180s during the day. throughout her hospitalization, the patient had no symptoms/signs of hypertensive emergency." 109,125288.0,14799,2141-11-23,14797,172335.0,2141-09-24,Discharge summary,"Admission Date: [**2141-9-18**] Discharge Date: [**2141-9-24**] Date of Birth: [**2117-8-7**] Sex: F @@ -23550,7 +24129,23 @@ pivs ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [Pneumonia, organism unspecified; Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Hyperpotassemia; Sciatica; Other iatrogenic hypotension; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Anemia of other chronic disease; Hypocalcemia]" +SECONDARY: [Pneumonia, organism unspecified; Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Hyperpotassemia; Sciatica; Other iatrogenic hypotension; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Anemia of other chronic disease; Hypocalcemia]","24 yo with h/o of lupus, htn, and lupus nephropathy started on +peitoneal dialysis during this admissionwho was admitted +initially for r hip pain. micu course: on [**9-20**], the patient triggered for hypotension +(82/45), hypothermia (92.9) and altered mental status with +difficult arousability in setting of recent blood transfusion. urine culture and blood cultures are pending. patients +bp was in the 110s so hydralazine was stopped. her other bp meds +were otherwise continued. if patient has leg pain +again, may consider neurogenic source such a piriformis syndrome +as suggested by neurology. it would be good if we could arrange a pulmonary clinic follow +up for ms. [** she underwent ct head, and v/q scan which were unremarkable. her steroid dose was increased to 15mg given concern for need +for stress dose steroids. she was pan-cultured (blood, urine, +peritoneal dialysate) without obvious source of infection. source unclear at this point, but cxr with +question of retrocardiac opacity. continue home bp meds :labetalol 900 mg po tid but +difficult for patient to tolerate due to nausea, aliskiren *nf* +150 mg oral [**hospital1 **], nifedipine cr 60 mg po daily, clonidine patch, +hydralazine given hypertensive in setting of nausa. did well with pd on [**9-22**] but did +report some nause and cramping. # systemic lupus erythematosus: home prednisone dose 5mg.","lupus nephropathy patient on peitoneal dialysis with htn and lupus nephropathy. triggered for hypotension (82/45), hypothermia (92.9), altered mental status. concern was for sepsis, autonomic seizure, transfusion reaction, pulmonary embolus and/or narcosis." 109,125288.0,14799,2141-11-23,14798,126055.0,2141-11-03,Discharge summary,"Admission Date: [**2141-10-13**] Discharge Date: [**2141-11-3**] Date of Birth: [**2117-8-7**] Sex: F @@ -24248,7 +24843,41 @@ having undergone three rounds of hemodialysis, her bicarbonate was within normal limits at 28. ","PRIMARY: [Malignant essential hypertension] -SECONDARY: [Renal dialysis status; Epilepsy, unspecified, without mention of intractable epilepsy; Constipation, unspecified; Anemia in chronic kidney disease; Abnormal coagulation profile; Obstructive sleep apnea (adult)(pediatric); Other diseases of lung, not elsewhere classified; Other chest pain; Fever, unspecified; Rash and other nonspecific skin eruption; Other chronic pulmonary heart diseases; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Unspecified disease of pericardium; Other ascites; Acidosis; Hyposmolality and/or hyponatremia; Abdominal pain, other specified site; Abdominal pain, epigastric; Nausea with vomiting; Diarrhea; Systemic lupus erythematosus; Hyperparathyroidism, unspecified; Anemia, unspecified; Thrombocytopenia, unspecified; Esophageal reflux]" +SECONDARY: [Renal dialysis status; Epilepsy, unspecified, without mention of intractable epilepsy; Constipation, unspecified; Anemia in chronic kidney disease; Abnormal coagulation profile; Obstructive sleep apnea (adult)(pediatric); Other diseases of lung, not elsewhere classified; Other chest pain; Fever, unspecified; Rash and other nonspecific skin eruption; Other chronic pulmonary heart diseases; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Unspecified disease of pericardium; Other ascites; Acidosis; Hyposmolality and/or hyponatremia; Abdominal pain, other specified site; Abdominal pain, epigastric; Nausea with vomiting; Diarrhea; Systemic lupus erythematosus; Hyperparathyroidism, unspecified; Anemia, unspecified; Thrombocytopenia, unspecified; Esophageal reflux]","this is a 24 year old woman with esrd secondary to sle (started +peritoneal dialysis approximately one week prior to admission), +malignant htn, h/o svc syndrome, and multiple thrombotic events +(on warfarin) who is presenting with persistent suprapubic/lower +abdominal pain and new onset severe epigastric pain w/ nausea +and vomiting, and hypertension. however, during +the initial part of her admission, the patient remained afebrile +with an initial relative leukocytosis which trended to within +baseline limits. pericarditis +was considered, but her ekg was unchanged from prior studies and +there had been on interval increase in her pericardial effusion +since [**2141-10-13**]. the patient tolerated the procedure well and immediately +reported that both her epigastric and suprapubic pain were gone +after the surgery. multiple medication regimens +were attempted and changed throughout her hospital course. when +sbp>180, give 25 mg po hydral every 30 min until sbp<150. during her admission, the patient underwent multiple +trials of peritoneal dialysis, but was unable to tolerate it on +a consistent basis secondary to abdominal pain. upon discharge, her electrolytes were back to her +baseline. epo alfa sc was +also given on [**2141-10-17**]. the patients +hct remained stable (hovering between 25 - 27) from [**2141-10-19**] - +[**2141-10-23**]. between [**2141-10-23**] - [**2141-10-24**], the patient had a hct +drop from 26 to 20 in the setting of occult positive emesis. gi +was aware and planned to perform a non-urgent egd on [**10-25**] or +[**10-26**] as the patient was hemodynamically stable and her hct +returned to baseline. she was +also started heparin drip secondary to concern for ischemic +bowel [**2-11**] microthrombotic disease. as a result, she underwent upper +extremity venous ultrasound on [**2141-11-2**], which showed no +evidence of a dvt within the left upper extremity and the +previously noted thrombus within the left subclavian vein was +not seen as well. # sle: rheumatology was consulted several times throughout her +hospital course, but they did not think that a lupus flare was +contributing to her presentation. # obstructive sleep apnea: the patient was noted to have osa +based on clinical nocturnal exam during admission.","esrd secondary to sle, malignant htn, h/o svc syndrome, and multiple thrombotic events were considered. the patient was placed on iv flagyl, but this was discontinued when stool samples were negative for c.difficile. a heparin drip and warfarin were started for treatment of possible microthrombotic ischemia." 109,125288.0,14799,2141-11-23,15330,131345.0,2141-09-08,Discharge summary,"Admission Date: [**2141-9-5**] Discharge Date: [**2141-9-8**] Date of Birth: [**2117-8-7**] Sex: F @@ -24651,7 +25280,14 @@ for 2d # dispo status: ambulating, pain free, bp in the 150/90 range ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Nausea alone; Other antihypertensive agents causing adverse effects in therapeutic use; Hip and thigh injury; Unspecified accident; Hypotension, unspecified; Anemia, unspecified; Personal history of venous thrombosis and embolism; End stage renal disease; ; Urinary tract infection, site not specified; Hyperpotassemia; Acidosis; Disorders of phosphorus metabolism; Hypocalcemia; Secondary hyperparathyroidism (of renal origin)]" +SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Nausea alone; Other antihypertensive agents causing adverse effects in therapeutic use; Hip and thigh injury; Unspecified accident; Hypotension, unspecified; Anemia, unspecified; Personal history of venous thrombosis and embolism; End stage renal disease; ; Urinary tract infection, site not specified; Hyperpotassemia; Acidosis; Disorders of phosphorus metabolism; Hypocalcemia; Secondary hyperparathyroidism (of renal origin)]","ms [**known lastname **] is a 24 year old woman with sle, ckd v, and multiple +admissions for labile hypertension who presented to the ed +complaining of about a weeks?????? we opted to discharge her on her home regimen +(without decreasing doses) since she is more often having issues +with elevated blood pressures. # right leg pain: no evidence of avascular necrosis or fracture +on plain film. also had +temp to 101 on evening prior to discharge. # systemic lupus erythematosus: cont home prednisone dose +.","ms [**known lastname **] is a 24 year old woman with sle, ckd v, and multiple admissions for labile hypertension. she presented to the ed complaining of about a weeks?????? worth of right leg pain. she was initially admitted to the micu for hypertensive urgency and then transferred to the floor after a day. she was started on her home meds and tolerated them fairly well." 109,125288.0,14799,2141-11-23,15328,170149.0,2141-06-06,Discharge summary,"Admission Date: [**2141-5-24**] Discharge Date: [**2141-6-6**] Date of Birth: [**2117-8-7**] Sex: F @@ -25294,7 +25930,21 @@ her mother extensively. [**name2 (ni) **] medication hcanges were also extensively reviewed. ","PRIMARY: [] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Compression of vein; Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; ; Systemic lupus erythematosus; Anemia in chronic kidney disease; Hyperpotassemia; Hyperparathyroidism, unspecified; Other iatrogenic hypotension; Nausea with vomiting; ; Abnormal glandular Papanicolaou smear of cervix; Abdominal pain, other specified site; Other specified disorders of pancreatic internal secretion; Adrenal cortical steroids causing adverse effects in therapeutic use]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Compression of vein; Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; ; Systemic lupus erythematosus; Anemia in chronic kidney disease; Hyperpotassemia; Hyperparathyroidism, unspecified; Other iatrogenic hypotension; Nausea with vomiting; ; Abnormal glandular Papanicolaou smear of cervix; Abdominal pain, other specified site; Other specified disorders of pancreatic internal secretion; Adrenal cortical steroids causing adverse effects in therapeutic use]","known lastname **] is a 23yo woman with a history of sle, esrd and htn +who presented with acute onset bilateral facial swelling and +hypertensive urgency, which developed into l sided facial, l arm +and l breast swelling throughout her stay. mra could not +visualize the l brachiocephalic vein. it +remains unclear why her blood pressure is so chronically labile. we stopped her ace and [**last name (un) **] as above. the importance of bp control, especially +in the setting of new anticoagulation, was discussed extensively +with the patient. # esrd: the patient has esrd due to lupus nephritis. the renal team followed her +closely throughout her stay. she +will call [**doctor first name 3040**] the pd nurse tomorrow to set up an appointment +to have her catheter flushed and to start pd. we discussed the importance of +following this up with the patient, and at her request scheduled +her for an ob/gyn appointment as an outpatient shortly after +discharge. the above plan and appoitnments were reviewed with the pt and +her mother extensively. [**","a 23yo woman with a history of sle, esrd and htn presented with bilateral facial swelling. she developed l sided facial, l arm and l breast swelling throughout her stay. most likely etiology of her swelling is an acute-on-chronic (now occlusive) thrombus of l brachiocephalic vein." 109,137510.0,14810,2142-04-22,14798,126055.0,2141-11-03,Discharge summary,"Admission Date: [**2141-10-13**] Discharge Date: [**2141-11-3**] Date of Birth: [**2117-8-7**] Sex: F @@ -25992,7 +26642,41 @@ having undergone three rounds of hemodialysis, her bicarbonate was within normal limits at 28. ","PRIMARY: [Malignant essential hypertension] -SECONDARY: [Renal dialysis status; Epilepsy, unspecified, without mention of intractable epilepsy; Constipation, unspecified; Anemia in chronic kidney disease; Abnormal coagulation profile; Obstructive sleep apnea (adult)(pediatric); Other diseases of lung, not elsewhere classified; Other chest pain; Fever, unspecified; Rash and other nonspecific skin eruption; Other chronic pulmonary heart diseases; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Unspecified disease of pericardium; Other ascites; Acidosis; Hyposmolality and/or hyponatremia; Abdominal pain, other specified site; Abdominal pain, epigastric; Nausea with vomiting; Diarrhea; Systemic lupus erythematosus; Hyperparathyroidism, unspecified; Anemia, unspecified; Thrombocytopenia, unspecified; Esophageal reflux]" +SECONDARY: [Renal dialysis status; Epilepsy, unspecified, without mention of intractable epilepsy; Constipation, unspecified; Anemia in chronic kidney disease; Abnormal coagulation profile; Obstructive sleep apnea (adult)(pediatric); Other diseases of lung, not elsewhere classified; Other chest pain; Fever, unspecified; Rash and other nonspecific skin eruption; Other chronic pulmonary heart diseases; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Unspecified disease of pericardium; Other ascites; Acidosis; Hyposmolality and/or hyponatremia; Abdominal pain, other specified site; Abdominal pain, epigastric; Nausea with vomiting; Diarrhea; Systemic lupus erythematosus; Hyperparathyroidism, unspecified; Anemia, unspecified; Thrombocytopenia, unspecified; Esophageal reflux]","this is a 24 year old woman with esrd secondary to sle (started +peritoneal dialysis approximately one week prior to admission), +malignant htn, h/o svc syndrome, and multiple thrombotic events +(on warfarin) who is presenting with persistent suprapubic/lower +abdominal pain and new onset severe epigastric pain w/ nausea +and vomiting, and hypertension. however, during +the initial part of her admission, the patient remained afebrile +with an initial relative leukocytosis which trended to within +baseline limits. pericarditis +was considered, but her ekg was unchanged from prior studies and +there had been on interval increase in her pericardial effusion +since [**2141-10-13**]. the patient tolerated the procedure well and immediately +reported that both her epigastric and suprapubic pain were gone +after the surgery. multiple medication regimens +were attempted and changed throughout her hospital course. when +sbp>180, give 25 mg po hydral every 30 min until sbp<150. during her admission, the patient underwent multiple +trials of peritoneal dialysis, but was unable to tolerate it on +a consistent basis secondary to abdominal pain. upon discharge, her electrolytes were back to her +baseline. epo alfa sc was +also given on [**2141-10-17**]. the patients +hct remained stable (hovering between 25 - 27) from [**2141-10-19**] - +[**2141-10-23**]. between [**2141-10-23**] - [**2141-10-24**], the patient had a hct +drop from 26 to 20 in the setting of occult positive emesis. gi +was aware and planned to perform a non-urgent egd on [**10-25**] or +[**10-26**] as the patient was hemodynamically stable and her hct +returned to baseline. she was +also started heparin drip secondary to concern for ischemic +bowel [**2-11**] microthrombotic disease. as a result, she underwent upper +extremity venous ultrasound on [**2141-11-2**], which showed no +evidence of a dvt within the left upper extremity and the +previously noted thrombus within the left subclavian vein was +not seen as well. # sle: rheumatology was consulted several times throughout her +hospital course, but they did not think that a lupus flare was +contributing to her presentation. # obstructive sleep apnea: the patient was noted to have osa +based on clinical nocturnal exam during admission.","esrd secondary to sle, malignant htn, h/o svc syndrome, and multiple thrombotic events were considered. the patient was placed on iv flagyl, but this was discontinued when stool samples were negative for c.difficile. a heparin drip and warfarin were started for treatment of possible microthrombotic ischemia." 109,137510.0,14810,2142-04-22,14799,125288.0,2141-11-23,Discharge summary,"Admission Date: [**2141-11-18**] Discharge Date: [**2141-11-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -26361,7 +27045,15 @@ is agreeable to outpatient follow up with [**company 191**] social work, and potential cbt. these can be arranged by her pcp. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Abdominal pain, unspecified site; Anemia, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Abdominal pain, unspecified site; Anemia, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","1) hypertension: patient has history of extremely labile +hypertension on an aggressive outpatient regimen. her hydralazine was increased from 75mg to 100mg tid with mild +improvement. peritoneal fluid was obtained and contained 544 +polys. the dose was lowered to 4mg daily at +discharge to prevent overshooting the therapeutic range, but the +patient will have close follow up with coumadin clinic, with +dose titrations as needed. her nephrologist felt +this may be contributing to her recurrent pain and hypertension, +so psychiatry was consulted.","patient has history of extremely labile hypertension on aggressive outpatient regimen. overnight in the micu, patient required iv and po labetalol for sbp > 200. ct scan showed increasing ascites, but no acute pathology." 109,137510.0,14810,2142-04-22,14800,161950.0,2141-12-01,Discharge summary,"Admission Date: [**2141-11-24**] Discharge Date: [**2141-12-1**] Date of Birth: [**2117-8-7**] Sex: F @@ -26750,7 +27442,10 @@ patient succesfully switched to po meds and transferred to the floor. upon transfer to the floor, the following was her ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Other ascites; ; Systemic lupus erythematosus; Headache; Anemia in chronic kidney disease; Anxiety state, unspecified; Other chest pain; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Renal dialysis status; Acquired absence of organ, eye]" +SECONDARY: [End stage renal disease; Other ascites; ; Systemic lupus erythematosus; Headache; Anemia in chronic kidney disease; Anxiety state, unspecified; Other chest pain; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Renal dialysis status; Acquired absence of organ, eye]","24yo f with sle, esrd on hd and malignant hypertension who +presented with abdominal pain and headache and was admitted for +hypertensive urgency. the renal team was consulted, and recommended no change +to home med regimen.","a 24yo f with sle, esrd on hd and malignant hypertension presented with abdominal pain and headache. the patient was found to be hypocalcemic, and was started on calcium replacement therapy. she successfully switched to po meds and was transferred to the floor." 109,137510.0,14810,2142-04-22,14801,173633.0,2141-12-14,Discharge summary,"Admission Date: [**2141-12-8**] Discharge Date: [**2141-12-14**] Date of Birth: [**2117-8-7**] Sex: F @@ -27205,7 +27900,18 @@ transfused 1u prbc at hd on [**12-12**]. she was also given epo at hd. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Systemic lupus erythematosus; Other and unspecified noninfectious gastroenteritis and colitis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Other iatrogenic hypotension; Obstructive sleep apnea (adult)(pediatric); Hemangioma of intra-abdominal structures; Other chronic pain; Abdominal pain, unspecified site; Abnormal coagulation profile; Renal dialysis status; Personal history of venous thrombosis and embolism]" +SECONDARY: [End stage renal disease; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Systemic lupus erythematosus; Other and unspecified noninfectious gastroenteritis and colitis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Other iatrogenic hypotension; Obstructive sleep apnea (adult)(pediatric); Hemangioma of intra-abdominal structures; Other chronic pain; Abdominal pain, unspecified site; Abnormal coagulation profile; Renal dialysis status; Personal history of venous thrombosis and embolism]","24 year old woman with ckd v and severe hypertension due to sle +admitted with flare of chronic abdominal pain and hypertensive +urgency. initially her blood pressure over-corrected to +sbps in the 80s (patient was asymptomatic). the patient was +transferred to the floor on [**12-10**] after resolution of her +hypertensive urgency with a decreased blood pressure regimen due +to her hypotension in response to home doses of her medications. the patient was continuned on her +admission hypertensive regimen. a ct scan was +performed that showed bowel wall changes that are likely +secondary to recent peritoneal dialysis and unrelated to pain. ckd v from lupus nephritis: the patient was continued on hd +during her admission. she was therapetuic the same day and her heparin gtt +was stopped.",24 year old woman with ckd v and severe hypertension due to sle admitted. patient was initially maintained on a labetalol drip and hydralazine iv prn. initially her blood pressure over-corrected to sbps in the 80s (patient was asymptomatic) 109,137510.0,14810,2142-04-22,14802,140167.0,2141-12-23,Discharge summary,"Admission Date: [**2141-12-18**] Discharge Date: [**2141-12-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -27677,7 +28383,23 @@ pericarditis. she was continued on her home prednisone dose of ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Mechanical complication due to peritoneal dialysis catheter; ; Unspecified disease of pericardium; Angioneurotic edema, not elsewhere classified; Abdominal pain, other specified site; Systemic lupus erythematosus; ; Anemia in chronic kidney disease; Dysthymic disorder; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of steroids; Long-term (current) use of anticoagulants; Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation; Other antihypertensive agents causing adverse effects in therapeutic use]" +SECONDARY: [End stage renal disease; Mechanical complication due to peritoneal dialysis catheter; ; Unspecified disease of pericardium; Angioneurotic edema, not elsewhere classified; Abdominal pain, other specified site; Systemic lupus erythematosus; ; Anemia in chronic kidney disease; Dysthymic disorder; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of steroids; Long-term (current) use of anticoagulants; Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation; Other antihypertensive agents causing adverse effects in therapeutic use]","24 year old female with sle, esrd on hd and malignant +hypertension presents with abdominal pain and headache +consistent with her usual hypertensive urgency and was found to +be in hypertensive urgency in ed. she was given 10mg iv labetalol and started on a labatelol drip. nephrology was consulted and dialysis +initiated in the am. she received a total of 60 mg iv hydralazine over the course of +the morning as well as 0.1 mg po clonidine. she reports bilateral calf cramping but no +leg swelling. she took her am bp meds without difficulty. her +tekturna was discontinued for concern that it might be causing +angioedema. the patient +was maintained on her heparin drip for her svc syndrome. abdominal pain: the patient has had extensive prior workup +that has been unrevealing. the +patients tunneled dialysis catheter had a cuff that was out +and qas subsequently replaced with a temporary femoral line on +[**12-21**]. the patient was scheduled +to have dialysis on [**12-23**]. she was admitted with a +subtherpeutic inr of 1.2 she was started on a heparin drip. there was +no evidence of active, acute bleeding.","24 year old female with sle, esrd on hd presents with abdominal pain and headache consistent with her usual hypertensive urgency. she was found to be in hypertensive urgency in ed. she received hydralazine iv 10 mg once and 2 inches of nitropaste." 109,137510.0,14810,2142-04-22,14803,135923.0,2142-01-12,Discharge summary,"Admission Date: [**2142-1-8**] Discharge Date: [**2142-1-13**] Date of Birth: [**2117-8-7**] Sex: F @@ -28068,7 +28790,17 @@ clonazepam. level. follow-up with transplant surgery. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Hypoxemia; Other opiates and related narcotics causing adverse effects in therapeutic use; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Abdominal pain, other specified site; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Renal dialysis status; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Other postprocedural status]" +SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Hypoxemia; Other opiates and related narcotics causing adverse effects in therapeutic use; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Abdominal pain, other specified site; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Renal dialysis status; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Other postprocedural status]","24 yo woman with hx of sle, ersd on hd, admitted with +hypertensive urgency. # hypertension: pt with extensive history of repeated admissions +for hypertension. # sle: stable, continued prednisone at 4 mg po daily. patient was +oversedated on dilaudid and had episode of oxygen desaturation +which was reversed with narcan. first name (stitle) **] (transplant +surgery). she will be sent home with low-dose morphine ir and +tylenol prn pain. if l groin pain should become uncontrollable +on current meds, pt should return to the ed for re-evaluation. this is likely secondary to aocd +and renal failure. pt will +need an inr check in the next week at her follow-up with her +pcp.","24 yo woman with hx of sle, ersd on hd, admitted with hypertensive urgency. patient was stablized on home medicaitons, suggesting medication non-compliance. patient was oversedated on dilaudid and had episode of oxygen desaturation." 109,137510.0,14810,2142-04-22,14804,124657.0,2142-01-20,Discharge summary,"Admission Date: [**2142-1-14**] Discharge Date: [**2142-1-20**] Date of Birth: [**2117-8-7**] Sex: F @@ -28487,7 +29219,15 @@ prn. # contact: [**first name8 (namepattern2) **] [**name (ni) **] (mother) [**telephone/fax (1) 43503**] ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; ; Other vascular complications of medical care, not elsewhere classified; Systemic lupus erythematosus; Hyperpotassemia; Phlebitis and thrombophlebitis of upper extremities, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [End stage renal disease; ; Other vascular complications of medical care, not elsewhere classified; Systemic lupus erythematosus; Hyperpotassemia; Phlebitis and thrombophlebitis of upper extremities, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","24 yo woman with hx of sle, ersd on hd, admitted with +hypertensive urgency. in the micu, +nifedipine extended release was added in place of nicardipine as +pts blood pressures seemed to rise prior to nicardipine doses. pt was continued on +gabapentin, tylenol around the clock, and low-dose morphine as +needed for pain. # anemia: hct was mildly decreased from baseline during +admission. # hocm: pt has evidence of myocardial hypertrophy on recent +echo. # fen: repleted lytes prn / regular diet +. # contact: [**first name8 (namepattern2) **] [**name (ni) **] (mother) [**telephone/fax (1) 43503**]","24 yo woman with hx of sle, ersd on hd, admitted with hypertensive urgency. pt was transferred to the floor as blood pressure stabilized. pt reported that morphine did not help pain, and was switched to dilaudid po in the micu." 109,137510.0,14810,2142-04-22,14805,176760.0,2142-01-23,Discharge summary,"Admission Date: [**2142-1-21**] Discharge Date: [**2142-1-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -28929,7 +29669,13 @@ pericardial effusion. continued beta blocker ","PRIMARY: [Other vascular complications of medical care, not elsewhere classified] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; ; Systemic lupus erythematosus; Phlebitis and thrombophlebitis of upper extremities, unspecified]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; ; Systemic lupus erythematosus; Phlebitis and thrombophlebitis of upper extremities, unspecified]","24 yo woman with hx of sle, ersd on hd, admitted with +hypertensive urgency and left wrist pain. she was started on nicardipine drip and 1"" nitropaste +and admitted to the icu for further treatment. she was +continued on iv vanco with hd for 10day course. esrd: continued on regularly scheduled dialysis. her hct was mildly decreased from +baseline. hocm: evidence of myocardial hypertrophy on recent echo. echo without evidence of worsening +pericardial effusion. continued celexa, clonazepam 0.5mg [**hospital1 **] +.","24 yo woman with hx of sle, ersd on hd, admitted with hypertensive urgency and left wrist pain. she was started on nicardipine drip and 1"" nitropaste and admitted to the icu for further treatment. her bp quickly stabilized and she was called out to the medical floor where her sbp ranged 110-150." 109,137510.0,14810,2142-04-22,14806,113189.0,2142-02-17,Discharge summary,"Admission Date: [**2142-2-14**] Discharge Date: [**2142-2-17**] Date of Birth: [**2117-8-7**] Sex: F @@ -29250,7 +29996,11 @@ infusions were needed. # depression/anxiety: continued celexa, clonazepam 0.5mg [**hospital1 **] ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Thrombotic microangiopathy; Systemic lupus erythematosus; Anemia in chronic kidney disease; Thrombocytopenia, unspecified; Obstructive sleep apnea (adult)(pediatric); Nontraumatic hematoma of soft tissue; Dysthymic disorder; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]" +SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Thrombotic microangiopathy; Systemic lupus erythematosus; Anemia in chronic kidney disease; Thrombocytopenia, unspecified; Obstructive sleep apnea (adult)(pediatric); Nontraumatic hematoma of soft tissue; Dysthymic disorder; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]","24 y.o female with sle, esrd on hd and malignant hypertension +who presents with htn and sob aftering missing hd. pt was treated per omr +hypertensive protocol created by the patients primary +providers, with a goal sbp of 160-180. # coagulopathy/history of dvt: patient on lifetime +anticoagulation for hx of multiple thrombotic events.","24 y.o female with sle, esrd on hd and malignant hypertension who presents with htn and sob after missing hd. pt was treated per omr hypertensive protocol created by the patients primary providers, with a goal sbp of 160-180. she was well maintained on oral outpt regimen of clonidine, labetalol, aliskiren, nifedipine." 109,137510.0,14810,2142-04-22,14808,158943.0,2142-03-23,Discharge summary,"Admission Date: [**2142-3-21**] Discharge Date: [**2142-3-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -29602,7 +30352,13 @@ multiple thrombotic events. continued coumadin not symptomatic. continued labetalol. ","PRIMARY: [] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Compression of vein; Unspecified disease of pericardium; Infection and inflammatory reaction due to other vascular device, implant, and graft; Bacteremia; Primary hypercoagulable state; Other primary cardiomyopathies; ; Abdominal pain, unspecified site; Urinary tract infection, site not specified; Acidosis; Other chest pain; Other chronic pain; Systemic lupus erythematosus; Noncompliance with renal dialysis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Hyperpotassemia; Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus]; Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Methicillin resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Compression of vein; Unspecified disease of pericardium; Infection and inflammatory reaction due to other vascular device, implant, and graft; Bacteremia; Primary hypercoagulable state; Other primary cardiomyopathies; ; Abdominal pain, unspecified site; Urinary tract infection, site not specified; Acidosis; Other chest pain; Other chronic pain; Systemic lupus erythematosus; Noncompliance with renal dialysis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Hyperpotassemia; Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus]; Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Methicillin resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","this is a 24 y.o f with sle, esrd on hd and malignant +hypertension + presenting with abd pain, diarrhea, and htn. ct prelim neg +for small bowel obstruction. on +arrival to the floor, abd pain was back to baseline and well +controlled on dilaudid 2mg po q 4hrs +.","a 24 y.o f with sle, esrd on hd and malignant hypertension presenting with abd pain, diarrhea, and htn. initial attempts were made to control her bp with hydralazine and labetalol iv but after these failed to control her blood pressure. she was successfully transitioned to home medications of clonidine, labetalol, aliskiren, nifedipine" 109,137510.0,14810,2142-04-22,14809,124398.0,2142-03-31,Discharge summary,"Admission Date: [**2142-3-24**] Discharge Date: [**2142-3-31**] Date of Birth: [**2117-8-7**] Sex: F @@ -29924,7 +30680,12 @@ she was discharged to followup with her nephrologist, dr. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Systemic lupus erythematosus; Anemia in chronic kidney disease; Long-term (current) use of steroids; Other chronic pain; Obstructive sleep apnea (adult)(pediatric); Abdominal pain, generalized; Hyperpotassemia]" +SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Systemic lupus erythematosus; Anemia in chronic kidney disease; Long-term (current) use of steroids; Other chronic pain; Obstructive sleep apnea (adult)(pediatric); Abdominal pain, generalized; Hyperpotassemia]","the patient was admitted to the micu on a ntg gtt from the ed. her bp goal was for a systolic +of 180-200. instructions were +written for explicit am administration and nifedipine long +acting 30mg was added at night, in addition to the 90mg long +acting she was taking in the morning. she established a three three +times weekly dialysus regemin.","the patient was admitted to the micu on a nicardipine gtt from the ed. she was given her usual afternoon home medications, and transitioned to a nicardipine gtt, which has worked well for her in the past. on arrival to the floor, she in fact missed her morning medications on [**month/day/year 766**] this resulted in elevate blood pressures requiring iv hydralazing for control " 109,137510.0,14810,2142-04-22,14807,158995.0,2142-02-26,Discharge summary,"Admission Date: [**2142-2-25**] Discharge Date: [**2142-2-26**] Date of Birth: [**2117-8-7**] Sex: F @@ -30255,7 +31016,9 @@ sleep medicine. ","PRIMARY: [Poisoning by other opiates and related narcotics] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Thrombotic microangiopathy; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Altered mental status; Other iatrogenic hypotension; Accidental poisoning by other opiates and related narcotics; Hyperpotassemia; Anemia in chronic kidney disease; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Nontraumatic hematoma of soft tissue; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Thrombotic microangiopathy; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Altered mental status; Other iatrogenic hypotension; Accidental poisoning by other opiates and related narcotics; Hyperpotassemia; Anemia in chronic kidney disease; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Nontraumatic hematoma of soft tissue; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]","24 yo woman with hx of sle, ersd on hd, admitted hypotension and +decreased mental status. hypotension and altered mental status +were in the setting of excessive narcotic use. # hypotension: resolved, patient normotensive on arrival to icu. relative hypotension likely due to dilaudid. from previous peritoneal [**location 2286**] hematoma ??????","24 yo woman with hx of sle, ersd on hd, admitted hypotension and decreased mental status. narcotics were held, pressors returned to and patient was mentating fine. patient was encouraged to take less pain medications and to use morphine." 109,124398.0,14809,2142-03-31,14798,126055.0,2141-11-03,Discharge summary,"Admission Date: [**2141-10-13**] Discharge Date: [**2141-11-3**] Date of Birth: [**2117-8-7**] Sex: F @@ -30953,7 +31716,41 @@ having undergone three rounds of hemodialysis, her bicarbonate was within normal limits at 28. ","PRIMARY: [Malignant essential hypertension] -SECONDARY: [Renal dialysis status; Epilepsy, unspecified, without mention of intractable epilepsy; Constipation, unspecified; Anemia in chronic kidney disease; Abnormal coagulation profile; Obstructive sleep apnea (adult)(pediatric); Other diseases of lung, not elsewhere classified; Other chest pain; Fever, unspecified; Rash and other nonspecific skin eruption; Other chronic pulmonary heart diseases; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Unspecified disease of pericardium; Other ascites; Acidosis; Hyposmolality and/or hyponatremia; Abdominal pain, other specified site; Abdominal pain, epigastric; Nausea with vomiting; Diarrhea; Systemic lupus erythematosus; Hyperparathyroidism, unspecified; Anemia, unspecified; Thrombocytopenia, unspecified; Esophageal reflux]" +SECONDARY: [Renal dialysis status; Epilepsy, unspecified, without mention of intractable epilepsy; Constipation, unspecified; Anemia in chronic kidney disease; Abnormal coagulation profile; Obstructive sleep apnea (adult)(pediatric); Other diseases of lung, not elsewhere classified; Other chest pain; Fever, unspecified; Rash and other nonspecific skin eruption; Other chronic pulmonary heart diseases; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Unspecified disease of pericardium; Other ascites; Acidosis; Hyposmolality and/or hyponatremia; Abdominal pain, other specified site; Abdominal pain, epigastric; Nausea with vomiting; Diarrhea; Systemic lupus erythematosus; Hyperparathyroidism, unspecified; Anemia, unspecified; Thrombocytopenia, unspecified; Esophageal reflux]","this is a 24 year old woman with esrd secondary to sle (started +peritoneal dialysis approximately one week prior to admission), +malignant htn, h/o svc syndrome, and multiple thrombotic events +(on warfarin) who is presenting with persistent suprapubic/lower +abdominal pain and new onset severe epigastric pain w/ nausea +and vomiting, and hypertension. however, during +the initial part of her admission, the patient remained afebrile +with an initial relative leukocytosis which trended to within +baseline limits. pericarditis +was considered, but her ekg was unchanged from prior studies and +there had been on interval increase in her pericardial effusion +since [**2141-10-13**]. the patient tolerated the procedure well and immediately +reported that both her epigastric and suprapubic pain were gone +after the surgery. multiple medication regimens +were attempted and changed throughout her hospital course. when +sbp>180, give 25 mg po hydral every 30 min until sbp<150. during her admission, the patient underwent multiple +trials of peritoneal dialysis, but was unable to tolerate it on +a consistent basis secondary to abdominal pain. upon discharge, her electrolytes were back to her +baseline. epo alfa sc was +also given on [**2141-10-17**]. the patients +hct remained stable (hovering between 25 - 27) from [**2141-10-19**] - +[**2141-10-23**]. between [**2141-10-23**] - [**2141-10-24**], the patient had a hct +drop from 26 to 20 in the setting of occult positive emesis. gi +was aware and planned to perform a non-urgent egd on [**10-25**] or +[**10-26**] as the patient was hemodynamically stable and her hct +returned to baseline. she was +also started heparin drip secondary to concern for ischemic +bowel [**2-11**] microthrombotic disease. as a result, she underwent upper +extremity venous ultrasound on [**2141-11-2**], which showed no +evidence of a dvt within the left upper extremity and the +previously noted thrombus within the left subclavian vein was +not seen as well. # sle: rheumatology was consulted several times throughout her +hospital course, but they did not think that a lupus flare was +contributing to her presentation. # obstructive sleep apnea: the patient was noted to have osa +based on clinical nocturnal exam during admission.","esrd secondary to sle, malignant htn, h/o svc syndrome, and multiple thrombotic events were considered. the patient was placed on iv flagyl, but this was discontinued when stool samples were negative for c.difficile. a heparin drip and warfarin were started for treatment of possible microthrombotic ischemia." 109,124398.0,14809,2142-03-31,14799,125288.0,2141-11-23,Discharge summary,"Admission Date: [**2141-11-18**] Discharge Date: [**2141-11-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -31322,7 +32119,15 @@ is agreeable to outpatient follow up with [**company 191**] social work, and potential cbt. these can be arranged by her pcp. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Abdominal pain, unspecified site; Anemia, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Abdominal pain, unspecified site; Anemia, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","1) hypertension: patient has history of extremely labile +hypertension on an aggressive outpatient regimen. her hydralazine was increased from 75mg to 100mg tid with mild +improvement. peritoneal fluid was obtained and contained 544 +polys. the dose was lowered to 4mg daily at +discharge to prevent overshooting the therapeutic range, but the +patient will have close follow up with coumadin clinic, with +dose titrations as needed. her nephrologist felt +this may be contributing to her recurrent pain and hypertension, +so psychiatry was consulted.","patient has history of extremely labile hypertension on aggressive outpatient regimen. overnight in the micu, patient required iv and po labetalol for sbp > 200. ct scan showed increasing ascites, but no acute pathology." 109,124398.0,14809,2142-03-31,14800,161950.0,2141-12-01,Discharge summary,"Admission Date: [**2141-11-24**] Discharge Date: [**2141-12-1**] Date of Birth: [**2117-8-7**] Sex: F @@ -31711,7 +32516,10 @@ patient succesfully switched to po meds and transferred to the floor. upon transfer to the floor, the following was her ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Other ascites; ; Systemic lupus erythematosus; Headache; Anemia in chronic kidney disease; Anxiety state, unspecified; Other chest pain; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Renal dialysis status; Acquired absence of organ, eye]" +SECONDARY: [End stage renal disease; Other ascites; ; Systemic lupus erythematosus; Headache; Anemia in chronic kidney disease; Anxiety state, unspecified; Other chest pain; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Renal dialysis status; Acquired absence of organ, eye]","24yo f with sle, esrd on hd and malignant hypertension who +presented with abdominal pain and headache and was admitted for +hypertensive urgency. the renal team was consulted, and recommended no change +to home med regimen.","a 24yo f with sle, esrd on hd and malignant hypertension presented with abdominal pain and headache. the patient was found to be hypocalcemic, and was started on calcium replacement therapy. she successfully switched to po meds and was transferred to the floor." 109,124398.0,14809,2142-03-31,14801,173633.0,2141-12-14,Discharge summary,"Admission Date: [**2141-12-8**] Discharge Date: [**2141-12-14**] Date of Birth: [**2117-8-7**] Sex: F @@ -32166,7 +32974,18 @@ transfused 1u prbc at hd on [**12-12**]. she was also given epo at hd. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Systemic lupus erythematosus; Other and unspecified noninfectious gastroenteritis and colitis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Other iatrogenic hypotension; Obstructive sleep apnea (adult)(pediatric); Hemangioma of intra-abdominal structures; Other chronic pain; Abdominal pain, unspecified site; Abnormal coagulation profile; Renal dialysis status; Personal history of venous thrombosis and embolism]" +SECONDARY: [End stage renal disease; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Systemic lupus erythematosus; Other and unspecified noninfectious gastroenteritis and colitis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Other iatrogenic hypotension; Obstructive sleep apnea (adult)(pediatric); Hemangioma of intra-abdominal structures; Other chronic pain; Abdominal pain, unspecified site; Abnormal coagulation profile; Renal dialysis status; Personal history of venous thrombosis and embolism]","24 year old woman with ckd v and severe hypertension due to sle +admitted with flare of chronic abdominal pain and hypertensive +urgency. initially her blood pressure over-corrected to +sbps in the 80s (patient was asymptomatic). the patient was +transferred to the floor on [**12-10**] after resolution of her +hypertensive urgency with a decreased blood pressure regimen due +to her hypotension in response to home doses of her medications. the patient was continuned on her +admission hypertensive regimen. a ct scan was +performed that showed bowel wall changes that are likely +secondary to recent peritoneal dialysis and unrelated to pain. ckd v from lupus nephritis: the patient was continued on hd +during her admission. she was therapetuic the same day and her heparin gtt +was stopped.",24 year old woman with ckd v and severe hypertension due to sle admitted. patient was initially maintained on a labetalol drip and hydralazine iv prn. initially her blood pressure over-corrected to sbps in the 80s (patient was asymptomatic) 109,124398.0,14809,2142-03-31,14802,140167.0,2141-12-23,Discharge summary,"Admission Date: [**2141-12-18**] Discharge Date: [**2141-12-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -32638,7 +33457,23 @@ pericarditis. she was continued on her home prednisone dose of ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Mechanical complication due to peritoneal dialysis catheter; ; Unspecified disease of pericardium; Angioneurotic edema, not elsewhere classified; Abdominal pain, other specified site; Systemic lupus erythematosus; ; Anemia in chronic kidney disease; Dysthymic disorder; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of steroids; Long-term (current) use of anticoagulants; Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation; Other antihypertensive agents causing adverse effects in therapeutic use]" +SECONDARY: [End stage renal disease; Mechanical complication due to peritoneal dialysis catheter; ; Unspecified disease of pericardium; Angioneurotic edema, not elsewhere classified; Abdominal pain, other specified site; Systemic lupus erythematosus; ; Anemia in chronic kidney disease; Dysthymic disorder; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of steroids; Long-term (current) use of anticoagulants; Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation; Other antihypertensive agents causing adverse effects in therapeutic use]","24 year old female with sle, esrd on hd and malignant +hypertension presents with abdominal pain and headache +consistent with her usual hypertensive urgency and was found to +be in hypertensive urgency in ed. she was given 10mg iv labetalol and started on a labatelol drip. nephrology was consulted and dialysis +initiated in the am. she received a total of 60 mg iv hydralazine over the course of +the morning as well as 0.1 mg po clonidine. she reports bilateral calf cramping but no +leg swelling. she took her am bp meds without difficulty. her +tekturna was discontinued for concern that it might be causing +angioedema. the patient +was maintained on her heparin drip for her svc syndrome. abdominal pain: the patient has had extensive prior workup +that has been unrevealing. the +patients tunneled dialysis catheter had a cuff that was out +and qas subsequently replaced with a temporary femoral line on +[**12-21**]. the patient was scheduled +to have dialysis on [**12-23**]. she was admitted with a +subtherpeutic inr of 1.2 she was started on a heparin drip. there was +no evidence of active, acute bleeding.","24 year old female with sle, esrd on hd presents with abdominal pain and headache consistent with her usual hypertensive urgency. she was found to be in hypertensive urgency in ed. she received hydralazine iv 10 mg once and 2 inches of nitropaste." 109,124398.0,14809,2142-03-31,14803,135923.0,2142-01-12,Discharge summary,"Admission Date: [**2142-1-8**] Discharge Date: [**2142-1-13**] Date of Birth: [**2117-8-7**] Sex: F @@ -33029,7 +33864,17 @@ clonazepam. level. follow-up with transplant surgery. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Hypoxemia; Other opiates and related narcotics causing adverse effects in therapeutic use; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Abdominal pain, other specified site; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Renal dialysis status; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Other postprocedural status]" +SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Hypoxemia; Other opiates and related narcotics causing adverse effects in therapeutic use; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Abdominal pain, other specified site; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Renal dialysis status; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Other postprocedural status]","24 yo woman with hx of sle, ersd on hd, admitted with +hypertensive urgency. # hypertension: pt with extensive history of repeated admissions +for hypertension. # sle: stable, continued prednisone at 4 mg po daily. patient was +oversedated on dilaudid and had episode of oxygen desaturation +which was reversed with narcan. first name (stitle) **] (transplant +surgery). she will be sent home with low-dose morphine ir and +tylenol prn pain. if l groin pain should become uncontrollable +on current meds, pt should return to the ed for re-evaluation. this is likely secondary to aocd +and renal failure. pt will +need an inr check in the next week at her follow-up with her +pcp.","24 yo woman with hx of sle, ersd on hd, admitted with hypertensive urgency. patient was stablized on home medicaitons, suggesting medication non-compliance. patient was oversedated on dilaudid and had episode of oxygen desaturation." 109,124398.0,14809,2142-03-31,14804,124657.0,2142-01-20,Discharge summary,"Admission Date: [**2142-1-14**] Discharge Date: [**2142-1-20**] Date of Birth: [**2117-8-7**] Sex: F @@ -33448,7 +34293,15 @@ prn. # contact: [**first name8 (namepattern2) **] [**name (ni) **] (mother) [**telephone/fax (1) 43503**] ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; ; Other vascular complications of medical care, not elsewhere classified; Systemic lupus erythematosus; Hyperpotassemia; Phlebitis and thrombophlebitis of upper extremities, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [End stage renal disease; ; Other vascular complications of medical care, not elsewhere classified; Systemic lupus erythematosus; Hyperpotassemia; Phlebitis and thrombophlebitis of upper extremities, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","24 yo woman with hx of sle, ersd on hd, admitted with +hypertensive urgency. in the micu, +nifedipine extended release was added in place of nicardipine as +pts blood pressures seemed to rise prior to nicardipine doses. pt was continued on +gabapentin, tylenol around the clock, and low-dose morphine as +needed for pain. # anemia: hct was mildly decreased from baseline during +admission. # hocm: pt has evidence of myocardial hypertrophy on recent +echo. # fen: repleted lytes prn / regular diet +. # contact: [**first name8 (namepattern2) **] [**name (ni) **] (mother) [**telephone/fax (1) 43503**]","24 yo woman with hx of sle, ersd on hd, admitted with hypertensive urgency. pt was transferred to the floor as blood pressure stabilized. pt reported that morphine did not help pain, and was switched to dilaudid po in the micu." 109,124398.0,14809,2142-03-31,14805,176760.0,2142-01-23,Discharge summary,"Admission Date: [**2142-1-21**] Discharge Date: [**2142-1-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -33890,7 +34743,13 @@ pericardial effusion. continued beta blocker ","PRIMARY: [Other vascular complications of medical care, not elsewhere classified] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; ; Systemic lupus erythematosus; Phlebitis and thrombophlebitis of upper extremities, unspecified]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; ; Systemic lupus erythematosus; Phlebitis and thrombophlebitis of upper extremities, unspecified]","24 yo woman with hx of sle, ersd on hd, admitted with +hypertensive urgency and left wrist pain. she was started on nicardipine drip and 1"" nitropaste +and admitted to the icu for further treatment. she was +continued on iv vanco with hd for 10day course. esrd: continued on regularly scheduled dialysis. her hct was mildly decreased from +baseline. hocm: evidence of myocardial hypertrophy on recent echo. echo without evidence of worsening +pericardial effusion. continued celexa, clonazepam 0.5mg [**hospital1 **] +.","24 yo woman with hx of sle, ersd on hd, admitted with hypertensive urgency and left wrist pain. she was started on nicardipine drip and 1"" nitropaste and admitted to the icu for further treatment. her bp quickly stabilized and she was called out to the medical floor where her sbp ranged 110-150." 109,124398.0,14809,2142-03-31,14807,158995.0,2142-02-26,Discharge summary,"Admission Date: [**2142-2-25**] Discharge Date: [**2142-2-26**] Date of Birth: [**2117-8-7**] Sex: F @@ -34221,7 +35080,9 @@ sleep medicine. ","PRIMARY: [Poisoning by other opiates and related narcotics] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Thrombotic microangiopathy; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Altered mental status; Other iatrogenic hypotension; Accidental poisoning by other opiates and related narcotics; Hyperpotassemia; Anemia in chronic kidney disease; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Nontraumatic hematoma of soft tissue; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Thrombotic microangiopathy; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Altered mental status; Other iatrogenic hypotension; Accidental poisoning by other opiates and related narcotics; Hyperpotassemia; Anemia in chronic kidney disease; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Nontraumatic hematoma of soft tissue; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]","24 yo woman with hx of sle, ersd on hd, admitted hypotension and +decreased mental status. hypotension and altered mental status +were in the setting of excessive narcotic use. # hypotension: resolved, patient normotensive on arrival to icu. relative hypotension likely due to dilaudid. from previous peritoneal [**location 2286**] hematoma ??????","24 yo woman with hx of sle, ersd on hd, admitted hypotension and decreased mental status. narcotics were held, pressors returned to and patient was mentating fine. patient was encouraged to take less pain medications and to use morphine." 109,124398.0,14809,2142-03-31,14808,158943.0,2142-03-23,Discharge summary,"Admission Date: [**2142-3-21**] Discharge Date: [**2142-3-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -34573,7 +35434,13 @@ multiple thrombotic events. continued coumadin not symptomatic. continued labetalol. ","PRIMARY: [] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Compression of vein; Unspecified disease of pericardium; Infection and inflammatory reaction due to other vascular device, implant, and graft; Bacteremia; Primary hypercoagulable state; Other primary cardiomyopathies; ; Abdominal pain, unspecified site; Urinary tract infection, site not specified; Acidosis; Other chest pain; Other chronic pain; Systemic lupus erythematosus; Noncompliance with renal dialysis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Hyperpotassemia; Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus]; Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Methicillin resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Compression of vein; Unspecified disease of pericardium; Infection and inflammatory reaction due to other vascular device, implant, and graft; Bacteremia; Primary hypercoagulable state; Other primary cardiomyopathies; ; Abdominal pain, unspecified site; Urinary tract infection, site not specified; Acidosis; Other chest pain; Other chronic pain; Systemic lupus erythematosus; Noncompliance with renal dialysis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Hyperpotassemia; Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus]; Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Methicillin resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","this is a 24 y.o f with sle, esrd on hd and malignant +hypertension + presenting with abd pain, diarrhea, and htn. ct prelim neg +for small bowel obstruction. on +arrival to the floor, abd pain was back to baseline and well +controlled on dilaudid 2mg po q 4hrs +.","a 24 y.o f with sle, esrd on hd and malignant hypertension presenting with abd pain, diarrhea, and htn. initial attempts were made to control her bp with hydralazine and labetalol iv but after these failed to control her blood pressure. she was successfully transitioned to home medications of clonidine, labetalol, aliskiren, nifedipine" 109,124398.0,14809,2142-03-31,14806,113189.0,2142-02-17,Discharge summary,"Admission Date: [**2142-2-14**] Discharge Date: [**2142-2-17**] Date of Birth: [**2117-8-7**] Sex: F @@ -34894,7 +35761,11 @@ infusions were needed. # depression/anxiety: continued celexa, clonazepam 0.5mg [**hospital1 **] ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Thrombotic microangiopathy; Systemic lupus erythematosus; Anemia in chronic kidney disease; Thrombocytopenia, unspecified; Obstructive sleep apnea (adult)(pediatric); Nontraumatic hematoma of soft tissue; Dysthymic disorder; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]" +SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Thrombotic microangiopathy; Systemic lupus erythematosus; Anemia in chronic kidney disease; Thrombocytopenia, unspecified; Obstructive sleep apnea (adult)(pediatric); Nontraumatic hematoma of soft tissue; Dysthymic disorder; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]","24 y.o female with sle, esrd on hd and malignant hypertension +who presents with htn and sob aftering missing hd. pt was treated per omr +hypertensive protocol created by the patients primary +providers, with a goal sbp of 160-180. # coagulopathy/history of dvt: patient on lifetime +anticoagulation for hx of multiple thrombotic events.","24 y.o female with sle, esrd on hd and malignant hypertension who presents with htn and sob after missing hd. pt was treated per omr hypertensive protocol created by the patients primary providers, with a goal sbp of 160-180. she was well maintained on oral outpt regimen of clonidine, labetalol, aliskiren, nifedipine." 109,131345.0,15330,2141-09-08,15327,166018.0,2141-03-28,Discharge summary,"Admission Date: [**2141-3-27**] Discharge Date: [**2141-3-28**] Date of Birth: [**2117-8-7**] Sex: F @@ -35195,7 +36066,10 @@ should be addressed as an outpatient. ","PRIMARY: [Malignant essential hypertension] -SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; ; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Anemia, unspecified; ; Other postprocedural status; Other states following surgery of eye and adnexa]" +SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; ; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Anemia, unspecified; ; Other postprocedural status; Other states following surgery of eye and adnexa]","f with lupus and renal failure [**2-11**] sle, not on hd x 1 +year, htn, and cardiomyopathy admitted with elevated bps. on discharge, she was instructed to +decrease her prednisone to 10 mg daily per renal. pcp [**name9 (pre) **] +should be addressed as an outpatient.","sle, not on hd x 1 year, htn, and cardiomyopathy admitted with elevated bps. sle, not on hd x 1 year, not on hd x 1 year, htn, and cardiomyopathy admitted. sle, not on hd x 1 year, not on hd x 1 year, not on hd x 1 year." 109,131345.0,15330,2141-09-08,15328,170149.0,2141-06-06,Discharge summary,"Admission Date: [**2141-5-24**] Discharge Date: [**2141-6-6**] Date of Birth: [**2117-8-7**] Sex: F @@ -35838,7 +36712,21 @@ her mother extensively. [**name2 (ni) **] medication hcanges were also extensively reviewed. ","PRIMARY: [] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Compression of vein; Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; ; Systemic lupus erythematosus; Anemia in chronic kidney disease; Hyperpotassemia; Hyperparathyroidism, unspecified; Other iatrogenic hypotension; Nausea with vomiting; ; Abnormal glandular Papanicolaou smear of cervix; Abdominal pain, other specified site; Other specified disorders of pancreatic internal secretion; Adrenal cortical steroids causing adverse effects in therapeutic use]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Compression of vein; Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; ; Systemic lupus erythematosus; Anemia in chronic kidney disease; Hyperpotassemia; Hyperparathyroidism, unspecified; Other iatrogenic hypotension; Nausea with vomiting; ; Abnormal glandular Papanicolaou smear of cervix; Abdominal pain, other specified site; Other specified disorders of pancreatic internal secretion; Adrenal cortical steroids causing adverse effects in therapeutic use]","known lastname **] is a 23yo woman with a history of sle, esrd and htn +who presented with acute onset bilateral facial swelling and +hypertensive urgency, which developed into l sided facial, l arm +and l breast swelling throughout her stay. mra could not +visualize the l brachiocephalic vein. it +remains unclear why her blood pressure is so chronically labile. we stopped her ace and [**last name (un) **] as above. the importance of bp control, especially +in the setting of new anticoagulation, was discussed extensively +with the patient. # esrd: the patient has esrd due to lupus nephritis. the renal team followed her +closely throughout her stay. she +will call [**doctor first name 3040**] the pd nurse tomorrow to set up an appointment +to have her catheter flushed and to start pd. we discussed the importance of +following this up with the patient, and at her request scheduled +her for an ob/gyn appointment as an outpatient shortly after +discharge. the above plan and appoitnments were reviewed with the pt and +her mother extensively. [**","a 23yo woman with a history of sle, esrd and htn presented with bilateral facial swelling. she developed l sided facial, l arm and l breast swelling throughout her stay. most likely etiology of her swelling is an acute-on-chronic (now occlusive) thrombus of l brachiocephalic vein." 109,131345.0,15330,2141-09-08,15329,147469.0,2141-06-17,Discharge summary,"Admission Date: [**2141-6-11**] Discharge Date: [**2141-6-17**] Date of Birth: [**2117-8-7**] Sex: F @@ -36340,7 +37228,15 @@ continued on prednisone 10mg (dropped from 15mg 2 weeks ago) ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Other encephalopathy; Chronic glomerulonephritis in diseases classified elsewhere; Urinary tract infection, site not specified; Acidosis; Unspecified iridocyclitis; Acquired hemolytic anemia, unspecified; Systemic lupus erythematosus; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Swelling, mass, or lump in head and neck; Hyperpotassemia; Lump or mass in breast; Thrombocytopenia, unspecified; Hypocalcemia; Disorders of phosphorus metabolism]" +SECONDARY: [End stage renal disease; Other encephalopathy; Chronic glomerulonephritis in diseases classified elsewhere; Urinary tract infection, site not specified; Acidosis; Unspecified iridocyclitis; Acquired hemolytic anemia, unspecified; Systemic lupus erythematosus; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Swelling, mass, or lump in head and neck; Hyperpotassemia; Lump or mass in breast; Thrombocytopenia, unspecified; Hypocalcemia; Disorders of phosphorus metabolism]","a/p: 23 f with sle, esrd not on hd, chronic vte with rue and +facial swelling p/w hypertensive emergency and delta ms +initially admitted to the [**hospital unit name 153**]. she was evaluated by neurology who +considered pres, though she did not seize. aliskiren was not covered by masshealth, and a prior auth was +faxed over. also likely component of osa although this seems +chronic. inr +2.1 coumadin was held in [**hospital unit name 153**] for anticipation of procedures. avoided +fluid overload with lasix, patient currently making urine. # metabolic acidosis/electrolytes abnormalities. # ppx: systemically anticoagulated, getting kayexalate, ppi +# fen: electrolytes as above, no standing fluids i/os goal even.","delta ms was evaluated by neurology who considered pres, though she did not seize. she was started on keppra as she has had seizures before, and will follow up with them. her bp remained between 120-170 before discharge, she no longer had headaches, or nausea." 109,147469.0,15329,2141-06-17,15327,166018.0,2141-03-28,Discharge summary,"Admission Date: [**2141-3-27**] Discharge Date: [**2141-3-28**] Date of Birth: [**2117-8-7**] Sex: F @@ -36641,7 +37537,10 @@ should be addressed as an outpatient. ","PRIMARY: [Malignant essential hypertension] -SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; ; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Anemia, unspecified; ; Other postprocedural status; Other states following surgery of eye and adnexa]" +SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; ; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Anemia, unspecified; ; Other postprocedural status; Other states following surgery of eye and adnexa]","f with lupus and renal failure [**2-11**] sle, not on hd x 1 +year, htn, and cardiomyopathy admitted with elevated bps. on discharge, she was instructed to +decrease her prednisone to 10 mg daily per renal. pcp [**name9 (pre) **] +should be addressed as an outpatient.","sle, not on hd x 1 year, htn, and cardiomyopathy admitted with elevated bps. sle, not on hd x 1 year, not on hd x 1 year, htn, and cardiomyopathy admitted. sle, not on hd x 1 year, not on hd x 1 year, not on hd x 1 year." 109,147469.0,15329,2141-06-17,15328,170149.0,2141-06-06,Discharge summary,"Admission Date: [**2141-5-24**] Discharge Date: [**2141-6-6**] Date of Birth: [**2117-8-7**] Sex: F @@ -37284,7 +38183,21 @@ her mother extensively. [**name2 (ni) **] medication hcanges were also extensively reviewed. ","PRIMARY: [] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Compression of vein; Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; ; Systemic lupus erythematosus; Anemia in chronic kidney disease; Hyperpotassemia; Hyperparathyroidism, unspecified; Other iatrogenic hypotension; Nausea with vomiting; ; Abnormal glandular Papanicolaou smear of cervix; Abdominal pain, other specified site; Other specified disorders of pancreatic internal secretion; Adrenal cortical steroids causing adverse effects in therapeutic use]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Compression of vein; Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; ; Systemic lupus erythematosus; Anemia in chronic kidney disease; Hyperpotassemia; Hyperparathyroidism, unspecified; Other iatrogenic hypotension; Nausea with vomiting; ; Abnormal glandular Papanicolaou smear of cervix; Abdominal pain, other specified site; Other specified disorders of pancreatic internal secretion; Adrenal cortical steroids causing adverse effects in therapeutic use]","known lastname **] is a 23yo woman with a history of sle, esrd and htn +who presented with acute onset bilateral facial swelling and +hypertensive urgency, which developed into l sided facial, l arm +and l breast swelling throughout her stay. mra could not +visualize the l brachiocephalic vein. it +remains unclear why her blood pressure is so chronically labile. we stopped her ace and [**last name (un) **] as above. the importance of bp control, especially +in the setting of new anticoagulation, was discussed extensively +with the patient. # esrd: the patient has esrd due to lupus nephritis. the renal team followed her +closely throughout her stay. she +will call [**doctor first name 3040**] the pd nurse tomorrow to set up an appointment +to have her catheter flushed and to start pd. we discussed the importance of +following this up with the patient, and at her request scheduled +her for an ob/gyn appointment as an outpatient shortly after +discharge. the above plan and appoitnments were reviewed with the pt and +her mother extensively. [**","a 23yo woman with a history of sle, esrd and htn presented with bilateral facial swelling. she developed l sided facial, l arm and l breast swelling throughout her stay. most likely etiology of her swelling is an acute-on-chronic (now occlusive) thrombus of l brachiocephalic vein." 109,113189.0,14806,2142-02-17,14796,139061.0,2141-09-14,Discharge summary,"Admission Date: [**2141-9-11**] Discharge Date: [**2141-9-14**] Date of Birth: [**2117-8-7**] Sex: F @@ -37740,7 +38653,16 @@ maintained on warfarin with inr goal 2.5 to 3.0. patients home prednisone regimen was continued. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Urinary tract infection, site not specified; Other primary cardiomyopathies; Systemic lupus erythematosus; Sciatica; Hyperpotassemia; Thrombocytopenia, unspecified; Abnormal coagulation profile; Hyperparathyroidism, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism]" +SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Urinary tract infection, site not specified; Other primary cardiomyopathies; Systemic lupus erythematosus; Sciatica; Hyperpotassemia; Thrombocytopenia, unspecified; Abnormal coagulation profile; Hyperparathyroidism, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism]","icu course: +ekg showed no change from prior, and cxr showed a suggestion of +rll/r diaphragm haziness. the renal team was consulted, and recommended +no change to home medication regimen. right leg pain: upon arrival on the floor, the patient +complained of [**2143-4-15**] pain in r buttock and posterior thigh, much +exacerbated with standing. of note, lumbar spine mri and r hip +xr on most recent admission were both negative. she was treated with a +three day course of ciprofloxacin. esrd: the patient has end-stage renal disease due to her +lupus. anemia: the patients hematocrit remained near her baseline +low 20s throughout her stay.","ekg showed no change from prior, and cxr showed a suggestion of rll/r diaphragm haziness. the patient was found to by hypocalcemic, and was started on calcium replacement therapy. she became more hypertensive, with sbps to the 170s-180s during the day. throughout her hospitalization, the patient had no symptoms/signs of hypertensive emergency." 109,113189.0,14806,2142-02-17,14797,172335.0,2141-09-24,Discharge summary,"Admission Date: [**2141-9-18**] Discharge Date: [**2141-9-24**] Date of Birth: [**2117-8-7**] Sex: F @@ -38313,7 +39235,23 @@ pivs ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [Pneumonia, organism unspecified; Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Hyperpotassemia; Sciatica; Other iatrogenic hypotension; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Anemia of other chronic disease; Hypocalcemia]" +SECONDARY: [Pneumonia, organism unspecified; Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Hyperpotassemia; Sciatica; Other iatrogenic hypotension; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Anemia of other chronic disease; Hypocalcemia]","24 yo with h/o of lupus, htn, and lupus nephropathy started on +peitoneal dialysis during this admissionwho was admitted +initially for r hip pain. micu course: on [**9-20**], the patient triggered for hypotension +(82/45), hypothermia (92.9) and altered mental status with +difficult arousability in setting of recent blood transfusion. urine culture and blood cultures are pending. patients +bp was in the 110s so hydralazine was stopped. her other bp meds +were otherwise continued. if patient has leg pain +again, may consider neurogenic source such a piriformis syndrome +as suggested by neurology. it would be good if we could arrange a pulmonary clinic follow +up for ms. [** she underwent ct head, and v/q scan which were unremarkable. her steroid dose was increased to 15mg given concern for need +for stress dose steroids. she was pan-cultured (blood, urine, +peritoneal dialysate) without obvious source of infection. source unclear at this point, but cxr with +question of retrocardiac opacity. continue home bp meds :labetalol 900 mg po tid but +difficult for patient to tolerate due to nausea, aliskiren *nf* +150 mg oral [**hospital1 **], nifedipine cr 60 mg po daily, clonidine patch, +hydralazine given hypertensive in setting of nausa. did well with pd on [**9-22**] but did +report some nause and cramping. # systemic lupus erythematosus: home prednisone dose 5mg.","lupus nephropathy patient on peitoneal dialysis with htn and lupus nephropathy. triggered for hypotension (82/45), hypothermia (92.9), altered mental status. concern was for sepsis, autonomic seizure, transfusion reaction, pulmonary embolus and/or narcosis." 109,113189.0,14806,2142-02-17,14798,126055.0,2141-11-03,Discharge summary,"Admission Date: [**2141-10-13**] Discharge Date: [**2141-11-3**] Date of Birth: [**2117-8-7**] Sex: F @@ -39011,7 +39949,41 @@ having undergone three rounds of hemodialysis, her bicarbonate was within normal limits at 28. ","PRIMARY: [Malignant essential hypertension] -SECONDARY: [Renal dialysis status; Epilepsy, unspecified, without mention of intractable epilepsy; Constipation, unspecified; Anemia in chronic kidney disease; Abnormal coagulation profile; Obstructive sleep apnea (adult)(pediatric); Other diseases of lung, not elsewhere classified; Other chest pain; Fever, unspecified; Rash and other nonspecific skin eruption; Other chronic pulmonary heart diseases; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Unspecified disease of pericardium; Other ascites; Acidosis; Hyposmolality and/or hyponatremia; Abdominal pain, other specified site; Abdominal pain, epigastric; Nausea with vomiting; Diarrhea; Systemic lupus erythematosus; Hyperparathyroidism, unspecified; Anemia, unspecified; Thrombocytopenia, unspecified; Esophageal reflux]" +SECONDARY: [Renal dialysis status; Epilepsy, unspecified, without mention of intractable epilepsy; Constipation, unspecified; Anemia in chronic kidney disease; Abnormal coagulation profile; Obstructive sleep apnea (adult)(pediatric); Other diseases of lung, not elsewhere classified; Other chest pain; Fever, unspecified; Rash and other nonspecific skin eruption; Other chronic pulmonary heart diseases; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Unspecified disease of pericardium; Other ascites; Acidosis; Hyposmolality and/or hyponatremia; Abdominal pain, other specified site; Abdominal pain, epigastric; Nausea with vomiting; Diarrhea; Systemic lupus erythematosus; Hyperparathyroidism, unspecified; Anemia, unspecified; Thrombocytopenia, unspecified; Esophageal reflux]","this is a 24 year old woman with esrd secondary to sle (started +peritoneal dialysis approximately one week prior to admission), +malignant htn, h/o svc syndrome, and multiple thrombotic events +(on warfarin) who is presenting with persistent suprapubic/lower +abdominal pain and new onset severe epigastric pain w/ nausea +and vomiting, and hypertension. however, during +the initial part of her admission, the patient remained afebrile +with an initial relative leukocytosis which trended to within +baseline limits. pericarditis +was considered, but her ekg was unchanged from prior studies and +there had been on interval increase in her pericardial effusion +since [**2141-10-13**]. the patient tolerated the procedure well and immediately +reported that both her epigastric and suprapubic pain were gone +after the surgery. multiple medication regimens +were attempted and changed throughout her hospital course. when +sbp>180, give 25 mg po hydral every 30 min until sbp<150. during her admission, the patient underwent multiple +trials of peritoneal dialysis, but was unable to tolerate it on +a consistent basis secondary to abdominal pain. upon discharge, her electrolytes were back to her +baseline. epo alfa sc was +also given on [**2141-10-17**]. the patients +hct remained stable (hovering between 25 - 27) from [**2141-10-19**] - +[**2141-10-23**]. between [**2141-10-23**] - [**2141-10-24**], the patient had a hct +drop from 26 to 20 in the setting of occult positive emesis. gi +was aware and planned to perform a non-urgent egd on [**10-25**] or +[**10-26**] as the patient was hemodynamically stable and her hct +returned to baseline. she was +also started heparin drip secondary to concern for ischemic +bowel [**2-11**] microthrombotic disease. as a result, she underwent upper +extremity venous ultrasound on [**2141-11-2**], which showed no +evidence of a dvt within the left upper extremity and the +previously noted thrombus within the left subclavian vein was +not seen as well. # sle: rheumatology was consulted several times throughout her +hospital course, but they did not think that a lupus flare was +contributing to her presentation. # obstructive sleep apnea: the patient was noted to have osa +based on clinical nocturnal exam during admission.","esrd secondary to sle, malignant htn, h/o svc syndrome, and multiple thrombotic events were considered. the patient was placed on iv flagyl, but this was discontinued when stool samples were negative for c.difficile. a heparin drip and warfarin were started for treatment of possible microthrombotic ischemia." 109,113189.0,14806,2142-02-17,14799,125288.0,2141-11-23,Discharge summary,"Admission Date: [**2141-11-18**] Discharge Date: [**2141-11-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -39380,7 +40352,15 @@ is agreeable to outpatient follow up with [**company 191**] social work, and potential cbt. these can be arranged by her pcp. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Abdominal pain, unspecified site; Anemia, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Abdominal pain, unspecified site; Anemia, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","1) hypertension: patient has history of extremely labile +hypertension on an aggressive outpatient regimen. her hydralazine was increased from 75mg to 100mg tid with mild +improvement. peritoneal fluid was obtained and contained 544 +polys. the dose was lowered to 4mg daily at +discharge to prevent overshooting the therapeutic range, but the +patient will have close follow up with coumadin clinic, with +dose titrations as needed. her nephrologist felt +this may be contributing to her recurrent pain and hypertension, +so psychiatry was consulted.","patient has history of extremely labile hypertension on aggressive outpatient regimen. overnight in the micu, patient required iv and po labetalol for sbp > 200. ct scan showed increasing ascites, but no acute pathology." 109,113189.0,14806,2142-02-17,14800,161950.0,2141-12-01,Discharge summary,"Admission Date: [**2141-11-24**] Discharge Date: [**2141-12-1**] Date of Birth: [**2117-8-7**] Sex: F @@ -39769,7 +40749,10 @@ patient succesfully switched to po meds and transferred to the floor. upon transfer to the floor, the following was her ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Other ascites; ; Systemic lupus erythematosus; Headache; Anemia in chronic kidney disease; Anxiety state, unspecified; Other chest pain; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Renal dialysis status; Acquired absence of organ, eye]" +SECONDARY: [End stage renal disease; Other ascites; ; Systemic lupus erythematosus; Headache; Anemia in chronic kidney disease; Anxiety state, unspecified; Other chest pain; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Renal dialysis status; Acquired absence of organ, eye]","24yo f with sle, esrd on hd and malignant hypertension who +presented with abdominal pain and headache and was admitted for +hypertensive urgency. the renal team was consulted, and recommended no change +to home med regimen.","a 24yo f with sle, esrd on hd and malignant hypertension presented with abdominal pain and headache. the patient was found to be hypocalcemic, and was started on calcium replacement therapy. she successfully switched to po meds and was transferred to the floor." 109,113189.0,14806,2142-02-17,14801,173633.0,2141-12-14,Discharge summary,"Admission Date: [**2141-12-8**] Discharge Date: [**2141-12-14**] Date of Birth: [**2117-8-7**] Sex: F @@ -40224,7 +41207,18 @@ transfused 1u prbc at hd on [**12-12**]. she was also given epo at hd. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Systemic lupus erythematosus; Other and unspecified noninfectious gastroenteritis and colitis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Other iatrogenic hypotension; Obstructive sleep apnea (adult)(pediatric); Hemangioma of intra-abdominal structures; Other chronic pain; Abdominal pain, unspecified site; Abnormal coagulation profile; Renal dialysis status; Personal history of venous thrombosis and embolism]" +SECONDARY: [End stage renal disease; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Systemic lupus erythematosus; Other and unspecified noninfectious gastroenteritis and colitis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Other iatrogenic hypotension; Obstructive sleep apnea (adult)(pediatric); Hemangioma of intra-abdominal structures; Other chronic pain; Abdominal pain, unspecified site; Abnormal coagulation profile; Renal dialysis status; Personal history of venous thrombosis and embolism]","24 year old woman with ckd v and severe hypertension due to sle +admitted with flare of chronic abdominal pain and hypertensive +urgency. initially her blood pressure over-corrected to +sbps in the 80s (patient was asymptomatic). the patient was +transferred to the floor on [**12-10**] after resolution of her +hypertensive urgency with a decreased blood pressure regimen due +to her hypotension in response to home doses of her medications. the patient was continuned on her +admission hypertensive regimen. a ct scan was +performed that showed bowel wall changes that are likely +secondary to recent peritoneal dialysis and unrelated to pain. ckd v from lupus nephritis: the patient was continued on hd +during her admission. she was therapetuic the same day and her heparin gtt +was stopped.",24 year old woman with ckd v and severe hypertension due to sle admitted. patient was initially maintained on a labetalol drip and hydralazine iv prn. initially her blood pressure over-corrected to sbps in the 80s (patient was asymptomatic) 109,113189.0,14806,2142-02-17,14802,140167.0,2141-12-23,Discharge summary,"Admission Date: [**2141-12-18**] Discharge Date: [**2141-12-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -40696,7 +41690,23 @@ pericarditis. she was continued on her home prednisone dose of ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Mechanical complication due to peritoneal dialysis catheter; ; Unspecified disease of pericardium; Angioneurotic edema, not elsewhere classified; Abdominal pain, other specified site; Systemic lupus erythematosus; ; Anemia in chronic kidney disease; Dysthymic disorder; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of steroids; Long-term (current) use of anticoagulants; Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation; Other antihypertensive agents causing adverse effects in therapeutic use]" +SECONDARY: [End stage renal disease; Mechanical complication due to peritoneal dialysis catheter; ; Unspecified disease of pericardium; Angioneurotic edema, not elsewhere classified; Abdominal pain, other specified site; Systemic lupus erythematosus; ; Anemia in chronic kidney disease; Dysthymic disorder; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of steroids; Long-term (current) use of anticoagulants; Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation; Other antihypertensive agents causing adverse effects in therapeutic use]","24 year old female with sle, esrd on hd and malignant +hypertension presents with abdominal pain and headache +consistent with her usual hypertensive urgency and was found to +be in hypertensive urgency in ed. she was given 10mg iv labetalol and started on a labatelol drip. nephrology was consulted and dialysis +initiated in the am. she received a total of 60 mg iv hydralazine over the course of +the morning as well as 0.1 mg po clonidine. she reports bilateral calf cramping but no +leg swelling. she took her am bp meds without difficulty. her +tekturna was discontinued for concern that it might be causing +angioedema. the patient +was maintained on her heparin drip for her svc syndrome. abdominal pain: the patient has had extensive prior workup +that has been unrevealing. the +patients tunneled dialysis catheter had a cuff that was out +and qas subsequently replaced with a temporary femoral line on +[**12-21**]. the patient was scheduled +to have dialysis on [**12-23**]. she was admitted with a +subtherpeutic inr of 1.2 she was started on a heparin drip. there was +no evidence of active, acute bleeding.","24 year old female with sle, esrd on hd presents with abdominal pain and headache consistent with her usual hypertensive urgency. she was found to be in hypertensive urgency in ed. she received hydralazine iv 10 mg once and 2 inches of nitropaste." 109,113189.0,14806,2142-02-17,14803,135923.0,2142-01-12,Discharge summary,"Admission Date: [**2142-1-8**] Discharge Date: [**2142-1-13**] Date of Birth: [**2117-8-7**] Sex: F @@ -41087,7 +42097,17 @@ clonazepam. level. follow-up with transplant surgery. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Hypoxemia; Other opiates and related narcotics causing adverse effects in therapeutic use; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Abdominal pain, other specified site; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Renal dialysis status; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Other postprocedural status]" +SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Hypoxemia; Other opiates and related narcotics causing adverse effects in therapeutic use; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Abdominal pain, other specified site; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Renal dialysis status; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Other postprocedural status]","24 yo woman with hx of sle, ersd on hd, admitted with +hypertensive urgency. # hypertension: pt with extensive history of repeated admissions +for hypertension. # sle: stable, continued prednisone at 4 mg po daily. patient was +oversedated on dilaudid and had episode of oxygen desaturation +which was reversed with narcan. first name (stitle) **] (transplant +surgery). she will be sent home with low-dose morphine ir and +tylenol prn pain. if l groin pain should become uncontrollable +on current meds, pt should return to the ed for re-evaluation. this is likely secondary to aocd +and renal failure. pt will +need an inr check in the next week at her follow-up with her +pcp.","24 yo woman with hx of sle, ersd on hd, admitted with hypertensive urgency. patient was stablized on home medicaitons, suggesting medication non-compliance. patient was oversedated on dilaudid and had episode of oxygen desaturation." 109,113189.0,14806,2142-02-17,14804,124657.0,2142-01-20,Discharge summary,"Admission Date: [**2142-1-14**] Discharge Date: [**2142-1-20**] Date of Birth: [**2117-8-7**] Sex: F @@ -41506,7 +42526,15 @@ prn. # contact: [**first name8 (namepattern2) **] [**name (ni) **] (mother) [**telephone/fax (1) 43503**] ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; ; Other vascular complications of medical care, not elsewhere classified; Systemic lupus erythematosus; Hyperpotassemia; Phlebitis and thrombophlebitis of upper extremities, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [End stage renal disease; ; Other vascular complications of medical care, not elsewhere classified; Systemic lupus erythematosus; Hyperpotassemia; Phlebitis and thrombophlebitis of upper extremities, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","24 yo woman with hx of sle, ersd on hd, admitted with +hypertensive urgency. in the micu, +nifedipine extended release was added in place of nicardipine as +pts blood pressures seemed to rise prior to nicardipine doses. pt was continued on +gabapentin, tylenol around the clock, and low-dose morphine as +needed for pain. # anemia: hct was mildly decreased from baseline during +admission. # hocm: pt has evidence of myocardial hypertrophy on recent +echo. # fen: repleted lytes prn / regular diet +. # contact: [**first name8 (namepattern2) **] [**name (ni) **] (mother) [**telephone/fax (1) 43503**]","24 yo woman with hx of sle, ersd on hd, admitted with hypertensive urgency. pt was transferred to the floor as blood pressure stabilized. pt reported that morphine did not help pain, and was switched to dilaudid po in the micu." 109,113189.0,14806,2142-02-17,14805,176760.0,2142-01-23,Discharge summary,"Admission Date: [**2142-1-21**] Discharge Date: [**2142-1-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -41948,7 +42976,13 @@ pericardial effusion. continued beta blocker ","PRIMARY: [Other vascular complications of medical care, not elsewhere classified] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; ; Systemic lupus erythematosus; Phlebitis and thrombophlebitis of upper extremities, unspecified]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; ; Systemic lupus erythematosus; Phlebitis and thrombophlebitis of upper extremities, unspecified]","24 yo woman with hx of sle, ersd on hd, admitted with +hypertensive urgency and left wrist pain. she was started on nicardipine drip and 1"" nitropaste +and admitted to the icu for further treatment. she was +continued on iv vanco with hd for 10day course. esrd: continued on regularly scheduled dialysis. her hct was mildly decreased from +baseline. hocm: evidence of myocardial hypertrophy on recent echo. echo without evidence of worsening +pericardial effusion. continued celexa, clonazepam 0.5mg [**hospital1 **] +.","24 yo woman with hx of sle, ersd on hd, admitted with hypertensive urgency and left wrist pain. she was started on nicardipine drip and 1"" nitropaste and admitted to the icu for further treatment. her bp quickly stabilized and she was called out to the medical floor where her sbp ranged 110-150." 109,113189.0,14806,2142-02-17,15330,131345.0,2141-09-08,Discharge summary,"Admission Date: [**2141-9-5**] Discharge Date: [**2141-9-8**] Date of Birth: [**2117-8-7**] Sex: F @@ -42351,7 +43385,14 @@ for 2d # dispo status: ambulating, pain free, bp in the 150/90 range ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Nausea alone; Other antihypertensive agents causing adverse effects in therapeutic use; Hip and thigh injury; Unspecified accident; Hypotension, unspecified; Anemia, unspecified; Personal history of venous thrombosis and embolism; End stage renal disease; ; Urinary tract infection, site not specified; Hyperpotassemia; Acidosis; Disorders of phosphorus metabolism; Hypocalcemia; Secondary hyperparathyroidism (of renal origin)]" +SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Nausea alone; Other antihypertensive agents causing adverse effects in therapeutic use; Hip and thigh injury; Unspecified accident; Hypotension, unspecified; Anemia, unspecified; Personal history of venous thrombosis and embolism; End stage renal disease; ; Urinary tract infection, site not specified; Hyperpotassemia; Acidosis; Disorders of phosphorus metabolism; Hypocalcemia; Secondary hyperparathyroidism (of renal origin)]","ms [**known lastname **] is a 24 year old woman with sle, ckd v, and multiple +admissions for labile hypertension who presented to the ed +complaining of about a weeks?????? we opted to discharge her on her home regimen +(without decreasing doses) since she is more often having issues +with elevated blood pressures. # right leg pain: no evidence of avascular necrosis or fracture +on plain film. also had +temp to 101 on evening prior to discharge. # systemic lupus erythematosus: cont home prednisone dose +.","ms [**known lastname **] is a 24 year old woman with sle, ckd v, and multiple admissions for labile hypertension. she presented to the ed complaining of about a weeks?????? worth of right leg pain. she was initially admitted to the micu for hypertensive urgency and then transferred to the floor after a day. she was started on her home meds and tolerated them fairly well." 109,176760.0,14805,2142-01-23,15330,131345.0,2141-09-08,Discharge summary,"Admission Date: [**2141-9-5**] Discharge Date: [**2141-9-8**] Date of Birth: [**2117-8-7**] Sex: F @@ -42754,7 +43795,14 @@ for 2d # dispo status: ambulating, pain free, bp in the 150/90 range ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Nausea alone; Other antihypertensive agents causing adverse effects in therapeutic use; Hip and thigh injury; Unspecified accident; Hypotension, unspecified; Anemia, unspecified; Personal history of venous thrombosis and embolism; End stage renal disease; ; Urinary tract infection, site not specified; Hyperpotassemia; Acidosis; Disorders of phosphorus metabolism; Hypocalcemia; Secondary hyperparathyroidism (of renal origin)]" +SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Nausea alone; Other antihypertensive agents causing adverse effects in therapeutic use; Hip and thigh injury; Unspecified accident; Hypotension, unspecified; Anemia, unspecified; Personal history of venous thrombosis and embolism; End stage renal disease; ; Urinary tract infection, site not specified; Hyperpotassemia; Acidosis; Disorders of phosphorus metabolism; Hypocalcemia; Secondary hyperparathyroidism (of renal origin)]","ms [**known lastname **] is a 24 year old woman with sle, ckd v, and multiple +admissions for labile hypertension who presented to the ed +complaining of about a weeks?????? we opted to discharge her on her home regimen +(without decreasing doses) since she is more often having issues +with elevated blood pressures. # right leg pain: no evidence of avascular necrosis or fracture +on plain film. also had +temp to 101 on evening prior to discharge. # systemic lupus erythematosus: cont home prednisone dose +.","ms [**known lastname **] is a 24 year old woman with sle, ckd v, and multiple admissions for labile hypertension. she presented to the ed complaining of about a weeks?????? worth of right leg pain. she was initially admitted to the micu for hypertensive urgency and then transferred to the floor after a day. she was started on her home meds and tolerated them fairly well." 109,176760.0,14805,2142-01-23,14796,139061.0,2141-09-14,Discharge summary,"Admission Date: [**2141-9-11**] Discharge Date: [**2141-9-14**] Date of Birth: [**2117-8-7**] Sex: F @@ -43210,7 +44258,16 @@ maintained on warfarin with inr goal 2.5 to 3.0. patients home prednisone regimen was continued. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Urinary tract infection, site not specified; Other primary cardiomyopathies; Systemic lupus erythematosus; Sciatica; Hyperpotassemia; Thrombocytopenia, unspecified; Abnormal coagulation profile; Hyperparathyroidism, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism]" +SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Urinary tract infection, site not specified; Other primary cardiomyopathies; Systemic lupus erythematosus; Sciatica; Hyperpotassemia; Thrombocytopenia, unspecified; Abnormal coagulation profile; Hyperparathyroidism, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism]","icu course: +ekg showed no change from prior, and cxr showed a suggestion of +rll/r diaphragm haziness. the renal team was consulted, and recommended +no change to home medication regimen. right leg pain: upon arrival on the floor, the patient +complained of [**2143-4-15**] pain in r buttock and posterior thigh, much +exacerbated with standing. of note, lumbar spine mri and r hip +xr on most recent admission were both negative. she was treated with a +three day course of ciprofloxacin. esrd: the patient has end-stage renal disease due to her +lupus. anemia: the patients hematocrit remained near her baseline +low 20s throughout her stay.","ekg showed no change from prior, and cxr showed a suggestion of rll/r diaphragm haziness. the patient was found to by hypocalcemic, and was started on calcium replacement therapy. she became more hypertensive, with sbps to the 170s-180s during the day. throughout her hospitalization, the patient had no symptoms/signs of hypertensive emergency." 109,176760.0,14805,2142-01-23,14797,172335.0,2141-09-24,Discharge summary,"Admission Date: [**2141-9-18**] Discharge Date: [**2141-9-24**] Date of Birth: [**2117-8-7**] Sex: F @@ -43783,7 +44840,23 @@ pivs ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [Pneumonia, organism unspecified; Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Hyperpotassemia; Sciatica; Other iatrogenic hypotension; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Anemia of other chronic disease; Hypocalcemia]" +SECONDARY: [Pneumonia, organism unspecified; Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Hyperpotassemia; Sciatica; Other iatrogenic hypotension; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Anemia of other chronic disease; Hypocalcemia]","24 yo with h/o of lupus, htn, and lupus nephropathy started on +peitoneal dialysis during this admissionwho was admitted +initially for r hip pain. micu course: on [**9-20**], the patient triggered for hypotension +(82/45), hypothermia (92.9) and altered mental status with +difficult arousability in setting of recent blood transfusion. urine culture and blood cultures are pending. patients +bp was in the 110s so hydralazine was stopped. her other bp meds +were otherwise continued. if patient has leg pain +again, may consider neurogenic source such a piriformis syndrome +as suggested by neurology. it would be good if we could arrange a pulmonary clinic follow +up for ms. [** she underwent ct head, and v/q scan which were unremarkable. her steroid dose was increased to 15mg given concern for need +for stress dose steroids. she was pan-cultured (blood, urine, +peritoneal dialysate) without obvious source of infection. source unclear at this point, but cxr with +question of retrocardiac opacity. continue home bp meds :labetalol 900 mg po tid but +difficult for patient to tolerate due to nausea, aliskiren *nf* +150 mg oral [**hospital1 **], nifedipine cr 60 mg po daily, clonidine patch, +hydralazine given hypertensive in setting of nausa. did well with pd on [**9-22**] but did +report some nause and cramping. # systemic lupus erythematosus: home prednisone dose 5mg.","lupus nephropathy patient on peitoneal dialysis with htn and lupus nephropathy. triggered for hypotension (82/45), hypothermia (92.9), altered mental status. concern was for sepsis, autonomic seizure, transfusion reaction, pulmonary embolus and/or narcosis." 109,176760.0,14805,2142-01-23,14798,126055.0,2141-11-03,Discharge summary,"Admission Date: [**2141-10-13**] Discharge Date: [**2141-11-3**] Date of Birth: [**2117-8-7**] Sex: F @@ -44481,7 +45554,41 @@ having undergone three rounds of hemodialysis, her bicarbonate was within normal limits at 28. ","PRIMARY: [Malignant essential hypertension] -SECONDARY: [Renal dialysis status; Epilepsy, unspecified, without mention of intractable epilepsy; Constipation, unspecified; Anemia in chronic kidney disease; Abnormal coagulation profile; Obstructive sleep apnea (adult)(pediatric); Other diseases of lung, not elsewhere classified; Other chest pain; Fever, unspecified; Rash and other nonspecific skin eruption; Other chronic pulmonary heart diseases; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Unspecified disease of pericardium; Other ascites; Acidosis; Hyposmolality and/or hyponatremia; Abdominal pain, other specified site; Abdominal pain, epigastric; Nausea with vomiting; Diarrhea; Systemic lupus erythematosus; Hyperparathyroidism, unspecified; Anemia, unspecified; Thrombocytopenia, unspecified; Esophageal reflux]" +SECONDARY: [Renal dialysis status; Epilepsy, unspecified, without mention of intractable epilepsy; Constipation, unspecified; Anemia in chronic kidney disease; Abnormal coagulation profile; Obstructive sleep apnea (adult)(pediatric); Other diseases of lung, not elsewhere classified; Other chest pain; Fever, unspecified; Rash and other nonspecific skin eruption; Other chronic pulmonary heart diseases; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Unspecified disease of pericardium; Other ascites; Acidosis; Hyposmolality and/or hyponatremia; Abdominal pain, other specified site; Abdominal pain, epigastric; Nausea with vomiting; Diarrhea; Systemic lupus erythematosus; Hyperparathyroidism, unspecified; Anemia, unspecified; Thrombocytopenia, unspecified; Esophageal reflux]","this is a 24 year old woman with esrd secondary to sle (started +peritoneal dialysis approximately one week prior to admission), +malignant htn, h/o svc syndrome, and multiple thrombotic events +(on warfarin) who is presenting with persistent suprapubic/lower +abdominal pain and new onset severe epigastric pain w/ nausea +and vomiting, and hypertension. however, during +the initial part of her admission, the patient remained afebrile +with an initial relative leukocytosis which trended to within +baseline limits. pericarditis +was considered, but her ekg was unchanged from prior studies and +there had been on interval increase in her pericardial effusion +since [**2141-10-13**]. the patient tolerated the procedure well and immediately +reported that both her epigastric and suprapubic pain were gone +after the surgery. multiple medication regimens +were attempted and changed throughout her hospital course. when +sbp>180, give 25 mg po hydral every 30 min until sbp<150. during her admission, the patient underwent multiple +trials of peritoneal dialysis, but was unable to tolerate it on +a consistent basis secondary to abdominal pain. upon discharge, her electrolytes were back to her +baseline. epo alfa sc was +also given on [**2141-10-17**]. the patients +hct remained stable (hovering between 25 - 27) from [**2141-10-19**] - +[**2141-10-23**]. between [**2141-10-23**] - [**2141-10-24**], the patient had a hct +drop from 26 to 20 in the setting of occult positive emesis. gi +was aware and planned to perform a non-urgent egd on [**10-25**] or +[**10-26**] as the patient was hemodynamically stable and her hct +returned to baseline. she was +also started heparin drip secondary to concern for ischemic +bowel [**2-11**] microthrombotic disease. as a result, she underwent upper +extremity venous ultrasound on [**2141-11-2**], which showed no +evidence of a dvt within the left upper extremity and the +previously noted thrombus within the left subclavian vein was +not seen as well. # sle: rheumatology was consulted several times throughout her +hospital course, but they did not think that a lupus flare was +contributing to her presentation. # obstructive sleep apnea: the patient was noted to have osa +based on clinical nocturnal exam during admission.","esrd secondary to sle, malignant htn, h/o svc syndrome, and multiple thrombotic events were considered. the patient was placed on iv flagyl, but this was discontinued when stool samples were negative for c.difficile. a heparin drip and warfarin were started for treatment of possible microthrombotic ischemia." 109,176760.0,14805,2142-01-23,14799,125288.0,2141-11-23,Discharge summary,"Admission Date: [**2141-11-18**] Discharge Date: [**2141-11-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -44850,7 +45957,15 @@ is agreeable to outpatient follow up with [**company 191**] social work, and potential cbt. these can be arranged by her pcp. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Abdominal pain, unspecified site; Anemia, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Abdominal pain, unspecified site; Anemia, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","1) hypertension: patient has history of extremely labile +hypertension on an aggressive outpatient regimen. her hydralazine was increased from 75mg to 100mg tid with mild +improvement. peritoneal fluid was obtained and contained 544 +polys. the dose was lowered to 4mg daily at +discharge to prevent overshooting the therapeutic range, but the +patient will have close follow up with coumadin clinic, with +dose titrations as needed. her nephrologist felt +this may be contributing to her recurrent pain and hypertension, +so psychiatry was consulted.","patient has history of extremely labile hypertension on aggressive outpatient regimen. overnight in the micu, patient required iv and po labetalol for sbp > 200. ct scan showed increasing ascites, but no acute pathology." 109,176760.0,14805,2142-01-23,14800,161950.0,2141-12-01,Discharge summary,"Admission Date: [**2141-11-24**] Discharge Date: [**2141-12-1**] Date of Birth: [**2117-8-7**] Sex: F @@ -45239,7 +46354,10 @@ patient succesfully switched to po meds and transferred to the floor. upon transfer to the floor, the following was her ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Other ascites; ; Systemic lupus erythematosus; Headache; Anemia in chronic kidney disease; Anxiety state, unspecified; Other chest pain; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Renal dialysis status; Acquired absence of organ, eye]" +SECONDARY: [End stage renal disease; Other ascites; ; Systemic lupus erythematosus; Headache; Anemia in chronic kidney disease; Anxiety state, unspecified; Other chest pain; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Renal dialysis status; Acquired absence of organ, eye]","24yo f with sle, esrd on hd and malignant hypertension who +presented with abdominal pain and headache and was admitted for +hypertensive urgency. the renal team was consulted, and recommended no change +to home med regimen.","a 24yo f with sle, esrd on hd and malignant hypertension presented with abdominal pain and headache. the patient was found to be hypocalcemic, and was started on calcium replacement therapy. she successfully switched to po meds and was transferred to the floor." 109,176760.0,14805,2142-01-23,14801,173633.0,2141-12-14,Discharge summary,"Admission Date: [**2141-12-8**] Discharge Date: [**2141-12-14**] Date of Birth: [**2117-8-7**] Sex: F @@ -45694,7 +46812,18 @@ transfused 1u prbc at hd on [**12-12**]. she was also given epo at hd. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Systemic lupus erythematosus; Other and unspecified noninfectious gastroenteritis and colitis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Other iatrogenic hypotension; Obstructive sleep apnea (adult)(pediatric); Hemangioma of intra-abdominal structures; Other chronic pain; Abdominal pain, unspecified site; Abnormal coagulation profile; Renal dialysis status; Personal history of venous thrombosis and embolism]" +SECONDARY: [End stage renal disease; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Systemic lupus erythematosus; Other and unspecified noninfectious gastroenteritis and colitis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Other iatrogenic hypotension; Obstructive sleep apnea (adult)(pediatric); Hemangioma of intra-abdominal structures; Other chronic pain; Abdominal pain, unspecified site; Abnormal coagulation profile; Renal dialysis status; Personal history of venous thrombosis and embolism]","24 year old woman with ckd v and severe hypertension due to sle +admitted with flare of chronic abdominal pain and hypertensive +urgency. initially her blood pressure over-corrected to +sbps in the 80s (patient was asymptomatic). the patient was +transferred to the floor on [**12-10**] after resolution of her +hypertensive urgency with a decreased blood pressure regimen due +to her hypotension in response to home doses of her medications. the patient was continuned on her +admission hypertensive regimen. a ct scan was +performed that showed bowel wall changes that are likely +secondary to recent peritoneal dialysis and unrelated to pain. ckd v from lupus nephritis: the patient was continued on hd +during her admission. she was therapetuic the same day and her heparin gtt +was stopped.",24 year old woman with ckd v and severe hypertension due to sle admitted. patient was initially maintained on a labetalol drip and hydralazine iv prn. initially her blood pressure over-corrected to sbps in the 80s (patient was asymptomatic) 109,176760.0,14805,2142-01-23,14802,140167.0,2141-12-23,Discharge summary,"Admission Date: [**2141-12-18**] Discharge Date: [**2141-12-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -46166,7 +47295,23 @@ pericarditis. she was continued on her home prednisone dose of ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Mechanical complication due to peritoneal dialysis catheter; ; Unspecified disease of pericardium; Angioneurotic edema, not elsewhere classified; Abdominal pain, other specified site; Systemic lupus erythematosus; ; Anemia in chronic kidney disease; Dysthymic disorder; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of steroids; Long-term (current) use of anticoagulants; Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation; Other antihypertensive agents causing adverse effects in therapeutic use]" +SECONDARY: [End stage renal disease; Mechanical complication due to peritoneal dialysis catheter; ; Unspecified disease of pericardium; Angioneurotic edema, not elsewhere classified; Abdominal pain, other specified site; Systemic lupus erythematosus; ; Anemia in chronic kidney disease; Dysthymic disorder; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of steroids; Long-term (current) use of anticoagulants; Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation; Other antihypertensive agents causing adverse effects in therapeutic use]","24 year old female with sle, esrd on hd and malignant +hypertension presents with abdominal pain and headache +consistent with her usual hypertensive urgency and was found to +be in hypertensive urgency in ed. she was given 10mg iv labetalol and started on a labatelol drip. nephrology was consulted and dialysis +initiated in the am. she received a total of 60 mg iv hydralazine over the course of +the morning as well as 0.1 mg po clonidine. she reports bilateral calf cramping but no +leg swelling. she took her am bp meds without difficulty. her +tekturna was discontinued for concern that it might be causing +angioedema. the patient +was maintained on her heparin drip for her svc syndrome. abdominal pain: the patient has had extensive prior workup +that has been unrevealing. the +patients tunneled dialysis catheter had a cuff that was out +and qas subsequently replaced with a temporary femoral line on +[**12-21**]. the patient was scheduled +to have dialysis on [**12-23**]. she was admitted with a +subtherpeutic inr of 1.2 she was started on a heparin drip. there was +no evidence of active, acute bleeding.","24 year old female with sle, esrd on hd presents with abdominal pain and headache consistent with her usual hypertensive urgency. she was found to be in hypertensive urgency in ed. she received hydralazine iv 10 mg once and 2 inches of nitropaste." 109,176760.0,14805,2142-01-23,14803,135923.0,2142-01-12,Discharge summary,"Admission Date: [**2142-1-8**] Discharge Date: [**2142-1-13**] Date of Birth: [**2117-8-7**] Sex: F @@ -46557,7 +47702,17 @@ clonazepam. level. follow-up with transplant surgery. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Hypoxemia; Other opiates and related narcotics causing adverse effects in therapeutic use; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Abdominal pain, other specified site; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Renal dialysis status; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Other postprocedural status]" +SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Hypoxemia; Other opiates and related narcotics causing adverse effects in therapeutic use; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Abdominal pain, other specified site; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Renal dialysis status; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Other postprocedural status]","24 yo woman with hx of sle, ersd on hd, admitted with +hypertensive urgency. # hypertension: pt with extensive history of repeated admissions +for hypertension. # sle: stable, continued prednisone at 4 mg po daily. patient was +oversedated on dilaudid and had episode of oxygen desaturation +which was reversed with narcan. first name (stitle) **] (transplant +surgery). she will be sent home with low-dose morphine ir and +tylenol prn pain. if l groin pain should become uncontrollable +on current meds, pt should return to the ed for re-evaluation. this is likely secondary to aocd +and renal failure. pt will +need an inr check in the next week at her follow-up with her +pcp.","24 yo woman with hx of sle, ersd on hd, admitted with hypertensive urgency. patient was stablized on home medicaitons, suggesting medication non-compliance. patient was oversedated on dilaudid and had episode of oxygen desaturation." 109,176760.0,14805,2142-01-23,14804,124657.0,2142-01-20,Discharge summary,"Admission Date: [**2142-1-14**] Discharge Date: [**2142-1-20**] Date of Birth: [**2117-8-7**] Sex: F @@ -46976,7 +48131,15 @@ prn. # contact: [**first name8 (namepattern2) **] [**name (ni) **] (mother) [**telephone/fax (1) 43503**] ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; ; Other vascular complications of medical care, not elsewhere classified; Systemic lupus erythematosus; Hyperpotassemia; Phlebitis and thrombophlebitis of upper extremities, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [End stage renal disease; ; Other vascular complications of medical care, not elsewhere classified; Systemic lupus erythematosus; Hyperpotassemia; Phlebitis and thrombophlebitis of upper extremities, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","24 yo woman with hx of sle, ersd on hd, admitted with +hypertensive urgency. in the micu, +nifedipine extended release was added in place of nicardipine as +pts blood pressures seemed to rise prior to nicardipine doses. pt was continued on +gabapentin, tylenol around the clock, and low-dose morphine as +needed for pain. # anemia: hct was mildly decreased from baseline during +admission. # hocm: pt has evidence of myocardial hypertrophy on recent +echo. # fen: repleted lytes prn / regular diet +. # contact: [**first name8 (namepattern2) **] [**name (ni) **] (mother) [**telephone/fax (1) 43503**]","24 yo woman with hx of sle, ersd on hd, admitted with hypertensive urgency. pt was transferred to the floor as blood pressure stabilized. pt reported that morphine did not help pain, and was switched to dilaudid po in the micu." 109,158943.0,14808,2142-03-23,14798,126055.0,2141-11-03,Discharge summary,"Admission Date: [**2141-10-13**] Discharge Date: [**2141-11-3**] Date of Birth: [**2117-8-7**] Sex: F @@ -47674,7 +48837,41 @@ having undergone three rounds of hemodialysis, her bicarbonate was within normal limits at 28. ","PRIMARY: [Malignant essential hypertension] -SECONDARY: [Renal dialysis status; Epilepsy, unspecified, without mention of intractable epilepsy; Constipation, unspecified; Anemia in chronic kidney disease; Abnormal coagulation profile; Obstructive sleep apnea (adult)(pediatric); Other diseases of lung, not elsewhere classified; Other chest pain; Fever, unspecified; Rash and other nonspecific skin eruption; Other chronic pulmonary heart diseases; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Unspecified disease of pericardium; Other ascites; Acidosis; Hyposmolality and/or hyponatremia; Abdominal pain, other specified site; Abdominal pain, epigastric; Nausea with vomiting; Diarrhea; Systemic lupus erythematosus; Hyperparathyroidism, unspecified; Anemia, unspecified; Thrombocytopenia, unspecified; Esophageal reflux]" +SECONDARY: [Renal dialysis status; Epilepsy, unspecified, without mention of intractable epilepsy; Constipation, unspecified; Anemia in chronic kidney disease; Abnormal coagulation profile; Obstructive sleep apnea (adult)(pediatric); Other diseases of lung, not elsewhere classified; Other chest pain; Fever, unspecified; Rash and other nonspecific skin eruption; Other chronic pulmonary heart diseases; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Unspecified disease of pericardium; Other ascites; Acidosis; Hyposmolality and/or hyponatremia; Abdominal pain, other specified site; Abdominal pain, epigastric; Nausea with vomiting; Diarrhea; Systemic lupus erythematosus; Hyperparathyroidism, unspecified; Anemia, unspecified; Thrombocytopenia, unspecified; Esophageal reflux]","this is a 24 year old woman with esrd secondary to sle (started +peritoneal dialysis approximately one week prior to admission), +malignant htn, h/o svc syndrome, and multiple thrombotic events +(on warfarin) who is presenting with persistent suprapubic/lower +abdominal pain and new onset severe epigastric pain w/ nausea +and vomiting, and hypertension. however, during +the initial part of her admission, the patient remained afebrile +with an initial relative leukocytosis which trended to within +baseline limits. pericarditis +was considered, but her ekg was unchanged from prior studies and +there had been on interval increase in her pericardial effusion +since [**2141-10-13**]. the patient tolerated the procedure well and immediately +reported that both her epigastric and suprapubic pain were gone +after the surgery. multiple medication regimens +were attempted and changed throughout her hospital course. when +sbp>180, give 25 mg po hydral every 30 min until sbp<150. during her admission, the patient underwent multiple +trials of peritoneal dialysis, but was unable to tolerate it on +a consistent basis secondary to abdominal pain. upon discharge, her electrolytes were back to her +baseline. epo alfa sc was +also given on [**2141-10-17**]. the patients +hct remained stable (hovering between 25 - 27) from [**2141-10-19**] - +[**2141-10-23**]. between [**2141-10-23**] - [**2141-10-24**], the patient had a hct +drop from 26 to 20 in the setting of occult positive emesis. gi +was aware and planned to perform a non-urgent egd on [**10-25**] or +[**10-26**] as the patient was hemodynamically stable and her hct +returned to baseline. she was +also started heparin drip secondary to concern for ischemic +bowel [**2-11**] microthrombotic disease. as a result, she underwent upper +extremity venous ultrasound on [**2141-11-2**], which showed no +evidence of a dvt within the left upper extremity and the +previously noted thrombus within the left subclavian vein was +not seen as well. # sle: rheumatology was consulted several times throughout her +hospital course, but they did not think that a lupus flare was +contributing to her presentation. # obstructive sleep apnea: the patient was noted to have osa +based on clinical nocturnal exam during admission.","esrd secondary to sle, malignant htn, h/o svc syndrome, and multiple thrombotic events were considered. the patient was placed on iv flagyl, but this was discontinued when stool samples were negative for c.difficile. a heparin drip and warfarin were started for treatment of possible microthrombotic ischemia." 109,158943.0,14808,2142-03-23,14799,125288.0,2141-11-23,Discharge summary,"Admission Date: [**2141-11-18**] Discharge Date: [**2141-11-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -48043,7 +49240,15 @@ is agreeable to outpatient follow up with [**company 191**] social work, and potential cbt. these can be arranged by her pcp. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Abdominal pain, unspecified site; Anemia, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Abdominal pain, unspecified site; Anemia, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","1) hypertension: patient has history of extremely labile +hypertension on an aggressive outpatient regimen. her hydralazine was increased from 75mg to 100mg tid with mild +improvement. peritoneal fluid was obtained and contained 544 +polys. the dose was lowered to 4mg daily at +discharge to prevent overshooting the therapeutic range, but the +patient will have close follow up with coumadin clinic, with +dose titrations as needed. her nephrologist felt +this may be contributing to her recurrent pain and hypertension, +so psychiatry was consulted.","patient has history of extremely labile hypertension on aggressive outpatient regimen. overnight in the micu, patient required iv and po labetalol for sbp > 200. ct scan showed increasing ascites, but no acute pathology." 109,158943.0,14808,2142-03-23,14800,161950.0,2141-12-01,Discharge summary,"Admission Date: [**2141-11-24**] Discharge Date: [**2141-12-1**] Date of Birth: [**2117-8-7**] Sex: F @@ -48432,7 +49637,10 @@ patient succesfully switched to po meds and transferred to the floor. upon transfer to the floor, the following was her ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Other ascites; ; Systemic lupus erythematosus; Headache; Anemia in chronic kidney disease; Anxiety state, unspecified; Other chest pain; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Renal dialysis status; Acquired absence of organ, eye]" +SECONDARY: [End stage renal disease; Other ascites; ; Systemic lupus erythematosus; Headache; Anemia in chronic kidney disease; Anxiety state, unspecified; Other chest pain; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Renal dialysis status; Acquired absence of organ, eye]","24yo f with sle, esrd on hd and malignant hypertension who +presented with abdominal pain and headache and was admitted for +hypertensive urgency. the renal team was consulted, and recommended no change +to home med regimen.","a 24yo f with sle, esrd on hd and malignant hypertension presented with abdominal pain and headache. the patient was found to be hypocalcemic, and was started on calcium replacement therapy. she successfully switched to po meds and was transferred to the floor." 109,158943.0,14808,2142-03-23,14801,173633.0,2141-12-14,Discharge summary,"Admission Date: [**2141-12-8**] Discharge Date: [**2141-12-14**] Date of Birth: [**2117-8-7**] Sex: F @@ -48887,7 +50095,18 @@ transfused 1u prbc at hd on [**12-12**]. she was also given epo at hd. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Systemic lupus erythematosus; Other and unspecified noninfectious gastroenteritis and colitis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Other iatrogenic hypotension; Obstructive sleep apnea (adult)(pediatric); Hemangioma of intra-abdominal structures; Other chronic pain; Abdominal pain, unspecified site; Abnormal coagulation profile; Renal dialysis status; Personal history of venous thrombosis and embolism]" +SECONDARY: [End stage renal disease; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Systemic lupus erythematosus; Other and unspecified noninfectious gastroenteritis and colitis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Other iatrogenic hypotension; Obstructive sleep apnea (adult)(pediatric); Hemangioma of intra-abdominal structures; Other chronic pain; Abdominal pain, unspecified site; Abnormal coagulation profile; Renal dialysis status; Personal history of venous thrombosis and embolism]","24 year old woman with ckd v and severe hypertension due to sle +admitted with flare of chronic abdominal pain and hypertensive +urgency. initially her blood pressure over-corrected to +sbps in the 80s (patient was asymptomatic). the patient was +transferred to the floor on [**12-10**] after resolution of her +hypertensive urgency with a decreased blood pressure regimen due +to her hypotension in response to home doses of her medications. the patient was continuned on her +admission hypertensive regimen. a ct scan was +performed that showed bowel wall changes that are likely +secondary to recent peritoneal dialysis and unrelated to pain. ckd v from lupus nephritis: the patient was continued on hd +during her admission. she was therapetuic the same day and her heparin gtt +was stopped.",24 year old woman with ckd v and severe hypertension due to sle admitted. patient was initially maintained on a labetalol drip and hydralazine iv prn. initially her blood pressure over-corrected to sbps in the 80s (patient was asymptomatic) 109,158943.0,14808,2142-03-23,14802,140167.0,2141-12-23,Discharge summary,"Admission Date: [**2141-12-18**] Discharge Date: [**2141-12-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -49359,7 +50578,23 @@ pericarditis. she was continued on her home prednisone dose of ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Mechanical complication due to peritoneal dialysis catheter; ; Unspecified disease of pericardium; Angioneurotic edema, not elsewhere classified; Abdominal pain, other specified site; Systemic lupus erythematosus; ; Anemia in chronic kidney disease; Dysthymic disorder; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of steroids; Long-term (current) use of anticoagulants; Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation; Other antihypertensive agents causing adverse effects in therapeutic use]" +SECONDARY: [End stage renal disease; Mechanical complication due to peritoneal dialysis catheter; ; Unspecified disease of pericardium; Angioneurotic edema, not elsewhere classified; Abdominal pain, other specified site; Systemic lupus erythematosus; ; Anemia in chronic kidney disease; Dysthymic disorder; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of steroids; Long-term (current) use of anticoagulants; Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation; Other antihypertensive agents causing adverse effects in therapeutic use]","24 year old female with sle, esrd on hd and malignant +hypertension presents with abdominal pain and headache +consistent with her usual hypertensive urgency and was found to +be in hypertensive urgency in ed. she was given 10mg iv labetalol and started on a labatelol drip. nephrology was consulted and dialysis +initiated in the am. she received a total of 60 mg iv hydralazine over the course of +the morning as well as 0.1 mg po clonidine. she reports bilateral calf cramping but no +leg swelling. she took her am bp meds without difficulty. her +tekturna was discontinued for concern that it might be causing +angioedema. the patient +was maintained on her heparin drip for her svc syndrome. abdominal pain: the patient has had extensive prior workup +that has been unrevealing. the +patients tunneled dialysis catheter had a cuff that was out +and qas subsequently replaced with a temporary femoral line on +[**12-21**]. the patient was scheduled +to have dialysis on [**12-23**]. she was admitted with a +subtherpeutic inr of 1.2 she was started on a heparin drip. there was +no evidence of active, acute bleeding.","24 year old female with sle, esrd on hd presents with abdominal pain and headache consistent with her usual hypertensive urgency. she was found to be in hypertensive urgency in ed. she received hydralazine iv 10 mg once and 2 inches of nitropaste." 109,158943.0,14808,2142-03-23,14803,135923.0,2142-01-12,Discharge summary,"Admission Date: [**2142-1-8**] Discharge Date: [**2142-1-13**] Date of Birth: [**2117-8-7**] Sex: F @@ -49750,7 +50985,17 @@ clonazepam. level. follow-up with transplant surgery. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Hypoxemia; Other opiates and related narcotics causing adverse effects in therapeutic use; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Abdominal pain, other specified site; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Renal dialysis status; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Other postprocedural status]" +SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Hypoxemia; Other opiates and related narcotics causing adverse effects in therapeutic use; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Abdominal pain, other specified site; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Renal dialysis status; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Other postprocedural status]","24 yo woman with hx of sle, ersd on hd, admitted with +hypertensive urgency. # hypertension: pt with extensive history of repeated admissions +for hypertension. # sle: stable, continued prednisone at 4 mg po daily. patient was +oversedated on dilaudid and had episode of oxygen desaturation +which was reversed with narcan. first name (stitle) **] (transplant +surgery). she will be sent home with low-dose morphine ir and +tylenol prn pain. if l groin pain should become uncontrollable +on current meds, pt should return to the ed for re-evaluation. this is likely secondary to aocd +and renal failure. pt will +need an inr check in the next week at her follow-up with her +pcp.","24 yo woman with hx of sle, ersd on hd, admitted with hypertensive urgency. patient was stablized on home medicaitons, suggesting medication non-compliance. patient was oversedated on dilaudid and had episode of oxygen desaturation." 109,158943.0,14808,2142-03-23,14804,124657.0,2142-01-20,Discharge summary,"Admission Date: [**2142-1-14**] Discharge Date: [**2142-1-20**] Date of Birth: [**2117-8-7**] Sex: F @@ -50169,7 +51414,15 @@ prn. # contact: [**first name8 (namepattern2) **] [**name (ni) **] (mother) [**telephone/fax (1) 43503**] ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; ; Other vascular complications of medical care, not elsewhere classified; Systemic lupus erythematosus; Hyperpotassemia; Phlebitis and thrombophlebitis of upper extremities, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [End stage renal disease; ; Other vascular complications of medical care, not elsewhere classified; Systemic lupus erythematosus; Hyperpotassemia; Phlebitis and thrombophlebitis of upper extremities, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","24 yo woman with hx of sle, ersd on hd, admitted with +hypertensive urgency. in the micu, +nifedipine extended release was added in place of nicardipine as +pts blood pressures seemed to rise prior to nicardipine doses. pt was continued on +gabapentin, tylenol around the clock, and low-dose morphine as +needed for pain. # anemia: hct was mildly decreased from baseline during +admission. # hocm: pt has evidence of myocardial hypertrophy on recent +echo. # fen: repleted lytes prn / regular diet +. # contact: [**first name8 (namepattern2) **] [**name (ni) **] (mother) [**telephone/fax (1) 43503**]","24 yo woman with hx of sle, ersd on hd, admitted with hypertensive urgency. pt was transferred to the floor as blood pressure stabilized. pt reported that morphine did not help pain, and was switched to dilaudid po in the micu." 109,158943.0,14808,2142-03-23,14805,176760.0,2142-01-23,Discharge summary,"Admission Date: [**2142-1-21**] Discharge Date: [**2142-1-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -50611,7 +51864,13 @@ pericardial effusion. continued beta blocker ","PRIMARY: [Other vascular complications of medical care, not elsewhere classified] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; ; Systemic lupus erythematosus; Phlebitis and thrombophlebitis of upper extremities, unspecified]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; ; Systemic lupus erythematosus; Phlebitis and thrombophlebitis of upper extremities, unspecified]","24 yo woman with hx of sle, ersd on hd, admitted with +hypertensive urgency and left wrist pain. she was started on nicardipine drip and 1"" nitropaste +and admitted to the icu for further treatment. she was +continued on iv vanco with hd for 10day course. esrd: continued on regularly scheduled dialysis. her hct was mildly decreased from +baseline. hocm: evidence of myocardial hypertrophy on recent echo. echo without evidence of worsening +pericardial effusion. continued celexa, clonazepam 0.5mg [**hospital1 **] +.","24 yo woman with hx of sle, ersd on hd, admitted with hypertensive urgency and left wrist pain. she was started on nicardipine drip and 1"" nitropaste and admitted to the icu for further treatment. her bp quickly stabilized and she was called out to the medical floor where her sbp ranged 110-150." 109,158943.0,14808,2142-03-23,14807,158995.0,2142-02-26,Discharge summary,"Admission Date: [**2142-2-25**] Discharge Date: [**2142-2-26**] Date of Birth: [**2117-8-7**] Sex: F @@ -50942,7 +52201,9 @@ sleep medicine. ","PRIMARY: [Poisoning by other opiates and related narcotics] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Thrombotic microangiopathy; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Altered mental status; Other iatrogenic hypotension; Accidental poisoning by other opiates and related narcotics; Hyperpotassemia; Anemia in chronic kidney disease; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Nontraumatic hematoma of soft tissue; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Thrombotic microangiopathy; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Altered mental status; Other iatrogenic hypotension; Accidental poisoning by other opiates and related narcotics; Hyperpotassemia; Anemia in chronic kidney disease; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Nontraumatic hematoma of soft tissue; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]","24 yo woman with hx of sle, ersd on hd, admitted hypotension and +decreased mental status. hypotension and altered mental status +were in the setting of excessive narcotic use. # hypotension: resolved, patient normotensive on arrival to icu. relative hypotension likely due to dilaudid. from previous peritoneal [**location 2286**] hematoma ??????","24 yo woman with hx of sle, ersd on hd, admitted hypotension and decreased mental status. narcotics were held, pressors returned to and patient was mentating fine. patient was encouraged to take less pain medications and to use morphine." 109,158943.0,14808,2142-03-23,14806,113189.0,2142-02-17,Discharge summary,"Admission Date: [**2142-2-14**] Discharge Date: [**2142-2-17**] Date of Birth: [**2117-8-7**] Sex: F @@ -51263,7 +52524,11 @@ infusions were needed. # depression/anxiety: continued celexa, clonazepam 0.5mg [**hospital1 **] ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Thrombotic microangiopathy; Systemic lupus erythematosus; Anemia in chronic kidney disease; Thrombocytopenia, unspecified; Obstructive sleep apnea (adult)(pediatric); Nontraumatic hematoma of soft tissue; Dysthymic disorder; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]" +SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Thrombotic microangiopathy; Systemic lupus erythematosus; Anemia in chronic kidney disease; Thrombocytopenia, unspecified; Obstructive sleep apnea (adult)(pediatric); Nontraumatic hematoma of soft tissue; Dysthymic disorder; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]","24 y.o female with sle, esrd on hd and malignant hypertension +who presents with htn and sob aftering missing hd. pt was treated per omr +hypertensive protocol created by the patients primary +providers, with a goal sbp of 160-180. # coagulopathy/history of dvt: patient on lifetime +anticoagulation for hx of multiple thrombotic events.","24 y.o female with sle, esrd on hd and malignant hypertension who presents with htn and sob after missing hd. pt was treated per omr hypertensive protocol created by the patients primary providers, with a goal sbp of 160-180. she was well maintained on oral outpt regimen of clonidine, labetalol, aliskiren, nifedipine." 109,158995.0,14807,2142-02-26,15330,131345.0,2141-09-08,Discharge summary,"Admission Date: [**2141-9-5**] Discharge Date: [**2141-9-8**] Date of Birth: [**2117-8-7**] Sex: F @@ -51666,7 +52931,14 @@ for 2d # dispo status: ambulating, pain free, bp in the 150/90 range ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Nausea alone; Other antihypertensive agents causing adverse effects in therapeutic use; Hip and thigh injury; Unspecified accident; Hypotension, unspecified; Anemia, unspecified; Personal history of venous thrombosis and embolism; End stage renal disease; ; Urinary tract infection, site not specified; Hyperpotassemia; Acidosis; Disorders of phosphorus metabolism; Hypocalcemia; Secondary hyperparathyroidism (of renal origin)]" +SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Nausea alone; Other antihypertensive agents causing adverse effects in therapeutic use; Hip and thigh injury; Unspecified accident; Hypotension, unspecified; Anemia, unspecified; Personal history of venous thrombosis and embolism; End stage renal disease; ; Urinary tract infection, site not specified; Hyperpotassemia; Acidosis; Disorders of phosphorus metabolism; Hypocalcemia; Secondary hyperparathyroidism (of renal origin)]","ms [**known lastname **] is a 24 year old woman with sle, ckd v, and multiple +admissions for labile hypertension who presented to the ed +complaining of about a weeks?????? we opted to discharge her on her home regimen +(without decreasing doses) since she is more often having issues +with elevated blood pressures. # right leg pain: no evidence of avascular necrosis or fracture +on plain film. also had +temp to 101 on evening prior to discharge. # systemic lupus erythematosus: cont home prednisone dose +.","ms [**known lastname **] is a 24 year old woman with sle, ckd v, and multiple admissions for labile hypertension. she presented to the ed complaining of about a weeks?????? worth of right leg pain. she was initially admitted to the micu for hypertensive urgency and then transferred to the floor after a day. she was started on her home meds and tolerated them fairly well." 109,158995.0,14807,2142-02-26,14796,139061.0,2141-09-14,Discharge summary,"Admission Date: [**2141-9-11**] Discharge Date: [**2141-9-14**] Date of Birth: [**2117-8-7**] Sex: F @@ -52122,7 +53394,16 @@ maintained on warfarin with inr goal 2.5 to 3.0. patients home prednisone regimen was continued. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Urinary tract infection, site not specified; Other primary cardiomyopathies; Systemic lupus erythematosus; Sciatica; Hyperpotassemia; Thrombocytopenia, unspecified; Abnormal coagulation profile; Hyperparathyroidism, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism]" +SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Urinary tract infection, site not specified; Other primary cardiomyopathies; Systemic lupus erythematosus; Sciatica; Hyperpotassemia; Thrombocytopenia, unspecified; Abnormal coagulation profile; Hyperparathyroidism, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism]","icu course: +ekg showed no change from prior, and cxr showed a suggestion of +rll/r diaphragm haziness. the renal team was consulted, and recommended +no change to home medication regimen. right leg pain: upon arrival on the floor, the patient +complained of [**2143-4-15**] pain in r buttock and posterior thigh, much +exacerbated with standing. of note, lumbar spine mri and r hip +xr on most recent admission were both negative. she was treated with a +three day course of ciprofloxacin. esrd: the patient has end-stage renal disease due to her +lupus. anemia: the patients hematocrit remained near her baseline +low 20s throughout her stay.","ekg showed no change from prior, and cxr showed a suggestion of rll/r diaphragm haziness. the patient was found to by hypocalcemic, and was started on calcium replacement therapy. she became more hypertensive, with sbps to the 170s-180s during the day. throughout her hospitalization, the patient had no symptoms/signs of hypertensive emergency." 109,158995.0,14807,2142-02-26,14797,172335.0,2141-09-24,Discharge summary,"Admission Date: [**2141-9-18**] Discharge Date: [**2141-9-24**] Date of Birth: [**2117-8-7**] Sex: F @@ -52695,7 +53976,23 @@ pivs ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [Pneumonia, organism unspecified; Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Hyperpotassemia; Sciatica; Other iatrogenic hypotension; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Anemia of other chronic disease; Hypocalcemia]" +SECONDARY: [Pneumonia, organism unspecified; Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Hyperpotassemia; Sciatica; Other iatrogenic hypotension; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Anemia of other chronic disease; Hypocalcemia]","24 yo with h/o of lupus, htn, and lupus nephropathy started on +peitoneal dialysis during this admissionwho was admitted +initially for r hip pain. micu course: on [**9-20**], the patient triggered for hypotension +(82/45), hypothermia (92.9) and altered mental status with +difficult arousability in setting of recent blood transfusion. urine culture and blood cultures are pending. patients +bp was in the 110s so hydralazine was stopped. her other bp meds +were otherwise continued. if patient has leg pain +again, may consider neurogenic source such a piriformis syndrome +as suggested by neurology. it would be good if we could arrange a pulmonary clinic follow +up for ms. [** she underwent ct head, and v/q scan which were unremarkable. her steroid dose was increased to 15mg given concern for need +for stress dose steroids. she was pan-cultured (blood, urine, +peritoneal dialysate) without obvious source of infection. source unclear at this point, but cxr with +question of retrocardiac opacity. continue home bp meds :labetalol 900 mg po tid but +difficult for patient to tolerate due to nausea, aliskiren *nf* +150 mg oral [**hospital1 **], nifedipine cr 60 mg po daily, clonidine patch, +hydralazine given hypertensive in setting of nausa. did well with pd on [**9-22**] but did +report some nause and cramping. # systemic lupus erythematosus: home prednisone dose 5mg.","lupus nephropathy patient on peitoneal dialysis with htn and lupus nephropathy. triggered for hypotension (82/45), hypothermia (92.9), altered mental status. concern was for sepsis, autonomic seizure, transfusion reaction, pulmonary embolus and/or narcosis." 109,158995.0,14807,2142-02-26,14798,126055.0,2141-11-03,Discharge summary,"Admission Date: [**2141-10-13**] Discharge Date: [**2141-11-3**] Date of Birth: [**2117-8-7**] Sex: F @@ -53393,7 +54690,41 @@ having undergone three rounds of hemodialysis, her bicarbonate was within normal limits at 28. ","PRIMARY: [Malignant essential hypertension] -SECONDARY: [Renal dialysis status; Epilepsy, unspecified, without mention of intractable epilepsy; Constipation, unspecified; Anemia in chronic kidney disease; Abnormal coagulation profile; Obstructive sleep apnea (adult)(pediatric); Other diseases of lung, not elsewhere classified; Other chest pain; Fever, unspecified; Rash and other nonspecific skin eruption; Other chronic pulmonary heart diseases; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Unspecified disease of pericardium; Other ascites; Acidosis; Hyposmolality and/or hyponatremia; Abdominal pain, other specified site; Abdominal pain, epigastric; Nausea with vomiting; Diarrhea; Systemic lupus erythematosus; Hyperparathyroidism, unspecified; Anemia, unspecified; Thrombocytopenia, unspecified; Esophageal reflux]" +SECONDARY: [Renal dialysis status; Epilepsy, unspecified, without mention of intractable epilepsy; Constipation, unspecified; Anemia in chronic kidney disease; Abnormal coagulation profile; Obstructive sleep apnea (adult)(pediatric); Other diseases of lung, not elsewhere classified; Other chest pain; Fever, unspecified; Rash and other nonspecific skin eruption; Other chronic pulmonary heart diseases; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Unspecified disease of pericardium; Other ascites; Acidosis; Hyposmolality and/or hyponatremia; Abdominal pain, other specified site; Abdominal pain, epigastric; Nausea with vomiting; Diarrhea; Systemic lupus erythematosus; Hyperparathyroidism, unspecified; Anemia, unspecified; Thrombocytopenia, unspecified; Esophageal reflux]","this is a 24 year old woman with esrd secondary to sle (started +peritoneal dialysis approximately one week prior to admission), +malignant htn, h/o svc syndrome, and multiple thrombotic events +(on warfarin) who is presenting with persistent suprapubic/lower +abdominal pain and new onset severe epigastric pain w/ nausea +and vomiting, and hypertension. however, during +the initial part of her admission, the patient remained afebrile +with an initial relative leukocytosis which trended to within +baseline limits. pericarditis +was considered, but her ekg was unchanged from prior studies and +there had been on interval increase in her pericardial effusion +since [**2141-10-13**]. the patient tolerated the procedure well and immediately +reported that both her epigastric and suprapubic pain were gone +after the surgery. multiple medication regimens +were attempted and changed throughout her hospital course. when +sbp>180, give 25 mg po hydral every 30 min until sbp<150. during her admission, the patient underwent multiple +trials of peritoneal dialysis, but was unable to tolerate it on +a consistent basis secondary to abdominal pain. upon discharge, her electrolytes were back to her +baseline. epo alfa sc was +also given on [**2141-10-17**]. the patients +hct remained stable (hovering between 25 - 27) from [**2141-10-19**] - +[**2141-10-23**]. between [**2141-10-23**] - [**2141-10-24**], the patient had a hct +drop from 26 to 20 in the setting of occult positive emesis. gi +was aware and planned to perform a non-urgent egd on [**10-25**] or +[**10-26**] as the patient was hemodynamically stable and her hct +returned to baseline. she was +also started heparin drip secondary to concern for ischemic +bowel [**2-11**] microthrombotic disease. as a result, she underwent upper +extremity venous ultrasound on [**2141-11-2**], which showed no +evidence of a dvt within the left upper extremity and the +previously noted thrombus within the left subclavian vein was +not seen as well. # sle: rheumatology was consulted several times throughout her +hospital course, but they did not think that a lupus flare was +contributing to her presentation. # obstructive sleep apnea: the patient was noted to have osa +based on clinical nocturnal exam during admission.","esrd secondary to sle, malignant htn, h/o svc syndrome, and multiple thrombotic events were considered. the patient was placed on iv flagyl, but this was discontinued when stool samples were negative for c.difficile. a heparin drip and warfarin were started for treatment of possible microthrombotic ischemia." 109,158995.0,14807,2142-02-26,14799,125288.0,2141-11-23,Discharge summary,"Admission Date: [**2141-11-18**] Discharge Date: [**2141-11-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -53762,7 +55093,15 @@ is agreeable to outpatient follow up with [**company 191**] social work, and potential cbt. these can be arranged by her pcp. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Abdominal pain, unspecified site; Anemia, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Abdominal pain, unspecified site; Anemia, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","1) hypertension: patient has history of extremely labile +hypertension on an aggressive outpatient regimen. her hydralazine was increased from 75mg to 100mg tid with mild +improvement. peritoneal fluid was obtained and contained 544 +polys. the dose was lowered to 4mg daily at +discharge to prevent overshooting the therapeutic range, but the +patient will have close follow up with coumadin clinic, with +dose titrations as needed. her nephrologist felt +this may be contributing to her recurrent pain and hypertension, +so psychiatry was consulted.","patient has history of extremely labile hypertension on aggressive outpatient regimen. overnight in the micu, patient required iv and po labetalol for sbp > 200. ct scan showed increasing ascites, but no acute pathology." 109,158995.0,14807,2142-02-26,14800,161950.0,2141-12-01,Discharge summary,"Admission Date: [**2141-11-24**] Discharge Date: [**2141-12-1**] Date of Birth: [**2117-8-7**] Sex: F @@ -54151,7 +55490,10 @@ patient succesfully switched to po meds and transferred to the floor. upon transfer to the floor, the following was her ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Other ascites; ; Systemic lupus erythematosus; Headache; Anemia in chronic kidney disease; Anxiety state, unspecified; Other chest pain; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Renal dialysis status; Acquired absence of organ, eye]" +SECONDARY: [End stage renal disease; Other ascites; ; Systemic lupus erythematosus; Headache; Anemia in chronic kidney disease; Anxiety state, unspecified; Other chest pain; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Renal dialysis status; Acquired absence of organ, eye]","24yo f with sle, esrd on hd and malignant hypertension who +presented with abdominal pain and headache and was admitted for +hypertensive urgency. the renal team was consulted, and recommended no change +to home med regimen.","a 24yo f with sle, esrd on hd and malignant hypertension presented with abdominal pain and headache. the patient was found to be hypocalcemic, and was started on calcium replacement therapy. she successfully switched to po meds and was transferred to the floor." 109,158995.0,14807,2142-02-26,14801,173633.0,2141-12-14,Discharge summary,"Admission Date: [**2141-12-8**] Discharge Date: [**2141-12-14**] Date of Birth: [**2117-8-7**] Sex: F @@ -54606,7 +55948,18 @@ transfused 1u prbc at hd on [**12-12**]. she was also given epo at hd. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Systemic lupus erythematosus; Other and unspecified noninfectious gastroenteritis and colitis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Other iatrogenic hypotension; Obstructive sleep apnea (adult)(pediatric); Hemangioma of intra-abdominal structures; Other chronic pain; Abdominal pain, unspecified site; Abnormal coagulation profile; Renal dialysis status; Personal history of venous thrombosis and embolism]" +SECONDARY: [End stage renal disease; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Systemic lupus erythematosus; Other and unspecified noninfectious gastroenteritis and colitis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Other iatrogenic hypotension; Obstructive sleep apnea (adult)(pediatric); Hemangioma of intra-abdominal structures; Other chronic pain; Abdominal pain, unspecified site; Abnormal coagulation profile; Renal dialysis status; Personal history of venous thrombosis and embolism]","24 year old woman with ckd v and severe hypertension due to sle +admitted with flare of chronic abdominal pain and hypertensive +urgency. initially her blood pressure over-corrected to +sbps in the 80s (patient was asymptomatic). the patient was +transferred to the floor on [**12-10**] after resolution of her +hypertensive urgency with a decreased blood pressure regimen due +to her hypotension in response to home doses of her medications. the patient was continuned on her +admission hypertensive regimen. a ct scan was +performed that showed bowel wall changes that are likely +secondary to recent peritoneal dialysis and unrelated to pain. ckd v from lupus nephritis: the patient was continued on hd +during her admission. she was therapetuic the same day and her heparin gtt +was stopped.",24 year old woman with ckd v and severe hypertension due to sle admitted. patient was initially maintained on a labetalol drip and hydralazine iv prn. initially her blood pressure over-corrected to sbps in the 80s (patient was asymptomatic) 109,158995.0,14807,2142-02-26,14802,140167.0,2141-12-23,Discharge summary,"Admission Date: [**2141-12-18**] Discharge Date: [**2141-12-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -55078,7 +56431,23 @@ pericarditis. she was continued on her home prednisone dose of ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Mechanical complication due to peritoneal dialysis catheter; ; Unspecified disease of pericardium; Angioneurotic edema, not elsewhere classified; Abdominal pain, other specified site; Systemic lupus erythematosus; ; Anemia in chronic kidney disease; Dysthymic disorder; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of steroids; Long-term (current) use of anticoagulants; Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation; Other antihypertensive agents causing adverse effects in therapeutic use]" +SECONDARY: [End stage renal disease; Mechanical complication due to peritoneal dialysis catheter; ; Unspecified disease of pericardium; Angioneurotic edema, not elsewhere classified; Abdominal pain, other specified site; Systemic lupus erythematosus; ; Anemia in chronic kidney disease; Dysthymic disorder; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of steroids; Long-term (current) use of anticoagulants; Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation; Other antihypertensive agents causing adverse effects in therapeutic use]","24 year old female with sle, esrd on hd and malignant +hypertension presents with abdominal pain and headache +consistent with her usual hypertensive urgency and was found to +be in hypertensive urgency in ed. she was given 10mg iv labetalol and started on a labatelol drip. nephrology was consulted and dialysis +initiated in the am. she received a total of 60 mg iv hydralazine over the course of +the morning as well as 0.1 mg po clonidine. she reports bilateral calf cramping but no +leg swelling. she took her am bp meds without difficulty. her +tekturna was discontinued for concern that it might be causing +angioedema. the patient +was maintained on her heparin drip for her svc syndrome. abdominal pain: the patient has had extensive prior workup +that has been unrevealing. the +patients tunneled dialysis catheter had a cuff that was out +and qas subsequently replaced with a temporary femoral line on +[**12-21**]. the patient was scheduled +to have dialysis on [**12-23**]. she was admitted with a +subtherpeutic inr of 1.2 she was started on a heparin drip. there was +no evidence of active, acute bleeding.","24 year old female with sle, esrd on hd presents with abdominal pain and headache consistent with her usual hypertensive urgency. she was found to be in hypertensive urgency in ed. she received hydralazine iv 10 mg once and 2 inches of nitropaste." 109,158995.0,14807,2142-02-26,14803,135923.0,2142-01-12,Discharge summary,"Admission Date: [**2142-1-8**] Discharge Date: [**2142-1-13**] Date of Birth: [**2117-8-7**] Sex: F @@ -55469,7 +56838,17 @@ clonazepam. level. follow-up with transplant surgery. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Hypoxemia; Other opiates and related narcotics causing adverse effects in therapeutic use; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Abdominal pain, other specified site; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Renal dialysis status; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Other postprocedural status]" +SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Hypoxemia; Other opiates and related narcotics causing adverse effects in therapeutic use; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Abdominal pain, other specified site; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Renal dialysis status; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Other postprocedural status]","24 yo woman with hx of sle, ersd on hd, admitted with +hypertensive urgency. # hypertension: pt with extensive history of repeated admissions +for hypertension. # sle: stable, continued prednisone at 4 mg po daily. patient was +oversedated on dilaudid and had episode of oxygen desaturation +which was reversed with narcan. first name (stitle) **] (transplant +surgery). she will be sent home with low-dose morphine ir and +tylenol prn pain. if l groin pain should become uncontrollable +on current meds, pt should return to the ed for re-evaluation. this is likely secondary to aocd +and renal failure. pt will +need an inr check in the next week at her follow-up with her +pcp.","24 yo woman with hx of sle, ersd on hd, admitted with hypertensive urgency. patient was stablized on home medicaitons, suggesting medication non-compliance. patient was oversedated on dilaudid and had episode of oxygen desaturation." 109,158995.0,14807,2142-02-26,14804,124657.0,2142-01-20,Discharge summary,"Admission Date: [**2142-1-14**] Discharge Date: [**2142-1-20**] Date of Birth: [**2117-8-7**] Sex: F @@ -55888,7 +57267,15 @@ prn. # contact: [**first name8 (namepattern2) **] [**name (ni) **] (mother) [**telephone/fax (1) 43503**] ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; ; Other vascular complications of medical care, not elsewhere classified; Systemic lupus erythematosus; Hyperpotassemia; Phlebitis and thrombophlebitis of upper extremities, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [End stage renal disease; ; Other vascular complications of medical care, not elsewhere classified; Systemic lupus erythematosus; Hyperpotassemia; Phlebitis and thrombophlebitis of upper extremities, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","24 yo woman with hx of sle, ersd on hd, admitted with +hypertensive urgency. in the micu, +nifedipine extended release was added in place of nicardipine as +pts blood pressures seemed to rise prior to nicardipine doses. pt was continued on +gabapentin, tylenol around the clock, and low-dose morphine as +needed for pain. # anemia: hct was mildly decreased from baseline during +admission. # hocm: pt has evidence of myocardial hypertrophy on recent +echo. # fen: repleted lytes prn / regular diet +. # contact: [**first name8 (namepattern2) **] [**name (ni) **] (mother) [**telephone/fax (1) 43503**]","24 yo woman with hx of sle, ersd on hd, admitted with hypertensive urgency. pt was transferred to the floor as blood pressure stabilized. pt reported that morphine did not help pain, and was switched to dilaudid po in the micu." 109,158995.0,14807,2142-02-26,14805,176760.0,2142-01-23,Discharge summary,"Admission Date: [**2142-1-21**] Discharge Date: [**2142-1-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -56330,7 +57717,13 @@ pericardial effusion. continued beta blocker ","PRIMARY: [Other vascular complications of medical care, not elsewhere classified] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; ; Systemic lupus erythematosus; Phlebitis and thrombophlebitis of upper extremities, unspecified]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; ; Systemic lupus erythematosus; Phlebitis and thrombophlebitis of upper extremities, unspecified]","24 yo woman with hx of sle, ersd on hd, admitted with +hypertensive urgency and left wrist pain. she was started on nicardipine drip and 1"" nitropaste +and admitted to the icu for further treatment. she was +continued on iv vanco with hd for 10day course. esrd: continued on regularly scheduled dialysis. her hct was mildly decreased from +baseline. hocm: evidence of myocardial hypertrophy on recent echo. echo without evidence of worsening +pericardial effusion. continued celexa, clonazepam 0.5mg [**hospital1 **] +.","24 yo woman with hx of sle, ersd on hd, admitted with hypertensive urgency and left wrist pain. she was started on nicardipine drip and 1"" nitropaste and admitted to the icu for further treatment. her bp quickly stabilized and she was called out to the medical floor where her sbp ranged 110-150." 109,158995.0,14807,2142-02-26,14806,113189.0,2142-02-17,Discharge summary,"Admission Date: [**2142-2-14**] Discharge Date: [**2142-2-17**] Date of Birth: [**2117-8-7**] Sex: F @@ -56651,7 +58044,11 @@ infusions were needed. # depression/anxiety: continued celexa, clonazepam 0.5mg [**hospital1 **] ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Thrombotic microangiopathy; Systemic lupus erythematosus; Anemia in chronic kidney disease; Thrombocytopenia, unspecified; Obstructive sleep apnea (adult)(pediatric); Nontraumatic hematoma of soft tissue; Dysthymic disorder; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]" +SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Thrombotic microangiopathy; Systemic lupus erythematosus; Anemia in chronic kidney disease; Thrombocytopenia, unspecified; Obstructive sleep apnea (adult)(pediatric); Nontraumatic hematoma of soft tissue; Dysthymic disorder; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]","24 y.o female with sle, esrd on hd and malignant hypertension +who presents with htn and sob aftering missing hd. pt was treated per omr +hypertensive protocol created by the patients primary +providers, with a goal sbp of 160-180. # coagulopathy/history of dvt: patient on lifetime +anticoagulation for hx of multiple thrombotic events.","24 y.o female with sle, esrd on hd and malignant hypertension who presents with htn and sob after missing hd. pt was treated per omr hypertensive protocol created by the patients primary providers, with a goal sbp of 160-180. she was well maintained on oral outpt regimen of clonidine, labetalol, aliskiren, nifedipine." 109,124657.0,14804,2142-01-20,14796,139061.0,2141-09-14,Discharge summary,"Admission Date: [**2141-9-11**] Discharge Date: [**2141-9-14**] Date of Birth: [**2117-8-7**] Sex: F @@ -57107,7 +58504,16 @@ maintained on warfarin with inr goal 2.5 to 3.0. patients home prednisone regimen was continued. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Urinary tract infection, site not specified; Other primary cardiomyopathies; Systemic lupus erythematosus; Sciatica; Hyperpotassemia; Thrombocytopenia, unspecified; Abnormal coagulation profile; Hyperparathyroidism, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism]" +SECONDARY: [Chronic glomerulonephritis in diseases classified elsewhere; Chronic kidney disease, Stage V; Urinary tract infection, site not specified; Other primary cardiomyopathies; Systemic lupus erythematosus; Sciatica; Hyperpotassemia; Thrombocytopenia, unspecified; Abnormal coagulation profile; Hyperparathyroidism, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism]","icu course: +ekg showed no change from prior, and cxr showed a suggestion of +rll/r diaphragm haziness. the renal team was consulted, and recommended +no change to home medication regimen. right leg pain: upon arrival on the floor, the patient +complained of [**2143-4-15**] pain in r buttock and posterior thigh, much +exacerbated with standing. of note, lumbar spine mri and r hip +xr on most recent admission were both negative. she was treated with a +three day course of ciprofloxacin. esrd: the patient has end-stage renal disease due to her +lupus. anemia: the patients hematocrit remained near her baseline +low 20s throughout her stay.","ekg showed no change from prior, and cxr showed a suggestion of rll/r diaphragm haziness. the patient was found to by hypocalcemic, and was started on calcium replacement therapy. she became more hypertensive, with sbps to the 170s-180s during the day. throughout her hospitalization, the patient had no symptoms/signs of hypertensive emergency." 109,131376.0,14862,2142-07-08,14803,135923.0,2142-01-12,Discharge summary,"Admission Date: [**2142-1-8**] Discharge Date: [**2142-1-13**] Date of Birth: [**2117-8-7**] Sex: F @@ -57498,7 +58904,17 @@ clonazepam. level. follow-up with transplant surgery. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Hypoxemia; Other opiates and related narcotics causing adverse effects in therapeutic use; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Abdominal pain, other specified site; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Renal dialysis status; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Other postprocedural status]" +SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Hypoxemia; Other opiates and related narcotics causing adverse effects in therapeutic use; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Abdominal pain, other specified site; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Renal dialysis status; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Other postprocedural status]","24 yo woman with hx of sle, ersd on hd, admitted with +hypertensive urgency. # hypertension: pt with extensive history of repeated admissions +for hypertension. # sle: stable, continued prednisone at 4 mg po daily. patient was +oversedated on dilaudid and had episode of oxygen desaturation +which was reversed with narcan. first name (stitle) **] (transplant +surgery). she will be sent home with low-dose morphine ir and +tylenol prn pain. if l groin pain should become uncontrollable +on current meds, pt should return to the ed for re-evaluation. this is likely secondary to aocd +and renal failure. pt will +need an inr check in the next week at her follow-up with her +pcp.","24 yo woman with hx of sle, ersd on hd, admitted with hypertensive urgency. patient was stablized on home medicaitons, suggesting medication non-compliance. patient was oversedated on dilaudid and had episode of oxygen desaturation." 109,131376.0,14862,2142-07-08,14804,124657.0,2142-01-20,Discharge summary,"Admission Date: [**2142-1-14**] Discharge Date: [**2142-1-20**] Date of Birth: [**2117-8-7**] Sex: F @@ -57917,7 +59333,15 @@ prn. # contact: [**first name8 (namepattern2) **] [**name (ni) **] (mother) [**telephone/fax (1) 43503**] ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; ; Other vascular complications of medical care, not elsewhere classified; Systemic lupus erythematosus; Hyperpotassemia; Phlebitis and thrombophlebitis of upper extremities, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [End stage renal disease; ; Other vascular complications of medical care, not elsewhere classified; Systemic lupus erythematosus; Hyperpotassemia; Phlebitis and thrombophlebitis of upper extremities, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","24 yo woman with hx of sle, ersd on hd, admitted with +hypertensive urgency. in the micu, +nifedipine extended release was added in place of nicardipine as +pts blood pressures seemed to rise prior to nicardipine doses. pt was continued on +gabapentin, tylenol around the clock, and low-dose morphine as +needed for pain. # anemia: hct was mildly decreased from baseline during +admission. # hocm: pt has evidence of myocardial hypertrophy on recent +echo. # fen: repleted lytes prn / regular diet +. # contact: [**first name8 (namepattern2) **] [**name (ni) **] (mother) [**telephone/fax (1) 43503**]","24 yo woman with hx of sle, ersd on hd, admitted with hypertensive urgency. pt was transferred to the floor as blood pressure stabilized. pt reported that morphine did not help pain, and was switched to dilaudid po in the micu." 109,131376.0,14862,2142-07-08,14805,176760.0,2142-01-23,Discharge summary,"Admission Date: [**2142-1-21**] Discharge Date: [**2142-1-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -58359,7 +59783,13 @@ pericardial effusion. continued beta blocker ","PRIMARY: [Other vascular complications of medical care, not elsewhere classified] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; ; Systemic lupus erythematosus; Phlebitis and thrombophlebitis of upper extremities, unspecified]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; ; Systemic lupus erythematosus; Phlebitis and thrombophlebitis of upper extremities, unspecified]","24 yo woman with hx of sle, ersd on hd, admitted with +hypertensive urgency and left wrist pain. she was started on nicardipine drip and 1"" nitropaste +and admitted to the icu for further treatment. she was +continued on iv vanco with hd for 10day course. esrd: continued on regularly scheduled dialysis. her hct was mildly decreased from +baseline. hocm: evidence of myocardial hypertrophy on recent echo. echo without evidence of worsening +pericardial effusion. continued celexa, clonazepam 0.5mg [**hospital1 **] +.","24 yo woman with hx of sle, ersd on hd, admitted with hypertensive urgency and left wrist pain. she was started on nicardipine drip and 1"" nitropaste and admitted to the icu for further treatment. her bp quickly stabilized and she was called out to the medical floor where her sbp ranged 110-150." 109,131376.0,14862,2142-07-08,14806,113189.0,2142-02-17,Discharge summary,"Admission Date: [**2142-2-14**] Discharge Date: [**2142-2-17**] Date of Birth: [**2117-8-7**] Sex: F @@ -58680,7 +60110,11 @@ infusions were needed. # depression/anxiety: continued celexa, clonazepam 0.5mg [**hospital1 **] ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Thrombotic microangiopathy; Systemic lupus erythematosus; Anemia in chronic kidney disease; Thrombocytopenia, unspecified; Obstructive sleep apnea (adult)(pediatric); Nontraumatic hematoma of soft tissue; Dysthymic disorder; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]" +SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Thrombotic microangiopathy; Systemic lupus erythematosus; Anemia in chronic kidney disease; Thrombocytopenia, unspecified; Obstructive sleep apnea (adult)(pediatric); Nontraumatic hematoma of soft tissue; Dysthymic disorder; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]","24 y.o female with sle, esrd on hd and malignant hypertension +who presents with htn and sob aftering missing hd. pt was treated per omr +hypertensive protocol created by the patients primary +providers, with a goal sbp of 160-180. # coagulopathy/history of dvt: patient on lifetime +anticoagulation for hx of multiple thrombotic events.","24 y.o female with sle, esrd on hd and malignant hypertension who presents with htn and sob after missing hd. pt was treated per omr hypertensive protocol created by the patients primary providers, with a goal sbp of 160-180. she was well maintained on oral outpt regimen of clonidine, labetalol, aliskiren, nifedipine." 109,131376.0,14862,2142-07-08,14807,158995.0,2142-02-26,Discharge summary,"Admission Date: [**2142-2-25**] Discharge Date: [**2142-2-26**] Date of Birth: [**2117-8-7**] Sex: F @@ -59011,7 +60445,9 @@ sleep medicine. ","PRIMARY: [Poisoning by other opiates and related narcotics] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Thrombotic microangiopathy; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Altered mental status; Other iatrogenic hypotension; Accidental poisoning by other opiates and related narcotics; Hyperpotassemia; Anemia in chronic kidney disease; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Nontraumatic hematoma of soft tissue; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Thrombotic microangiopathy; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Altered mental status; Other iatrogenic hypotension; Accidental poisoning by other opiates and related narcotics; Hyperpotassemia; Anemia in chronic kidney disease; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Nontraumatic hematoma of soft tissue; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]","24 yo woman with hx of sle, ersd on hd, admitted hypotension and +decreased mental status. hypotension and altered mental status +were in the setting of excessive narcotic use. # hypotension: resolved, patient normotensive on arrival to icu. relative hypotension likely due to dilaudid. from previous peritoneal [**location 2286**] hematoma ??????","24 yo woman with hx of sle, ersd on hd, admitted hypotension and decreased mental status. narcotics were held, pressors returned to and patient was mentating fine. patient was encouraged to take less pain medications and to use morphine." 109,131376.0,14862,2142-07-08,14808,158943.0,2142-03-23,Discharge summary,"Admission Date: [**2142-3-21**] Discharge Date: [**2142-3-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -59363,7 +60799,13 @@ multiple thrombotic events. continued coumadin not symptomatic. continued labetalol. ","PRIMARY: [] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Compression of vein; Unspecified disease of pericardium; Infection and inflammatory reaction due to other vascular device, implant, and graft; Bacteremia; Primary hypercoagulable state; Other primary cardiomyopathies; ; Abdominal pain, unspecified site; Urinary tract infection, site not specified; Acidosis; Other chest pain; Other chronic pain; Systemic lupus erythematosus; Noncompliance with renal dialysis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Hyperpotassemia; Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus]; Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Methicillin resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Compression of vein; Unspecified disease of pericardium; Infection and inflammatory reaction due to other vascular device, implant, and graft; Bacteremia; Primary hypercoagulable state; Other primary cardiomyopathies; ; Abdominal pain, unspecified site; Urinary tract infection, site not specified; Acidosis; Other chest pain; Other chronic pain; Systemic lupus erythematosus; Noncompliance with renal dialysis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Hyperpotassemia; Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus]; Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Methicillin resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","this is a 24 y.o f with sle, esrd on hd and malignant +hypertension + presenting with abd pain, diarrhea, and htn. ct prelim neg +for small bowel obstruction. on +arrival to the floor, abd pain was back to baseline and well +controlled on dilaudid 2mg po q 4hrs +.","a 24 y.o f with sle, esrd on hd and malignant hypertension presenting with abd pain, diarrhea, and htn. initial attempts were made to control her bp with hydralazine and labetalol iv but after these failed to control her blood pressure. she was successfully transitioned to home medications of clonidine, labetalol, aliskiren, nifedipine" 109,131376.0,14862,2142-07-08,14809,124398.0,2142-03-31,Discharge summary,"Admission Date: [**2142-3-24**] Discharge Date: [**2142-3-31**] Date of Birth: [**2117-8-7**] Sex: F @@ -59685,7 +61127,12 @@ she was discharged to followup with her nephrologist, dr. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Systemic lupus erythematosus; Anemia in chronic kidney disease; Long-term (current) use of steroids; Other chronic pain; Obstructive sleep apnea (adult)(pediatric); Abdominal pain, generalized; Hyperpotassemia]" +SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Systemic lupus erythematosus; Anemia in chronic kidney disease; Long-term (current) use of steroids; Other chronic pain; Obstructive sleep apnea (adult)(pediatric); Abdominal pain, generalized; Hyperpotassemia]","the patient was admitted to the micu on a ntg gtt from the ed. her bp goal was for a systolic +of 180-200. instructions were +written for explicit am administration and nifedipine long +acting 30mg was added at night, in addition to the 90mg long +acting she was taking in the morning. she established a three three +times weekly dialysus regemin.","the patient was admitted to the micu on a nicardipine gtt from the ed. she was given her usual afternoon home medications, and transitioned to a nicardipine gtt, which has worked well for her in the past. on arrival to the floor, she in fact missed her morning medications on [**month/day/year 766**] this resulted in elevate blood pressures requiring iv hydralazing for control " 109,131376.0,14862,2142-07-08,14810,137510.0,2142-04-22,Discharge summary,"Admission Date: [**2142-4-20**] Discharge Date: [**2142-4-22**] Date of Birth: [**2117-8-7**] Sex: F @@ -60031,7 +61478,15 @@ anemia: hematocrit 24.5 initially. baseline 23 to 28. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Unspecified iridocyclitis; Other primary cardiomyopathies; Unspecified disease of pericardium; ; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Noncompliance with renal dialysis; Personal history of noncompliance with medical treatment, presenting hazards to health; Surgical or other procedure not carried out because of patient's decision; Abdominal pain, left lower quadrant; Renal dialysis status; Thrombocytopenia, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Peripheral vascular disease, unspecified; Acquired absence of organ, eye; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus]" +SECONDARY: [End stage renal disease; Unspecified iridocyclitis; Other primary cardiomyopathies; Unspecified disease of pericardium; ; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Noncompliance with renal dialysis; Personal history of noncompliance with medical treatment, presenting hazards to health; Surgical or other procedure not carried out because of patient's decision; Abdominal pain, left lower quadrant; Renal dialysis status; Thrombocytopenia, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Peripheral vascular disease, unspecified; Acquired absence of organ, eye; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus]","24 f with esrd on hemodialysis, sle, malignant hypertension, +history of svc syndrome, pres who presented to the icu for +hypertensive emergency, dyspnea, and headache, now resolved. known lastname **] [**last name (titles) 323**] refused to go to a ""home"" and +declined to talk to social work at this time. of note, she has +missed [**last name (titles) 2286**] sessions and often requests durations and flow +rates for her [**last name (titles) 2286**] that contradict recommendations by her +nephrologist. ultrafiltrate of 2 l on initial hd - continue +outpatient regimen +.","malignant hypertension, history of svc syndrome, pres who presented to the icu for hypertensive emergency, dyspnea, and headache, now resolved. she has received [**year/month/day 2286**] and her blood pressures remained at her baseline off the drips." 109,196721.0,14863,2142-07-23,14858,151240.0,2142-05-18,Discharge summary,"Admission Date: [**2142-5-15**] Discharge Date: [**2142-5-18**] Date of Birth: [**2117-8-7**] Sex: F @@ -60356,7 +61811,14 @@ continued on this during her hospitalization. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Other primary cardiomyopathies; Unspecified disease of pericardium; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Hyperpotassemia; Nausea with vomiting; Diarrhea; Disorders of phosphorus metabolism; Anemia of other chronic disease; Abdominal pain, left lower quadrant; Other chronic pain; Thrombocytopenia, unspecified; Other specified peripheral vascular diseases; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus; Long-term (current) use of anticoagulants; Noncompliance with renal dialysis; Renal dialysis status; Personal history of noncompliance with medical treatment, presenting hazards to health]" +SECONDARY: [End stage renal disease; Other primary cardiomyopathies; Unspecified disease of pericardium; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Hyperpotassemia; Nausea with vomiting; Diarrhea; Disorders of phosphorus metabolism; Anemia of other chronic disease; Abdominal pain, left lower quadrant; Other chronic pain; Thrombocytopenia, unspecified; Other specified peripheral vascular diseases; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus; Long-term (current) use of anticoagulants; Noncompliance with renal dialysis; Renal dialysis status; Personal history of noncompliance with medical treatment, presenting hazards to health]","24 yo female with esrd on hd, malignant hypertension with hx of +intracerebral hemorrhage, sle, chronic abdominal pain, and svc +syndrome admitted due to hypertensive urgency after developing +n/v and being unable to take her po medications. she was able to tolerate po intake +prior to discharge. # esrd on hd: she was hyperkalemic in the emergency room and was +given kayexalate. previous documentation +in omr states she does not need to be bridged while +subtherapeutic.","24 yo female with esrd on hd, malignant hypertension with hx of intracerebral hemorrhage, sle, chronic abdominal pain, and svc syndrome admitted due to hypertensive urgency. she was continued on her home regimen of aliskiren 150 mg po bid, clonidine 0.4 mg/24 hr patch weekly, labetalol 1000 mg po tid, nifedipine 60 mg" 109,196721.0,14863,2142-07-23,14859,102024.0,2142-06-05,Discharge summary,"Admission Date: [**2142-5-20**] Discharge Date: [**2142-6-5**] Date of Birth: [**2117-8-7**] Sex: F @@ -60875,7 +62337,24 @@ this should be reassessed in 3 months. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction; Acute posthemorrhagic anemia; Unspecified intestinal obstruction; Other primary cardiomyopathies; Unspecified disease of pericardium; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Disorders of phosphorus metabolism; Hypotension, unspecified; Hyperpotassemia; Mononeuritis of unspecified site; Anemia of other chronic disease; Abdominal pain, left lower quadrant; Other chronic pain; Thrombocytopenia, unspecified; Diaphragmatic hernia without mention of obstruction or gangrene; Other specified peripheral vascular diseases; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus; Noncompliance with renal dialysis; Renal dialysis status; Long-term (current) use of anticoagulants; Personal history of noncompliance with medical treatment, presenting hazards to health]" +SECONDARY: [End stage renal disease; Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction; Acute posthemorrhagic anemia; Unspecified intestinal obstruction; Other primary cardiomyopathies; Unspecified disease of pericardium; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Disorders of phosphorus metabolism; Hypotension, unspecified; Hyperpotassemia; Mononeuritis of unspecified site; Anemia of other chronic disease; Abdominal pain, left lower quadrant; Other chronic pain; Thrombocytopenia, unspecified; Diaphragmatic hernia without mention of obstruction or gangrene; Other specified peripheral vascular diseases; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus; Noncompliance with renal dialysis; Renal dialysis status; Long-term (current) use of anticoagulants; Personal history of noncompliance with medical treatment, presenting hazards to health]","kub: sbo + +head ct: (prelim read from radiology). ct chest/abd: preliminary read +normal aorta without dissection or acute abnormality. bp meds were held and +then re-initiated as the pressure came back up once she was able +to eat. gi was c/s re: abd pain and rec +cta-abdomen to eval for mesenteric ischemia vs. partial sbo, +however with esrd did not initially want to get cta so kub was +ordered. a few hours later she had 3 +episodes of coffee-ground emesis. afterward the pain resolved and +her hct remained stable. gi felt that the patient would need +general anesthesia in order to undergo an egd which showed an +ulcer at the ge junction. her pain was controlled with +her outpatient regimen of po dilaudid. broad spectrum antibiotics were initiated (vanc +ctx) at meningeal dosing. she should be continued on keppra 1gm with +dialysis three times weekly. c3, c4 were equivocal for active lupus flare, and +[**doctor first name **] was positive, as would be expected in lupus. # anemia: has anemia of chronic renal disease and her hct was +high on admission and epo was held per renal.","sbo head ct was negative for intracranial hemorrhage. no intracranial hemorrhage ekg: nsr, right axis, lvh, nl intervals, st elevations v2-3 (old), tw inversion v6 (new) no acute abnormalities in the abdomen to explain epigastric pain." 109,196721.0,14863,2142-07-23,14860,136572.0,2142-06-20,Discharge summary,"Admission Date: [**2142-6-18**] Discharge Date: [**2142-6-20**] Date of Birth: [**2117-8-7**] Sex: F @@ -61205,7 +62684,14 @@ epogen. ","PRIMARY: [] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Other primary cardiomyopathies; Unspecified disease of pericardium; Anemia of other chronic disease; Hyperpotassemia; Systemic lupus erythematosus; Abdominal pain, other specified site; Other chronic pain; Hypotension, unspecified; Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction; Epilepsy, unspecified, without mention of intractable epilepsy; Depressive disorder, not elsewhere classified; Personal history of venous thrombosis and embolism; Noncompliance with renal dialysis]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Other primary cardiomyopathies; Unspecified disease of pericardium; Anemia of other chronic disease; Hyperpotassemia; Systemic lupus erythematosus; Abdominal pain, other specified site; Other chronic pain; Hypotension, unspecified; Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction; Epilepsy, unspecified, without mention of intractable epilepsy; Depressive disorder, not elsewhere classified; Personal history of venous thrombosis and embolism; Noncompliance with renal dialysis]","# dyspnea: pts dypsnea improved on admission to the ed prior to +hd. lipases were noted to be +mildl elevated however no other concerning physical exam signs +of pancreatitis. # sle: pt was continued on her home regimen of prednisone 4mg +daily + +# history of dvt: pt had a sub-therapeutic inr on admission. she +was discharged on warfarin 3mg daily. # depression: pt was continued on her home regimen of celexa.",pts dypsnea improved on admission to the ed prior to hd. dyspnea likely related to fluid overload (pt missed 2 weeks of dialysis) and her level of anemia. 109,196721.0,14863,2142-07-23,14861,174489.0,2142-07-04,Discharge summary,"Admission Date: [**2142-7-3**] Discharge Date: [**2142-7-4**] Date of Birth: [**2117-8-7**] Sex: F @@ -61548,7 +63034,13 @@ mg qdaily without heparin bridge. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Unspecified iridocyclitis; Other primary cardiomyopathies; Abdominal pain, unspecified site; Other chronic pain; Nausea with vomiting; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Other specified peripheral vascular diseases; Obstructive sleep apnea (adult)(pediatric); Anemia of other chronic disease; Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction; Epilepsy, unspecified, without mention of intractable epilepsy; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism; Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits]" +SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Unspecified iridocyclitis; Other primary cardiomyopathies; Abdominal pain, unspecified site; Other chronic pain; Nausea with vomiting; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Other specified peripheral vascular diseases; Obstructive sleep apnea (adult)(pediatric); Anemia of other chronic disease; Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction; Epilepsy, unspecified, without mention of intractable epilepsy; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism; Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits]","24f with h/o sle, esrd on hd, malignant htn, h/o svc syndrome, +pres, prior ich, and recent sbo, p/w n/v, and hypertensive +urgency. she remained normotensive the following morning and +was taken to hemodialysis after which she was discharged home on +all of her old home medications. # abdominal pain - on presentation she was without n/v, soft +abdomen, passing flatus, and having daily bowel movements. # seizure disorder - continued on keppra 1000 mg po 3x/week +(tu,th,sa).","malignant htn, h/o svc syndrome, pres, prior ich, and recent sbo, p/w n/v, and hypertensive urgency. hypertensive urgency was treated as follows with nitro and labetalol gtt which were quickly weaned as blood pressures dropped below sbp 120. she evenutally became hypotensive to sbp of 90 which resolved on its own " 109,174489.0,14861,2142-07-04,14805,176760.0,2142-01-23,Discharge summary,"Admission Date: [**2142-1-21**] Discharge Date: [**2142-1-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -61990,7 +63482,13 @@ pericardial effusion. continued beta blocker ","PRIMARY: [Other vascular complications of medical care, not elsewhere classified] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; ; Systemic lupus erythematosus; Phlebitis and thrombophlebitis of upper extremities, unspecified]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; ; Systemic lupus erythematosus; Phlebitis and thrombophlebitis of upper extremities, unspecified]","24 yo woman with hx of sle, ersd on hd, admitted with +hypertensive urgency and left wrist pain. she was started on nicardipine drip and 1"" nitropaste +and admitted to the icu for further treatment. she was +continued on iv vanco with hd for 10day course. esrd: continued on regularly scheduled dialysis. her hct was mildly decreased from +baseline. hocm: evidence of myocardial hypertrophy on recent echo. echo without evidence of worsening +pericardial effusion. continued celexa, clonazepam 0.5mg [**hospital1 **] +.","24 yo woman with hx of sle, ersd on hd, admitted with hypertensive urgency and left wrist pain. she was started on nicardipine drip and 1"" nitropaste and admitted to the icu for further treatment. her bp quickly stabilized and she was called out to the medical floor where her sbp ranged 110-150." 109,174489.0,14861,2142-07-04,14806,113189.0,2142-02-17,Discharge summary,"Admission Date: [**2142-2-14**] Discharge Date: [**2142-2-17**] Date of Birth: [**2117-8-7**] Sex: F @@ -62311,7 +63809,11 @@ infusions were needed. # depression/anxiety: continued celexa, clonazepam 0.5mg [**hospital1 **] ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Thrombotic microangiopathy; Systemic lupus erythematosus; Anemia in chronic kidney disease; Thrombocytopenia, unspecified; Obstructive sleep apnea (adult)(pediatric); Nontraumatic hematoma of soft tissue; Dysthymic disorder; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]" +SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Thrombotic microangiopathy; Systemic lupus erythematosus; Anemia in chronic kidney disease; Thrombocytopenia, unspecified; Obstructive sleep apnea (adult)(pediatric); Nontraumatic hematoma of soft tissue; Dysthymic disorder; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]","24 y.o female with sle, esrd on hd and malignant hypertension +who presents with htn and sob aftering missing hd. pt was treated per omr +hypertensive protocol created by the patients primary +providers, with a goal sbp of 160-180. # coagulopathy/history of dvt: patient on lifetime +anticoagulation for hx of multiple thrombotic events.","24 y.o female with sle, esrd on hd and malignant hypertension who presents with htn and sob after missing hd. pt was treated per omr hypertensive protocol created by the patients primary providers, with a goal sbp of 160-180. she was well maintained on oral outpt regimen of clonidine, labetalol, aliskiren, nifedipine." 109,174489.0,14861,2142-07-04,14807,158995.0,2142-02-26,Discharge summary,"Admission Date: [**2142-2-25**] Discharge Date: [**2142-2-26**] Date of Birth: [**2117-8-7**] Sex: F @@ -62642,7 +64144,9 @@ sleep medicine. ","PRIMARY: [Poisoning by other opiates and related narcotics] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Thrombotic microangiopathy; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Altered mental status; Other iatrogenic hypotension; Accidental poisoning by other opiates and related narcotics; Hyperpotassemia; Anemia in chronic kidney disease; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Nontraumatic hematoma of soft tissue; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Thrombotic microangiopathy; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Altered mental status; Other iatrogenic hypotension; Accidental poisoning by other opiates and related narcotics; Hyperpotassemia; Anemia in chronic kidney disease; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Nontraumatic hematoma of soft tissue; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]","24 yo woman with hx of sle, ersd on hd, admitted hypotension and +decreased mental status. hypotension and altered mental status +were in the setting of excessive narcotic use. # hypotension: resolved, patient normotensive on arrival to icu. relative hypotension likely due to dilaudid. from previous peritoneal [**location 2286**] hematoma ??????","24 yo woman with hx of sle, ersd on hd, admitted hypotension and decreased mental status. narcotics were held, pressors returned to and patient was mentating fine. patient was encouraged to take less pain medications and to use morphine." 109,174489.0,14861,2142-07-04,14808,158943.0,2142-03-23,Discharge summary,"Admission Date: [**2142-3-21**] Discharge Date: [**2142-3-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -62994,7 +64498,13 @@ multiple thrombotic events. continued coumadin not symptomatic. continued labetalol. ","PRIMARY: [] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Compression of vein; Unspecified disease of pericardium; Infection and inflammatory reaction due to other vascular device, implant, and graft; Bacteremia; Primary hypercoagulable state; Other primary cardiomyopathies; ; Abdominal pain, unspecified site; Urinary tract infection, site not specified; Acidosis; Other chest pain; Other chronic pain; Systemic lupus erythematosus; Noncompliance with renal dialysis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Hyperpotassemia; Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus]; Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Methicillin resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Compression of vein; Unspecified disease of pericardium; Infection and inflammatory reaction due to other vascular device, implant, and graft; Bacteremia; Primary hypercoagulable state; Other primary cardiomyopathies; ; Abdominal pain, unspecified site; Urinary tract infection, site not specified; Acidosis; Other chest pain; Other chronic pain; Systemic lupus erythematosus; Noncompliance with renal dialysis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Hyperpotassemia; Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus]; Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Methicillin resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","this is a 24 y.o f with sle, esrd on hd and malignant +hypertension + presenting with abd pain, diarrhea, and htn. ct prelim neg +for small bowel obstruction. on +arrival to the floor, abd pain was back to baseline and well +controlled on dilaudid 2mg po q 4hrs +.","a 24 y.o f with sle, esrd on hd and malignant hypertension presenting with abd pain, diarrhea, and htn. initial attempts were made to control her bp with hydralazine and labetalol iv but after these failed to control her blood pressure. she was successfully transitioned to home medications of clonidine, labetalol, aliskiren, nifedipine" 109,174489.0,14861,2142-07-04,14809,124398.0,2142-03-31,Discharge summary,"Admission Date: [**2142-3-24**] Discharge Date: [**2142-3-31**] Date of Birth: [**2117-8-7**] Sex: F @@ -63316,7 +64826,12 @@ she was discharged to followup with her nephrologist, dr. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Systemic lupus erythematosus; Anemia in chronic kidney disease; Long-term (current) use of steroids; Other chronic pain; Obstructive sleep apnea (adult)(pediatric); Abdominal pain, generalized; Hyperpotassemia]" +SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Systemic lupus erythematosus; Anemia in chronic kidney disease; Long-term (current) use of steroids; Other chronic pain; Obstructive sleep apnea (adult)(pediatric); Abdominal pain, generalized; Hyperpotassemia]","the patient was admitted to the micu on a ntg gtt from the ed. her bp goal was for a systolic +of 180-200. instructions were +written for explicit am administration and nifedipine long +acting 30mg was added at night, in addition to the 90mg long +acting she was taking in the morning. she established a three three +times weekly dialysus regemin.","the patient was admitted to the micu on a nicardipine gtt from the ed. she was given her usual afternoon home medications, and transitioned to a nicardipine gtt, which has worked well for her in the past. on arrival to the floor, she in fact missed her morning medications on [**month/day/year 766**] this resulted in elevate blood pressures requiring iv hydralazing for control " 109,174489.0,14861,2142-07-04,14810,137510.0,2142-04-22,Discharge summary,"Admission Date: [**2142-4-20**] Discharge Date: [**2142-4-22**] Date of Birth: [**2117-8-7**] Sex: F @@ -63662,7 +65177,15 @@ anemia: hematocrit 24.5 initially. baseline 23 to 28. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Unspecified iridocyclitis; Other primary cardiomyopathies; Unspecified disease of pericardium; ; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Noncompliance with renal dialysis; Personal history of noncompliance with medical treatment, presenting hazards to health; Surgical or other procedure not carried out because of patient's decision; Abdominal pain, left lower quadrant; Renal dialysis status; Thrombocytopenia, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Peripheral vascular disease, unspecified; Acquired absence of organ, eye; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus]" +SECONDARY: [End stage renal disease; Unspecified iridocyclitis; Other primary cardiomyopathies; Unspecified disease of pericardium; ; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Noncompliance with renal dialysis; Personal history of noncompliance with medical treatment, presenting hazards to health; Surgical or other procedure not carried out because of patient's decision; Abdominal pain, left lower quadrant; Renal dialysis status; Thrombocytopenia, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Peripheral vascular disease, unspecified; Acquired absence of organ, eye; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus]","24 f with esrd on hemodialysis, sle, malignant hypertension, +history of svc syndrome, pres who presented to the icu for +hypertensive emergency, dyspnea, and headache, now resolved. known lastname **] [**last name (titles) 323**] refused to go to a ""home"" and +declined to talk to social work at this time. of note, she has +missed [**last name (titles) 2286**] sessions and often requests durations and flow +rates for her [**last name (titles) 2286**] that contradict recommendations by her +nephrologist. ultrafiltrate of 2 l on initial hd - continue +outpatient regimen +.","malignant hypertension, history of svc syndrome, pres who presented to the icu for hypertensive emergency, dyspnea, and headache, now resolved. she has received [**year/month/day 2286**] and her blood pressures remained at her baseline off the drips." 109,196721.0,14863,2142-07-23,14862,131376.0,2142-07-08,Discharge summary,"Admission Date: [**2142-7-7**] Discharge Date: [**2142-7-8**] Date of Birth: [**2117-8-7**] Sex: F @@ -63988,7 +65511,11 @@ celexa. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; Unspecified iridocyclitis; ; Other ascites; Other chronic pain; Abdominal pain, unspecified site; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Obstructive sleep apnea (adult)(pediatric); Other specified peripheral vascular diseases; Anemia of other chronic disease; Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction; Epilepsy, unspecified, without mention of intractable epilepsy; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism; Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits]" +SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; Unspecified iridocyclitis; ; Other ascites; Other chronic pain; Abdominal pain, unspecified site; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Obstructive sleep apnea (adult)(pediatric); Other specified peripheral vascular diseases; Anemia of other chronic disease; Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction; Epilepsy, unspecified, without mention of intractable epilepsy; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism; Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits]","# hypertensive urgency - at the time of admission, the patient +denied chest pain but continued to have mild headache. she stated that she did take her po meds. # abdominal pain - the patient also presented complaining of +adbominal pain. on admit, the patient was continued on her home does +of sevalemer. # h/o gastric ulcer - the patient was continued on her ppi [**hospital1 **]. # sle - the patient was continued on her home regimen of +prednisone 4mg po daily.","at the time of admission, the patient denied chest pain but continued to have mild headache. she also had resolving shortness of breath, likely secondary to hypertension. she had recently been treated for sbo; however, she was without nausea or vomiting." 109,131376.0,14862,2142-07-08,14858,151240.0,2142-05-18,Discharge summary,"Admission Date: [**2142-5-15**] Discharge Date: [**2142-5-18**] Date of Birth: [**2117-8-7**] Sex: F @@ -64313,7 +65840,14 @@ continued on this during her hospitalization. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Other primary cardiomyopathies; Unspecified disease of pericardium; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Hyperpotassemia; Nausea with vomiting; Diarrhea; Disorders of phosphorus metabolism; Anemia of other chronic disease; Abdominal pain, left lower quadrant; Other chronic pain; Thrombocytopenia, unspecified; Other specified peripheral vascular diseases; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus; Long-term (current) use of anticoagulants; Noncompliance with renal dialysis; Renal dialysis status; Personal history of noncompliance with medical treatment, presenting hazards to health]" +SECONDARY: [End stage renal disease; Other primary cardiomyopathies; Unspecified disease of pericardium; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Hyperpotassemia; Nausea with vomiting; Diarrhea; Disorders of phosphorus metabolism; Anemia of other chronic disease; Abdominal pain, left lower quadrant; Other chronic pain; Thrombocytopenia, unspecified; Other specified peripheral vascular diseases; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus; Long-term (current) use of anticoagulants; Noncompliance with renal dialysis; Renal dialysis status; Personal history of noncompliance with medical treatment, presenting hazards to health]","24 yo female with esrd on hd, malignant hypertension with hx of +intracerebral hemorrhage, sle, chronic abdominal pain, and svc +syndrome admitted due to hypertensive urgency after developing +n/v and being unable to take her po medications. she was able to tolerate po intake +prior to discharge. # esrd on hd: she was hyperkalemic in the emergency room and was +given kayexalate. previous documentation +in omr states she does not need to be bridged while +subtherapeutic.","24 yo female with esrd on hd, malignant hypertension with hx of intracerebral hemorrhage, sle, chronic abdominal pain, and svc syndrome admitted due to hypertensive urgency. she was continued on her home regimen of aliskiren 150 mg po bid, clonidine 0.4 mg/24 hr patch weekly, labetalol 1000 mg po tid, nifedipine 60 mg" 109,131376.0,14862,2142-07-08,14859,102024.0,2142-06-05,Discharge summary,"Admission Date: [**2142-5-20**] Discharge Date: [**2142-6-5**] Date of Birth: [**2117-8-7**] Sex: F @@ -64832,7 +66366,24 @@ this should be reassessed in 3 months. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction; Acute posthemorrhagic anemia; Unspecified intestinal obstruction; Other primary cardiomyopathies; Unspecified disease of pericardium; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Disorders of phosphorus metabolism; Hypotension, unspecified; Hyperpotassemia; Mononeuritis of unspecified site; Anemia of other chronic disease; Abdominal pain, left lower quadrant; Other chronic pain; Thrombocytopenia, unspecified; Diaphragmatic hernia without mention of obstruction or gangrene; Other specified peripheral vascular diseases; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus; Noncompliance with renal dialysis; Renal dialysis status; Long-term (current) use of anticoagulants; Personal history of noncompliance with medical treatment, presenting hazards to health]" +SECONDARY: [End stage renal disease; Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction; Acute posthemorrhagic anemia; Unspecified intestinal obstruction; Other primary cardiomyopathies; Unspecified disease of pericardium; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Disorders of phosphorus metabolism; Hypotension, unspecified; Hyperpotassemia; Mononeuritis of unspecified site; Anemia of other chronic disease; Abdominal pain, left lower quadrant; Other chronic pain; Thrombocytopenia, unspecified; Diaphragmatic hernia without mention of obstruction or gangrene; Other specified peripheral vascular diseases; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus; Noncompliance with renal dialysis; Renal dialysis status; Long-term (current) use of anticoagulants; Personal history of noncompliance with medical treatment, presenting hazards to health]","kub: sbo + +head ct: (prelim read from radiology). ct chest/abd: preliminary read +normal aorta without dissection or acute abnormality. bp meds were held and +then re-initiated as the pressure came back up once she was able +to eat. gi was c/s re: abd pain and rec +cta-abdomen to eval for mesenteric ischemia vs. partial sbo, +however with esrd did not initially want to get cta so kub was +ordered. a few hours later she had 3 +episodes of coffee-ground emesis. afterward the pain resolved and +her hct remained stable. gi felt that the patient would need +general anesthesia in order to undergo an egd which showed an +ulcer at the ge junction. her pain was controlled with +her outpatient regimen of po dilaudid. broad spectrum antibiotics were initiated (vanc +ctx) at meningeal dosing. she should be continued on keppra 1gm with +dialysis three times weekly. c3, c4 were equivocal for active lupus flare, and +[**doctor first name **] was positive, as would be expected in lupus. # anemia: has anemia of chronic renal disease and her hct was +high on admission and epo was held per renal.","sbo head ct was negative for intracranial hemorrhage. no intracranial hemorrhage ekg: nsr, right axis, lvh, nl intervals, st elevations v2-3 (old), tw inversion v6 (new) no acute abnormalities in the abdomen to explain epigastric pain." 109,131376.0,14862,2142-07-08,14860,136572.0,2142-06-20,Discharge summary,"Admission Date: [**2142-6-18**] Discharge Date: [**2142-6-20**] Date of Birth: [**2117-8-7**] Sex: F @@ -65162,7 +66713,14 @@ epogen. ","PRIMARY: [] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Other primary cardiomyopathies; Unspecified disease of pericardium; Anemia of other chronic disease; Hyperpotassemia; Systemic lupus erythematosus; Abdominal pain, other specified site; Other chronic pain; Hypotension, unspecified; Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction; Epilepsy, unspecified, without mention of intractable epilepsy; Depressive disorder, not elsewhere classified; Personal history of venous thrombosis and embolism; Noncompliance with renal dialysis]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Other primary cardiomyopathies; Unspecified disease of pericardium; Anemia of other chronic disease; Hyperpotassemia; Systemic lupus erythematosus; Abdominal pain, other specified site; Other chronic pain; Hypotension, unspecified; Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction; Epilepsy, unspecified, without mention of intractable epilepsy; Depressive disorder, not elsewhere classified; Personal history of venous thrombosis and embolism; Noncompliance with renal dialysis]","# dyspnea: pts dypsnea improved on admission to the ed prior to +hd. lipases were noted to be +mildl elevated however no other concerning physical exam signs +of pancreatitis. # sle: pt was continued on her home regimen of prednisone 4mg +daily + +# history of dvt: pt had a sub-therapeutic inr on admission. she +was discharged on warfarin 3mg daily. # depression: pt was continued on her home regimen of celexa.",pts dypsnea improved on admission to the ed prior to hd. dyspnea likely related to fluid overload (pt missed 2 weeks of dialysis) and her level of anemia. 109,131376.0,14862,2142-07-08,14861,174489.0,2142-07-04,Discharge summary,"Admission Date: [**2142-7-3**] Discharge Date: [**2142-7-4**] Date of Birth: [**2117-8-7**] Sex: F @@ -65505,7 +67063,13 @@ mg qdaily without heparin bridge. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Unspecified iridocyclitis; Other primary cardiomyopathies; Abdominal pain, unspecified site; Other chronic pain; Nausea with vomiting; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Other specified peripheral vascular diseases; Obstructive sleep apnea (adult)(pediatric); Anemia of other chronic disease; Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction; Epilepsy, unspecified, without mention of intractable epilepsy; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism; Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits]" +SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Unspecified iridocyclitis; Other primary cardiomyopathies; Abdominal pain, unspecified site; Other chronic pain; Nausea with vomiting; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Other specified peripheral vascular diseases; Obstructive sleep apnea (adult)(pediatric); Anemia of other chronic disease; Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction; Epilepsy, unspecified, without mention of intractable epilepsy; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism; Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits]","24f with h/o sle, esrd on hd, malignant htn, h/o svc syndrome, +pres, prior ich, and recent sbo, p/w n/v, and hypertensive +urgency. she remained normotensive the following morning and +was taken to hemodialysis after which she was discharged home on +all of her old home medications. # abdominal pain - on presentation she was without n/v, soft +abdomen, passing flatus, and having daily bowel movements. # seizure disorder - continued on keppra 1000 mg po 3x/week +(tu,th,sa).","malignant htn, h/o svc syndrome, pres, prior ich, and recent sbo, p/w n/v, and hypertensive urgency. hypertensive urgency was treated as follows with nitro and labetalol gtt which were quickly weaned as blood pressures dropped below sbp 120. she evenutally became hypotensive to sbp of 90 which resolved on its own " 109,174489.0,14861,2142-07-04,14804,124657.0,2142-01-20,Discharge summary,"Admission Date: [**2142-1-14**] Discharge Date: [**2142-1-20**] Date of Birth: [**2117-8-7**] Sex: F @@ -65924,7 +67488,15 @@ prn. # contact: [**first name8 (namepattern2) **] [**name (ni) **] (mother) [**telephone/fax (1) 43503**] ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; ; Other vascular complications of medical care, not elsewhere classified; Systemic lupus erythematosus; Hyperpotassemia; Phlebitis and thrombophlebitis of upper extremities, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [End stage renal disease; ; Other vascular complications of medical care, not elsewhere classified; Systemic lupus erythematosus; Hyperpotassemia; Phlebitis and thrombophlebitis of upper extremities, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","24 yo woman with hx of sle, ersd on hd, admitted with +hypertensive urgency. in the micu, +nifedipine extended release was added in place of nicardipine as +pts blood pressures seemed to rise prior to nicardipine doses. pt was continued on +gabapentin, tylenol around the clock, and low-dose morphine as +needed for pain. # anemia: hct was mildly decreased from baseline during +admission. # hocm: pt has evidence of myocardial hypertrophy on recent +echo. # fen: repleted lytes prn / regular diet +. # contact: [**first name8 (namepattern2) **] [**name (ni) **] (mother) [**telephone/fax (1) 43503**]","24 yo woman with hx of sle, ersd on hd, admitted with hypertensive urgency. pt was transferred to the floor as blood pressure stabilized. pt reported that morphine did not help pain, and was switched to dilaudid po in the micu." 109,155726.0,14864,2142-08-16,14862,131376.0,2142-07-08,Discharge summary,"Admission Date: [**2142-7-7**] Discharge Date: [**2142-7-8**] Date of Birth: [**2117-8-7**] Sex: F @@ -66250,7 +67822,11 @@ celexa. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; Unspecified iridocyclitis; ; Other ascites; Other chronic pain; Abdominal pain, unspecified site; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Obstructive sleep apnea (adult)(pediatric); Other specified peripheral vascular diseases; Anemia of other chronic disease; Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction; Epilepsy, unspecified, without mention of intractable epilepsy; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism; Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits]" +SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; Unspecified iridocyclitis; ; Other ascites; Other chronic pain; Abdominal pain, unspecified site; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Obstructive sleep apnea (adult)(pediatric); Other specified peripheral vascular diseases; Anemia of other chronic disease; Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction; Epilepsy, unspecified, without mention of intractable epilepsy; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism; Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits]","# hypertensive urgency - at the time of admission, the patient +denied chest pain but continued to have mild headache. she stated that she did take her po meds. # abdominal pain - the patient also presented complaining of +adbominal pain. on admit, the patient was continued on her home does +of sevalemer. # h/o gastric ulcer - the patient was continued on her ppi [**hospital1 **]. # sle - the patient was continued on her home regimen of +prednisone 4mg po daily.","at the time of admission, the patient denied chest pain but continued to have mild headache. she also had resolving shortness of breath, likely secondary to hypertension. she had recently been treated for sbo; however, she was without nausea or vomiting." 109,155726.0,14864,2142-08-16,14863,196721.0,2142-07-23,Discharge summary,"Admission Date: [**2142-7-12**] Discharge Date: [**2142-7-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -66695,7 +68271,17 @@ discontinue it altogether. . ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Other ascites; Infection and inflammatory reaction due to other vascular device, implant, and graft; Bacteremia; Other primary cardiomyopathies; Unspecified disease of pericardium; Compression of vein; Systemic lupus erythematosus; Abdominal pain, unspecified site; Other chronic pain; Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus; Stridor; Angioneurotic edema, not elsewhere classified; Unspecified accident; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Obstructive sleep apnea (adult)(pediatric); Other specified peripheral vascular diseases; Anemia of other chronic disease; Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction; Epilepsy, unspecified, without mention of intractable epilepsy; ; Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism; Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits]" +SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Other ascites; Infection and inflammatory reaction due to other vascular device, implant, and graft; Bacteremia; Other primary cardiomyopathies; Unspecified disease of pericardium; Compression of vein; Systemic lupus erythematosus; Abdominal pain, unspecified site; Other chronic pain; Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus; Stridor; Angioneurotic edema, not elsewhere classified; Unspecified accident; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Obstructive sleep apnea (adult)(pediatric); Other specified peripheral vascular diseases; Anemia of other chronic disease; Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction; Epilepsy, unspecified, without mention of intractable epilepsy; ; Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism; Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits]","24 y/o female with h/o sle, esrd on hd, malignant htn, h/o svc +syndrome, pres, prior ich, and recent sbo, presented to ed on +[**7-12**] for dyspnea and hypertensive urgency. she was taken to icu and +responded favorably to heliox. patient returned to floor and +has been comfortably breathing since. at time of transfer, pts dyspnea was largely resolved and these +findings were felt to be more consistent with edema given +hypertensive urgency. ascites - unclear etiology and new findings for her. h/o gastric ulcer - ppi was continued throughout +hospitalization. she frequently is outside +of therapeutic range on this medication and given the suspected +problems with medication compliance, it was felt it was safer to +discontinue it altogether.","24 y/o female with h/o sle, esrd on hd, malignant htn, h/o svc syndrome, pres, prior ich, and recent sbo, presented to ed on [**7-12**] for dyspnea and hypertensive urgency. she was started on her home bp regimen of oral labetalol on [**2142-7-15**], and nife" 109,155726.0,14864,2142-08-16,14807,158995.0,2142-02-26,Discharge summary,"Admission Date: [**2142-2-25**] Discharge Date: [**2142-2-26**] Date of Birth: [**2117-8-7**] Sex: F @@ -67026,7 +68612,9 @@ sleep medicine. ","PRIMARY: [Poisoning by other opiates and related narcotics] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Thrombotic microangiopathy; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Altered mental status; Other iatrogenic hypotension; Accidental poisoning by other opiates and related narcotics; Hyperpotassemia; Anemia in chronic kidney disease; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Nontraumatic hematoma of soft tissue; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Thrombotic microangiopathy; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Altered mental status; Other iatrogenic hypotension; Accidental poisoning by other opiates and related narcotics; Hyperpotassemia; Anemia in chronic kidney disease; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Nontraumatic hematoma of soft tissue; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]","24 yo woman with hx of sle, ersd on hd, admitted hypotension and +decreased mental status. hypotension and altered mental status +were in the setting of excessive narcotic use. # hypotension: resolved, patient normotensive on arrival to icu. relative hypotension likely due to dilaudid. from previous peritoneal [**location 2286**] hematoma ??????","24 yo woman with hx of sle, ersd on hd, admitted hypotension and decreased mental status. narcotics were held, pressors returned to and patient was mentating fine. patient was encouraged to take less pain medications and to use morphine." 109,155726.0,14864,2142-08-16,14808,158943.0,2142-03-23,Discharge summary,"Admission Date: [**2142-3-21**] Discharge Date: [**2142-3-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -67378,7 +68966,13 @@ multiple thrombotic events. continued coumadin not symptomatic. continued labetalol. ","PRIMARY: [] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Compression of vein; Unspecified disease of pericardium; Infection and inflammatory reaction due to other vascular device, implant, and graft; Bacteremia; Primary hypercoagulable state; Other primary cardiomyopathies; ; Abdominal pain, unspecified site; Urinary tract infection, site not specified; Acidosis; Other chest pain; Other chronic pain; Systemic lupus erythematosus; Noncompliance with renal dialysis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Hyperpotassemia; Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus]; Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Methicillin resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Compression of vein; Unspecified disease of pericardium; Infection and inflammatory reaction due to other vascular device, implant, and graft; Bacteremia; Primary hypercoagulable state; Other primary cardiomyopathies; ; Abdominal pain, unspecified site; Urinary tract infection, site not specified; Acidosis; Other chest pain; Other chronic pain; Systemic lupus erythematosus; Noncompliance with renal dialysis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Hyperpotassemia; Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus]; Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Methicillin resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","this is a 24 y.o f with sle, esrd on hd and malignant +hypertension + presenting with abd pain, diarrhea, and htn. ct prelim neg +for small bowel obstruction. on +arrival to the floor, abd pain was back to baseline and well +controlled on dilaudid 2mg po q 4hrs +.","a 24 y.o f with sle, esrd on hd and malignant hypertension presenting with abd pain, diarrhea, and htn. initial attempts were made to control her bp with hydralazine and labetalol iv but after these failed to control her blood pressure. she was successfully transitioned to home medications of clonidine, labetalol, aliskiren, nifedipine" 109,155726.0,14864,2142-08-16,14809,124398.0,2142-03-31,Discharge summary,"Admission Date: [**2142-3-24**] Discharge Date: [**2142-3-31**] Date of Birth: [**2117-8-7**] Sex: F @@ -67700,7 +69294,12 @@ she was discharged to followup with her nephrologist, dr. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Systemic lupus erythematosus; Anemia in chronic kidney disease; Long-term (current) use of steroids; Other chronic pain; Obstructive sleep apnea (adult)(pediatric); Abdominal pain, generalized; Hyperpotassemia]" +SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Systemic lupus erythematosus; Anemia in chronic kidney disease; Long-term (current) use of steroids; Other chronic pain; Obstructive sleep apnea (adult)(pediatric); Abdominal pain, generalized; Hyperpotassemia]","the patient was admitted to the micu on a ntg gtt from the ed. her bp goal was for a systolic +of 180-200. instructions were +written for explicit am administration and nifedipine long +acting 30mg was added at night, in addition to the 90mg long +acting she was taking in the morning. she established a three three +times weekly dialysus regemin.","the patient was admitted to the micu on a nicardipine gtt from the ed. she was given her usual afternoon home medications, and transitioned to a nicardipine gtt, which has worked well for her in the past. on arrival to the floor, she in fact missed her morning medications on [**month/day/year 766**] this resulted in elevate blood pressures requiring iv hydralazing for control " 109,155726.0,14864,2142-08-16,14810,137510.0,2142-04-22,Discharge summary,"Admission Date: [**2142-4-20**] Discharge Date: [**2142-4-22**] Date of Birth: [**2117-8-7**] Sex: F @@ -68046,7 +69645,15 @@ anemia: hematocrit 24.5 initially. baseline 23 to 28. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Unspecified iridocyclitis; Other primary cardiomyopathies; Unspecified disease of pericardium; ; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Noncompliance with renal dialysis; Personal history of noncompliance with medical treatment, presenting hazards to health; Surgical or other procedure not carried out because of patient's decision; Abdominal pain, left lower quadrant; Renal dialysis status; Thrombocytopenia, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Peripheral vascular disease, unspecified; Acquired absence of organ, eye; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus]" +SECONDARY: [End stage renal disease; Unspecified iridocyclitis; Other primary cardiomyopathies; Unspecified disease of pericardium; ; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Noncompliance with renal dialysis; Personal history of noncompliance with medical treatment, presenting hazards to health; Surgical or other procedure not carried out because of patient's decision; Abdominal pain, left lower quadrant; Renal dialysis status; Thrombocytopenia, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Peripheral vascular disease, unspecified; Acquired absence of organ, eye; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus]","24 f with esrd on hemodialysis, sle, malignant hypertension, +history of svc syndrome, pres who presented to the icu for +hypertensive emergency, dyspnea, and headache, now resolved. known lastname **] [**last name (titles) 323**] refused to go to a ""home"" and +declined to talk to social work at this time. of note, she has +missed [**last name (titles) 2286**] sessions and often requests durations and flow +rates for her [**last name (titles) 2286**] that contradict recommendations by her +nephrologist. ultrafiltrate of 2 l on initial hd - continue +outpatient regimen +.","malignant hypertension, history of svc syndrome, pres who presented to the icu for hypertensive emergency, dyspnea, and headache, now resolved. she has received [**year/month/day 2286**] and her blood pressures remained at her baseline off the drips." 109,155726.0,14864,2142-08-16,14861,174489.0,2142-07-04,Discharge summary,"Admission Date: [**2142-7-3**] Discharge Date: [**2142-7-4**] Date of Birth: [**2117-8-7**] Sex: F @@ -68389,7 +69996,13 @@ mg qdaily without heparin bridge. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Unspecified iridocyclitis; Other primary cardiomyopathies; Abdominal pain, unspecified site; Other chronic pain; Nausea with vomiting; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Other specified peripheral vascular diseases; Obstructive sleep apnea (adult)(pediatric); Anemia of other chronic disease; Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction; Epilepsy, unspecified, without mention of intractable epilepsy; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism; Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits]" +SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Unspecified iridocyclitis; Other primary cardiomyopathies; Abdominal pain, unspecified site; Other chronic pain; Nausea with vomiting; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Other specified peripheral vascular diseases; Obstructive sleep apnea (adult)(pediatric); Anemia of other chronic disease; Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction; Epilepsy, unspecified, without mention of intractable epilepsy; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism; Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits]","24f with h/o sle, esrd on hd, malignant htn, h/o svc syndrome, +pres, prior ich, and recent sbo, p/w n/v, and hypertensive +urgency. she remained normotensive the following morning and +was taken to hemodialysis after which she was discharged home on +all of her old home medications. # abdominal pain - on presentation she was without n/v, soft +abdomen, passing flatus, and having daily bowel movements. # seizure disorder - continued on keppra 1000 mg po 3x/week +(tu,th,sa).","malignant htn, h/o svc syndrome, pres, prior ich, and recent sbo, p/w n/v, and hypertensive urgency. hypertensive urgency was treated as follows with nitro and labetalol gtt which were quickly weaned as blood pressures dropped below sbp 120. she evenutally became hypotensive to sbp of 90 which resolved on its own " 109,155726.0,14864,2142-08-16,14860,136572.0,2142-06-20,Discharge summary,"Admission Date: [**2142-6-18**] Discharge Date: [**2142-6-20**] Date of Birth: [**2117-8-7**] Sex: F @@ -68719,7 +70332,14 @@ epogen. ","PRIMARY: [] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Other primary cardiomyopathies; Unspecified disease of pericardium; Anemia of other chronic disease; Hyperpotassemia; Systemic lupus erythematosus; Abdominal pain, other specified site; Other chronic pain; Hypotension, unspecified; Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction; Epilepsy, unspecified, without mention of intractable epilepsy; Depressive disorder, not elsewhere classified; Personal history of venous thrombosis and embolism; Noncompliance with renal dialysis]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Other primary cardiomyopathies; Unspecified disease of pericardium; Anemia of other chronic disease; Hyperpotassemia; Systemic lupus erythematosus; Abdominal pain, other specified site; Other chronic pain; Hypotension, unspecified; Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction; Epilepsy, unspecified, without mention of intractable epilepsy; Depressive disorder, not elsewhere classified; Personal history of venous thrombosis and embolism; Noncompliance with renal dialysis]","# dyspnea: pts dypsnea improved on admission to the ed prior to +hd. lipases were noted to be +mildl elevated however no other concerning physical exam signs +of pancreatitis. # sle: pt was continued on her home regimen of prednisone 4mg +daily + +# history of dvt: pt had a sub-therapeutic inr on admission. she +was discharged on warfarin 3mg daily. # depression: pt was continued on her home regimen of celexa.",pts dypsnea improved on admission to the ed prior to hd. dyspnea likely related to fluid overload (pt missed 2 weeks of dialysis) and her level of anemia. 109,155726.0,14864,2142-08-16,14859,102024.0,2142-06-05,Discharge summary,"Admission Date: [**2142-5-20**] Discharge Date: [**2142-6-5**] Date of Birth: [**2117-8-7**] Sex: F @@ -69238,7 +70858,24 @@ this should be reassessed in 3 months. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction; Acute posthemorrhagic anemia; Unspecified intestinal obstruction; Other primary cardiomyopathies; Unspecified disease of pericardium; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Disorders of phosphorus metabolism; Hypotension, unspecified; Hyperpotassemia; Mononeuritis of unspecified site; Anemia of other chronic disease; Abdominal pain, left lower quadrant; Other chronic pain; Thrombocytopenia, unspecified; Diaphragmatic hernia without mention of obstruction or gangrene; Other specified peripheral vascular diseases; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus; Noncompliance with renal dialysis; Renal dialysis status; Long-term (current) use of anticoagulants; Personal history of noncompliance with medical treatment, presenting hazards to health]" +SECONDARY: [End stage renal disease; Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction; Acute posthemorrhagic anemia; Unspecified intestinal obstruction; Other primary cardiomyopathies; Unspecified disease of pericardium; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Disorders of phosphorus metabolism; Hypotension, unspecified; Hyperpotassemia; Mononeuritis of unspecified site; Anemia of other chronic disease; Abdominal pain, left lower quadrant; Other chronic pain; Thrombocytopenia, unspecified; Diaphragmatic hernia without mention of obstruction or gangrene; Other specified peripheral vascular diseases; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus; Noncompliance with renal dialysis; Renal dialysis status; Long-term (current) use of anticoagulants; Personal history of noncompliance with medical treatment, presenting hazards to health]","kub: sbo + +head ct: (prelim read from radiology). ct chest/abd: preliminary read +normal aorta without dissection or acute abnormality. bp meds were held and +then re-initiated as the pressure came back up once she was able +to eat. gi was c/s re: abd pain and rec +cta-abdomen to eval for mesenteric ischemia vs. partial sbo, +however with esrd did not initially want to get cta so kub was +ordered. a few hours later she had 3 +episodes of coffee-ground emesis. afterward the pain resolved and +her hct remained stable. gi felt that the patient would need +general anesthesia in order to undergo an egd which showed an +ulcer at the ge junction. her pain was controlled with +her outpatient regimen of po dilaudid. broad spectrum antibiotics were initiated (vanc +ctx) at meningeal dosing. she should be continued on keppra 1gm with +dialysis three times weekly. c3, c4 were equivocal for active lupus flare, and +[**doctor first name **] was positive, as would be expected in lupus. # anemia: has anemia of chronic renal disease and her hct was +high on admission and epo was held per renal.","sbo head ct was negative for intracranial hemorrhage. no intracranial hemorrhage ekg: nsr, right axis, lvh, nl intervals, st elevations v2-3 (old), tw inversion v6 (new) no acute abnormalities in the abdomen to explain epigastric pain." 109,155726.0,14864,2142-08-16,14858,151240.0,2142-05-18,Discharge summary,"Admission Date: [**2142-5-15**] Discharge Date: [**2142-5-18**] Date of Birth: [**2117-8-7**] Sex: F @@ -69563,7 +71200,14 @@ continued on this during her hospitalization. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Other primary cardiomyopathies; Unspecified disease of pericardium; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Hyperpotassemia; Nausea with vomiting; Diarrhea; Disorders of phosphorus metabolism; Anemia of other chronic disease; Abdominal pain, left lower quadrant; Other chronic pain; Thrombocytopenia, unspecified; Other specified peripheral vascular diseases; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus; Long-term (current) use of anticoagulants; Noncompliance with renal dialysis; Renal dialysis status; Personal history of noncompliance with medical treatment, presenting hazards to health]" +SECONDARY: [End stage renal disease; Other primary cardiomyopathies; Unspecified disease of pericardium; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Hyperpotassemia; Nausea with vomiting; Diarrhea; Disorders of phosphorus metabolism; Anemia of other chronic disease; Abdominal pain, left lower quadrant; Other chronic pain; Thrombocytopenia, unspecified; Other specified peripheral vascular diseases; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus; Long-term (current) use of anticoagulants; Noncompliance with renal dialysis; Renal dialysis status; Personal history of noncompliance with medical treatment, presenting hazards to health]","24 yo female with esrd on hd, malignant hypertension with hx of +intracerebral hemorrhage, sle, chronic abdominal pain, and svc +syndrome admitted due to hypertensive urgency after developing +n/v and being unable to take her po medications. she was able to tolerate po intake +prior to discharge. # esrd on hd: she was hyperkalemic in the emergency room and was +given kayexalate. previous documentation +in omr states she does not need to be bridged while +subtherapeutic.","24 yo female with esrd on hd, malignant hypertension with hx of intracerebral hemorrhage, sle, chronic abdominal pain, and svc syndrome admitted due to hypertensive urgency. she was continued on her home regimen of aliskiren 150 mg po bid, clonidine 0.4 mg/24 hr patch weekly, labetalol 1000 mg po tid, nifedipine 60 mg" 109,196721.0,14863,2142-07-23,14806,113189.0,2142-02-17,Discharge summary,"Admission Date: [**2142-2-14**] Discharge Date: [**2142-2-17**] Date of Birth: [**2117-8-7**] Sex: F @@ -69884,7 +71528,11 @@ infusions were needed. # depression/anxiety: continued celexa, clonazepam 0.5mg [**hospital1 **] ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Thrombotic microangiopathy; Systemic lupus erythematosus; Anemia in chronic kidney disease; Thrombocytopenia, unspecified; Obstructive sleep apnea (adult)(pediatric); Nontraumatic hematoma of soft tissue; Dysthymic disorder; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]" +SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Thrombotic microangiopathy; Systemic lupus erythematosus; Anemia in chronic kidney disease; Thrombocytopenia, unspecified; Obstructive sleep apnea (adult)(pediatric); Nontraumatic hematoma of soft tissue; Dysthymic disorder; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]","24 y.o female with sle, esrd on hd and malignant hypertension +who presents with htn and sob aftering missing hd. pt was treated per omr +hypertensive protocol created by the patients primary +providers, with a goal sbp of 160-180. # coagulopathy/history of dvt: patient on lifetime +anticoagulation for hx of multiple thrombotic events.","24 y.o female with sle, esrd on hd and malignant hypertension who presents with htn and sob after missing hd. pt was treated per omr hypertensive protocol created by the patients primary providers, with a goal sbp of 160-180. she was well maintained on oral outpt regimen of clonidine, labetalol, aliskiren, nifedipine." 109,196721.0,14863,2142-07-23,14807,158995.0,2142-02-26,Discharge summary,"Admission Date: [**2142-2-25**] Discharge Date: [**2142-2-26**] Date of Birth: [**2117-8-7**] Sex: F @@ -70215,7 +71863,9 @@ sleep medicine. ","PRIMARY: [Poisoning by other opiates and related narcotics] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Thrombotic microangiopathy; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Altered mental status; Other iatrogenic hypotension; Accidental poisoning by other opiates and related narcotics; Hyperpotassemia; Anemia in chronic kidney disease; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Nontraumatic hematoma of soft tissue; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Thrombotic microangiopathy; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Altered mental status; Other iatrogenic hypotension; Accidental poisoning by other opiates and related narcotics; Hyperpotassemia; Anemia in chronic kidney disease; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Nontraumatic hematoma of soft tissue; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]","24 yo woman with hx of sle, ersd on hd, admitted hypotension and +decreased mental status. hypotension and altered mental status +were in the setting of excessive narcotic use. # hypotension: resolved, patient normotensive on arrival to icu. relative hypotension likely due to dilaudid. from previous peritoneal [**location 2286**] hematoma ??????","24 yo woman with hx of sle, ersd on hd, admitted hypotension and decreased mental status. narcotics were held, pressors returned to and patient was mentating fine. patient was encouraged to take less pain medications and to use morphine." 109,196721.0,14863,2142-07-23,14808,158943.0,2142-03-23,Discharge summary,"Admission Date: [**2142-3-21**] Discharge Date: [**2142-3-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -70567,7 +72217,13 @@ multiple thrombotic events. continued coumadin not symptomatic. continued labetalol. ","PRIMARY: [] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Compression of vein; Unspecified disease of pericardium; Infection and inflammatory reaction due to other vascular device, implant, and graft; Bacteremia; Primary hypercoagulable state; Other primary cardiomyopathies; ; Abdominal pain, unspecified site; Urinary tract infection, site not specified; Acidosis; Other chest pain; Other chronic pain; Systemic lupus erythematosus; Noncompliance with renal dialysis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Hyperpotassemia; Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus]; Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Methicillin resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Compression of vein; Unspecified disease of pericardium; Infection and inflammatory reaction due to other vascular device, implant, and graft; Bacteremia; Primary hypercoagulable state; Other primary cardiomyopathies; ; Abdominal pain, unspecified site; Urinary tract infection, site not specified; Acidosis; Other chest pain; Other chronic pain; Systemic lupus erythematosus; Noncompliance with renal dialysis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Hyperpotassemia; Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus]; Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Methicillin resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","this is a 24 y.o f with sle, esrd on hd and malignant +hypertension + presenting with abd pain, diarrhea, and htn. ct prelim neg +for small bowel obstruction. on +arrival to the floor, abd pain was back to baseline and well +controlled on dilaudid 2mg po q 4hrs +.","a 24 y.o f with sle, esrd on hd and malignant hypertension presenting with abd pain, diarrhea, and htn. initial attempts were made to control her bp with hydralazine and labetalol iv but after these failed to control her blood pressure. she was successfully transitioned to home medications of clonidine, labetalol, aliskiren, nifedipine" 109,196721.0,14863,2142-07-23,14810,137510.0,2142-04-22,Discharge summary,"Admission Date: [**2142-4-20**] Discharge Date: [**2142-4-22**] Date of Birth: [**2117-8-7**] Sex: F @@ -70913,7 +72569,15 @@ anemia: hematocrit 24.5 initially. baseline 23 to 28. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Unspecified iridocyclitis; Other primary cardiomyopathies; Unspecified disease of pericardium; ; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Noncompliance with renal dialysis; Personal history of noncompliance with medical treatment, presenting hazards to health; Surgical or other procedure not carried out because of patient's decision; Abdominal pain, left lower quadrant; Renal dialysis status; Thrombocytopenia, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Peripheral vascular disease, unspecified; Acquired absence of organ, eye; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus]" +SECONDARY: [End stage renal disease; Unspecified iridocyclitis; Other primary cardiomyopathies; Unspecified disease of pericardium; ; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Noncompliance with renal dialysis; Personal history of noncompliance with medical treatment, presenting hazards to health; Surgical or other procedure not carried out because of patient's decision; Abdominal pain, left lower quadrant; Renal dialysis status; Thrombocytopenia, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Peripheral vascular disease, unspecified; Acquired absence of organ, eye; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus]","24 f with esrd on hemodialysis, sle, malignant hypertension, +history of svc syndrome, pres who presented to the icu for +hypertensive emergency, dyspnea, and headache, now resolved. known lastname **] [**last name (titles) 323**] refused to go to a ""home"" and +declined to talk to social work at this time. of note, she has +missed [**last name (titles) 2286**] sessions and often requests durations and flow +rates for her [**last name (titles) 2286**] that contradict recommendations by her +nephrologist. ultrafiltrate of 2 l on initial hd - continue +outpatient regimen +.","malignant hypertension, history of svc syndrome, pres who presented to the icu for hypertensive emergency, dyspnea, and headache, now resolved. she has received [**year/month/day 2286**] and her blood pressures remained at her baseline off the drips." 109,196721.0,14863,2142-07-23,14809,124398.0,2142-03-31,Discharge summary,"Admission Date: [**2142-3-24**] Discharge Date: [**2142-3-31**] Date of Birth: [**2117-8-7**] Sex: F @@ -71235,7 +72899,12 @@ she was discharged to followup with her nephrologist, dr. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Systemic lupus erythematosus; Anemia in chronic kidney disease; Long-term (current) use of steroids; Other chronic pain; Obstructive sleep apnea (adult)(pediatric); Abdominal pain, generalized; Hyperpotassemia]" +SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Systemic lupus erythematosus; Anemia in chronic kidney disease; Long-term (current) use of steroids; Other chronic pain; Obstructive sleep apnea (adult)(pediatric); Abdominal pain, generalized; Hyperpotassemia]","the patient was admitted to the micu on a ntg gtt from the ed. her bp goal was for a systolic +of 180-200. instructions were +written for explicit am administration and nifedipine long +acting 30mg was added at night, in addition to the 90mg long +acting she was taking in the morning. she established a three three +times weekly dialysus regemin.","the patient was admitted to the micu on a nicardipine gtt from the ed. she was given her usual afternoon home medications, and transitioned to a nicardipine gtt, which has worked well for her in the past. on arrival to the floor, she in fact missed her morning medications on [**month/day/year 766**] this resulted in elevate blood pressures requiring iv hydralazing for control " 109,174489.0,14861,2142-07-04,14803,135923.0,2142-01-12,Discharge summary,"Admission Date: [**2142-1-8**] Discharge Date: [**2142-1-13**] Date of Birth: [**2117-8-7**] Sex: F @@ -71626,7 +73295,17 @@ clonazepam. level. follow-up with transplant surgery. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Hypoxemia; Other opiates and related narcotics causing adverse effects in therapeutic use; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Abdominal pain, other specified site; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Renal dialysis status; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Other postprocedural status]" +SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Hypoxemia; Other opiates and related narcotics causing adverse effects in therapeutic use; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Abdominal pain, other specified site; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Renal dialysis status; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Other postprocedural status]","24 yo woman with hx of sle, ersd on hd, admitted with +hypertensive urgency. # hypertension: pt with extensive history of repeated admissions +for hypertension. # sle: stable, continued prednisone at 4 mg po daily. patient was +oversedated on dilaudid and had episode of oxygen desaturation +which was reversed with narcan. first name (stitle) **] (transplant +surgery). she will be sent home with low-dose morphine ir and +tylenol prn pain. if l groin pain should become uncontrollable +on current meds, pt should return to the ed for re-evaluation. this is likely secondary to aocd +and renal failure. pt will +need an inr check in the next week at her follow-up with her +pcp.","24 yo woman with hx of sle, ersd on hd, admitted with hypertensive urgency. patient was stablized on home medicaitons, suggesting medication non-compliance. patient was oversedated on dilaudid and had episode of oxygen desaturation." 109,102024.0,14859,2142-06-05,14858,151240.0,2142-05-18,Discharge summary,"Admission Date: [**2142-5-15**] Discharge Date: [**2142-5-18**] Date of Birth: [**2117-8-7**] Sex: F @@ -71951,7 +73630,14 @@ continued on this during her hospitalization. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Other primary cardiomyopathies; Unspecified disease of pericardium; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Hyperpotassemia; Nausea with vomiting; Diarrhea; Disorders of phosphorus metabolism; Anemia of other chronic disease; Abdominal pain, left lower quadrant; Other chronic pain; Thrombocytopenia, unspecified; Other specified peripheral vascular diseases; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus; Long-term (current) use of anticoagulants; Noncompliance with renal dialysis; Renal dialysis status; Personal history of noncompliance with medical treatment, presenting hazards to health]" +SECONDARY: [End stage renal disease; Other primary cardiomyopathies; Unspecified disease of pericardium; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Hyperpotassemia; Nausea with vomiting; Diarrhea; Disorders of phosphorus metabolism; Anemia of other chronic disease; Abdominal pain, left lower quadrant; Other chronic pain; Thrombocytopenia, unspecified; Other specified peripheral vascular diseases; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus; Long-term (current) use of anticoagulants; Noncompliance with renal dialysis; Renal dialysis status; Personal history of noncompliance with medical treatment, presenting hazards to health]","24 yo female with esrd on hd, malignant hypertension with hx of +intracerebral hemorrhage, sle, chronic abdominal pain, and svc +syndrome admitted due to hypertensive urgency after developing +n/v and being unable to take her po medications. she was able to tolerate po intake +prior to discharge. # esrd on hd: she was hyperkalemic in the emergency room and was +given kayexalate. previous documentation +in omr states she does not need to be bridged while +subtherapeutic.","24 yo female with esrd on hd, malignant hypertension with hx of intracerebral hemorrhage, sle, chronic abdominal pain, and svc syndrome admitted due to hypertensive urgency. she was continued on her home regimen of aliskiren 150 mg po bid, clonidine 0.4 mg/24 hr patch weekly, labetalol 1000 mg po tid, nifedipine 60 mg" 109,102024.0,14859,2142-06-05,14801,173633.0,2141-12-14,Discharge summary,"Admission Date: [**2141-12-8**] Discharge Date: [**2141-12-14**] Date of Birth: [**2117-8-7**] Sex: F @@ -72406,7 +74092,18 @@ transfused 1u prbc at hd on [**12-12**]. she was also given epo at hd. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Systemic lupus erythematosus; Other and unspecified noninfectious gastroenteritis and colitis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Other iatrogenic hypotension; Obstructive sleep apnea (adult)(pediatric); Hemangioma of intra-abdominal structures; Other chronic pain; Abdominal pain, unspecified site; Abnormal coagulation profile; Renal dialysis status; Personal history of venous thrombosis and embolism]" +SECONDARY: [End stage renal disease; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Systemic lupus erythematosus; Other and unspecified noninfectious gastroenteritis and colitis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Other iatrogenic hypotension; Obstructive sleep apnea (adult)(pediatric); Hemangioma of intra-abdominal structures; Other chronic pain; Abdominal pain, unspecified site; Abnormal coagulation profile; Renal dialysis status; Personal history of venous thrombosis and embolism]","24 year old woman with ckd v and severe hypertension due to sle +admitted with flare of chronic abdominal pain and hypertensive +urgency. initially her blood pressure over-corrected to +sbps in the 80s (patient was asymptomatic). the patient was +transferred to the floor on [**12-10**] after resolution of her +hypertensive urgency with a decreased blood pressure regimen due +to her hypotension in response to home doses of her medications. the patient was continuned on her +admission hypertensive regimen. a ct scan was +performed that showed bowel wall changes that are likely +secondary to recent peritoneal dialysis and unrelated to pain. ckd v from lupus nephritis: the patient was continued on hd +during her admission. she was therapetuic the same day and her heparin gtt +was stopped.",24 year old woman with ckd v and severe hypertension due to sle admitted. patient was initially maintained on a labetalol drip and hydralazine iv prn. initially her blood pressure over-corrected to sbps in the 80s (patient was asymptomatic) 109,102024.0,14859,2142-06-05,14802,140167.0,2141-12-23,Discharge summary,"Admission Date: [**2141-12-18**] Discharge Date: [**2141-12-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -72878,7 +74575,23 @@ pericarditis. she was continued on her home prednisone dose of ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Mechanical complication due to peritoneal dialysis catheter; ; Unspecified disease of pericardium; Angioneurotic edema, not elsewhere classified; Abdominal pain, other specified site; Systemic lupus erythematosus; ; Anemia in chronic kidney disease; Dysthymic disorder; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of steroids; Long-term (current) use of anticoagulants; Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation; Other antihypertensive agents causing adverse effects in therapeutic use]" +SECONDARY: [End stage renal disease; Mechanical complication due to peritoneal dialysis catheter; ; Unspecified disease of pericardium; Angioneurotic edema, not elsewhere classified; Abdominal pain, other specified site; Systemic lupus erythematosus; ; Anemia in chronic kidney disease; Dysthymic disorder; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of steroids; Long-term (current) use of anticoagulants; Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation; Other antihypertensive agents causing adverse effects in therapeutic use]","24 year old female with sle, esrd on hd and malignant +hypertension presents with abdominal pain and headache +consistent with her usual hypertensive urgency and was found to +be in hypertensive urgency in ed. she was given 10mg iv labetalol and started on a labatelol drip. nephrology was consulted and dialysis +initiated in the am. she received a total of 60 mg iv hydralazine over the course of +the morning as well as 0.1 mg po clonidine. she reports bilateral calf cramping but no +leg swelling. she took her am bp meds without difficulty. her +tekturna was discontinued for concern that it might be causing +angioedema. the patient +was maintained on her heparin drip for her svc syndrome. abdominal pain: the patient has had extensive prior workup +that has been unrevealing. the +patients tunneled dialysis catheter had a cuff that was out +and qas subsequently replaced with a temporary femoral line on +[**12-21**]. the patient was scheduled +to have dialysis on [**12-23**]. she was admitted with a +subtherpeutic inr of 1.2 she was started on a heparin drip. there was +no evidence of active, acute bleeding.","24 year old female with sle, esrd on hd presents with abdominal pain and headache consistent with her usual hypertensive urgency. she was found to be in hypertensive urgency in ed. she received hydralazine iv 10 mg once and 2 inches of nitropaste." 109,102024.0,14859,2142-06-05,14803,135923.0,2142-01-12,Discharge summary,"Admission Date: [**2142-1-8**] Discharge Date: [**2142-1-13**] Date of Birth: [**2117-8-7**] Sex: F @@ -73269,7 +74982,17 @@ clonazepam. level. follow-up with transplant surgery. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Hypoxemia; Other opiates and related narcotics causing adverse effects in therapeutic use; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Abdominal pain, other specified site; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Renal dialysis status; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Other postprocedural status]" +SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Hypoxemia; Other opiates and related narcotics causing adverse effects in therapeutic use; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Abdominal pain, other specified site; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Renal dialysis status; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Other postprocedural status]","24 yo woman with hx of sle, ersd on hd, admitted with +hypertensive urgency. # hypertension: pt with extensive history of repeated admissions +for hypertension. # sle: stable, continued prednisone at 4 mg po daily. patient was +oversedated on dilaudid and had episode of oxygen desaturation +which was reversed with narcan. first name (stitle) **] (transplant +surgery). she will be sent home with low-dose morphine ir and +tylenol prn pain. if l groin pain should become uncontrollable +on current meds, pt should return to the ed for re-evaluation. this is likely secondary to aocd +and renal failure. pt will +need an inr check in the next week at her follow-up with her +pcp.","24 yo woman with hx of sle, ersd on hd, admitted with hypertensive urgency. patient was stablized on home medicaitons, suggesting medication non-compliance. patient was oversedated on dilaudid and had episode of oxygen desaturation." 109,102024.0,14859,2142-06-05,14804,124657.0,2142-01-20,Discharge summary,"Admission Date: [**2142-1-14**] Discharge Date: [**2142-1-20**] Date of Birth: [**2117-8-7**] Sex: F @@ -73688,7 +75411,15 @@ prn. # contact: [**first name8 (namepattern2) **] [**name (ni) **] (mother) [**telephone/fax (1) 43503**] ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; ; Other vascular complications of medical care, not elsewhere classified; Systemic lupus erythematosus; Hyperpotassemia; Phlebitis and thrombophlebitis of upper extremities, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [End stage renal disease; ; Other vascular complications of medical care, not elsewhere classified; Systemic lupus erythematosus; Hyperpotassemia; Phlebitis and thrombophlebitis of upper extremities, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","24 yo woman with hx of sle, ersd on hd, admitted with +hypertensive urgency. in the micu, +nifedipine extended release was added in place of nicardipine as +pts blood pressures seemed to rise prior to nicardipine doses. pt was continued on +gabapentin, tylenol around the clock, and low-dose morphine as +needed for pain. # anemia: hct was mildly decreased from baseline during +admission. # hocm: pt has evidence of myocardial hypertrophy on recent +echo. # fen: repleted lytes prn / regular diet +. # contact: [**first name8 (namepattern2) **] [**name (ni) **] (mother) [**telephone/fax (1) 43503**]","24 yo woman with hx of sle, ersd on hd, admitted with hypertensive urgency. pt was transferred to the floor as blood pressure stabilized. pt reported that morphine did not help pain, and was switched to dilaudid po in the micu." 109,102024.0,14859,2142-06-05,14805,176760.0,2142-01-23,Discharge summary,"Admission Date: [**2142-1-21**] Discharge Date: [**2142-1-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -74130,7 +75861,13 @@ pericardial effusion. continued beta blocker ","PRIMARY: [Other vascular complications of medical care, not elsewhere classified] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; ; Systemic lupus erythematosus; Phlebitis and thrombophlebitis of upper extremities, unspecified]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; ; Systemic lupus erythematosus; Phlebitis and thrombophlebitis of upper extremities, unspecified]","24 yo woman with hx of sle, ersd on hd, admitted with +hypertensive urgency and left wrist pain. she was started on nicardipine drip and 1"" nitropaste +and admitted to the icu for further treatment. she was +continued on iv vanco with hd for 10day course. esrd: continued on regularly scheduled dialysis. her hct was mildly decreased from +baseline. hocm: evidence of myocardial hypertrophy on recent echo. echo without evidence of worsening +pericardial effusion. continued celexa, clonazepam 0.5mg [**hospital1 **] +.","24 yo woman with hx of sle, ersd on hd, admitted with hypertensive urgency and left wrist pain. she was started on nicardipine drip and 1"" nitropaste and admitted to the icu for further treatment. her bp quickly stabilized and she was called out to the medical floor where her sbp ranged 110-150." 109,102024.0,14859,2142-06-05,14806,113189.0,2142-02-17,Discharge summary,"Admission Date: [**2142-2-14**] Discharge Date: [**2142-2-17**] Date of Birth: [**2117-8-7**] Sex: F @@ -74451,7 +76188,11 @@ infusions were needed. # depression/anxiety: continued celexa, clonazepam 0.5mg [**hospital1 **] ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Thrombotic microangiopathy; Systemic lupus erythematosus; Anemia in chronic kidney disease; Thrombocytopenia, unspecified; Obstructive sleep apnea (adult)(pediatric); Nontraumatic hematoma of soft tissue; Dysthymic disorder; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]" +SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Thrombotic microangiopathy; Systemic lupus erythematosus; Anemia in chronic kidney disease; Thrombocytopenia, unspecified; Obstructive sleep apnea (adult)(pediatric); Nontraumatic hematoma of soft tissue; Dysthymic disorder; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]","24 y.o female with sle, esrd on hd and malignant hypertension +who presents with htn and sob aftering missing hd. pt was treated per omr +hypertensive protocol created by the patients primary +providers, with a goal sbp of 160-180. # coagulopathy/history of dvt: patient on lifetime +anticoagulation for hx of multiple thrombotic events.","24 y.o female with sle, esrd on hd and malignant hypertension who presents with htn and sob after missing hd. pt was treated per omr hypertensive protocol created by the patients primary providers, with a goal sbp of 160-180. she was well maintained on oral outpt regimen of clonidine, labetalol, aliskiren, nifedipine." 109,102024.0,14859,2142-06-05,14807,158995.0,2142-02-26,Discharge summary,"Admission Date: [**2142-2-25**] Discharge Date: [**2142-2-26**] Date of Birth: [**2117-8-7**] Sex: F @@ -74782,7 +76523,9 @@ sleep medicine. ","PRIMARY: [Poisoning by other opiates and related narcotics] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Thrombotic microangiopathy; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Altered mental status; Other iatrogenic hypotension; Accidental poisoning by other opiates and related narcotics; Hyperpotassemia; Anemia in chronic kidney disease; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Nontraumatic hematoma of soft tissue; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Thrombotic microangiopathy; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Altered mental status; Other iatrogenic hypotension; Accidental poisoning by other opiates and related narcotics; Hyperpotassemia; Anemia in chronic kidney disease; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Nontraumatic hematoma of soft tissue; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]","24 yo woman with hx of sle, ersd on hd, admitted hypotension and +decreased mental status. hypotension and altered mental status +were in the setting of excessive narcotic use. # hypotension: resolved, patient normotensive on arrival to icu. relative hypotension likely due to dilaudid. from previous peritoneal [**location 2286**] hematoma ??????","24 yo woman with hx of sle, ersd on hd, admitted hypotension and decreased mental status. narcotics were held, pressors returned to and patient was mentating fine. patient was encouraged to take less pain medications and to use morphine." 109,102024.0,14859,2142-06-05,14808,158943.0,2142-03-23,Discharge summary,"Admission Date: [**2142-3-21**] Discharge Date: [**2142-3-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -75134,7 +76877,13 @@ multiple thrombotic events. continued coumadin not symptomatic. continued labetalol. ","PRIMARY: [] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Compression of vein; Unspecified disease of pericardium; Infection and inflammatory reaction due to other vascular device, implant, and graft; Bacteremia; Primary hypercoagulable state; Other primary cardiomyopathies; ; Abdominal pain, unspecified site; Urinary tract infection, site not specified; Acidosis; Other chest pain; Other chronic pain; Systemic lupus erythematosus; Noncompliance with renal dialysis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Hyperpotassemia; Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus]; Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Methicillin resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Compression of vein; Unspecified disease of pericardium; Infection and inflammatory reaction due to other vascular device, implant, and graft; Bacteremia; Primary hypercoagulable state; Other primary cardiomyopathies; ; Abdominal pain, unspecified site; Urinary tract infection, site not specified; Acidosis; Other chest pain; Other chronic pain; Systemic lupus erythematosus; Noncompliance with renal dialysis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Hyperpotassemia; Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus]; Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Methicillin resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","this is a 24 y.o f with sle, esrd on hd and malignant +hypertension + presenting with abd pain, diarrhea, and htn. ct prelim neg +for small bowel obstruction. on +arrival to the floor, abd pain was back to baseline and well +controlled on dilaudid 2mg po q 4hrs +.","a 24 y.o f with sle, esrd on hd and malignant hypertension presenting with abd pain, diarrhea, and htn. initial attempts were made to control her bp with hydralazine and labetalol iv but after these failed to control her blood pressure. she was successfully transitioned to home medications of clonidine, labetalol, aliskiren, nifedipine" 109,102024.0,14859,2142-06-05,14809,124398.0,2142-03-31,Discharge summary,"Admission Date: [**2142-3-24**] Discharge Date: [**2142-3-31**] Date of Birth: [**2117-8-7**] Sex: F @@ -75456,7 +77205,12 @@ she was discharged to followup with her nephrologist, dr. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Systemic lupus erythematosus; Anemia in chronic kidney disease; Long-term (current) use of steroids; Other chronic pain; Obstructive sleep apnea (adult)(pediatric); Abdominal pain, generalized; Hyperpotassemia]" +SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Systemic lupus erythematosus; Anemia in chronic kidney disease; Long-term (current) use of steroids; Other chronic pain; Obstructive sleep apnea (adult)(pediatric); Abdominal pain, generalized; Hyperpotassemia]","the patient was admitted to the micu on a ntg gtt from the ed. her bp goal was for a systolic +of 180-200. instructions were +written for explicit am administration and nifedipine long +acting 30mg was added at night, in addition to the 90mg long +acting she was taking in the morning. she established a three three +times weekly dialysus regemin.","the patient was admitted to the micu on a nicardipine gtt from the ed. she was given her usual afternoon home medications, and transitioned to a nicardipine gtt, which has worked well for her in the past. on arrival to the floor, she in fact missed her morning medications on [**month/day/year 766**] this resulted in elevate blood pressures requiring iv hydralazing for control " 109,151240.0,14858,2142-05-18,14799,125288.0,2141-11-23,Discharge summary,"Admission Date: [**2141-11-18**] Discharge Date: [**2141-11-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -75825,7 +77579,15 @@ is agreeable to outpatient follow up with [**company 191**] social work, and potential cbt. these can be arranged by her pcp. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Abdominal pain, unspecified site; Anemia, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Abdominal pain, unspecified site; Anemia, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","1) hypertension: patient has history of extremely labile +hypertension on an aggressive outpatient regimen. her hydralazine was increased from 75mg to 100mg tid with mild +improvement. peritoneal fluid was obtained and contained 544 +polys. the dose was lowered to 4mg daily at +discharge to prevent overshooting the therapeutic range, but the +patient will have close follow up with coumadin clinic, with +dose titrations as needed. her nephrologist felt +this may be contributing to her recurrent pain and hypertension, +so psychiatry was consulted.","patient has history of extremely labile hypertension on aggressive outpatient regimen. overnight in the micu, patient required iv and po labetalol for sbp > 200. ct scan showed increasing ascites, but no acute pathology." 109,102024.0,14859,2142-06-05,14810,137510.0,2142-04-22,Discharge summary,"Admission Date: [**2142-4-20**] Discharge Date: [**2142-4-22**] Date of Birth: [**2117-8-7**] Sex: F @@ -76171,7 +77933,15 @@ anemia: hematocrit 24.5 initially. baseline 23 to 28. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Unspecified iridocyclitis; Other primary cardiomyopathies; Unspecified disease of pericardium; ; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Noncompliance with renal dialysis; Personal history of noncompliance with medical treatment, presenting hazards to health; Surgical or other procedure not carried out because of patient's decision; Abdominal pain, left lower quadrant; Renal dialysis status; Thrombocytopenia, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Peripheral vascular disease, unspecified; Acquired absence of organ, eye; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus]" +SECONDARY: [End stage renal disease; Unspecified iridocyclitis; Other primary cardiomyopathies; Unspecified disease of pericardium; ; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Noncompliance with renal dialysis; Personal history of noncompliance with medical treatment, presenting hazards to health; Surgical or other procedure not carried out because of patient's decision; Abdominal pain, left lower quadrant; Renal dialysis status; Thrombocytopenia, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Peripheral vascular disease, unspecified; Acquired absence of organ, eye; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus]","24 f with esrd on hemodialysis, sle, malignant hypertension, +history of svc syndrome, pres who presented to the icu for +hypertensive emergency, dyspnea, and headache, now resolved. known lastname **] [**last name (titles) 323**] refused to go to a ""home"" and +declined to talk to social work at this time. of note, she has +missed [**last name (titles) 2286**] sessions and often requests durations and flow +rates for her [**last name (titles) 2286**] that contradict recommendations by her +nephrologist. ultrafiltrate of 2 l on initial hd - continue +outpatient regimen +.","malignant hypertension, history of svc syndrome, pres who presented to the icu for hypertensive emergency, dyspnea, and headache, now resolved. she has received [**year/month/day 2286**] and her blood pressures remained at her baseline off the drips." 109,151240.0,14858,2142-05-18,14800,161950.0,2141-12-01,Discharge summary,"Admission Date: [**2141-11-24**] Discharge Date: [**2141-12-1**] Date of Birth: [**2117-8-7**] Sex: F @@ -76560,7 +78330,10 @@ patient succesfully switched to po meds and transferred to the floor. upon transfer to the floor, the following was her ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Other ascites; ; Systemic lupus erythematosus; Headache; Anemia in chronic kidney disease; Anxiety state, unspecified; Other chest pain; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Renal dialysis status; Acquired absence of organ, eye]" +SECONDARY: [End stage renal disease; Other ascites; ; Systemic lupus erythematosus; Headache; Anemia in chronic kidney disease; Anxiety state, unspecified; Other chest pain; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Renal dialysis status; Acquired absence of organ, eye]","24yo f with sle, esrd on hd and malignant hypertension who +presented with abdominal pain and headache and was admitted for +hypertensive urgency. the renal team was consulted, and recommended no change +to home med regimen.","a 24yo f with sle, esrd on hd and malignant hypertension presented with abdominal pain and headache. the patient was found to be hypocalcemic, and was started on calcium replacement therapy. she successfully switched to po meds and was transferred to the floor." 109,151240.0,14858,2142-05-18,14802,140167.0,2141-12-23,Discharge summary,"Admission Date: [**2141-12-18**] Discharge Date: [**2141-12-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -77032,7 +78805,23 @@ pericarditis. she was continued on her home prednisone dose of ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Mechanical complication due to peritoneal dialysis catheter; ; Unspecified disease of pericardium; Angioneurotic edema, not elsewhere classified; Abdominal pain, other specified site; Systemic lupus erythematosus; ; Anemia in chronic kidney disease; Dysthymic disorder; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of steroids; Long-term (current) use of anticoagulants; Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation; Other antihypertensive agents causing adverse effects in therapeutic use]" +SECONDARY: [End stage renal disease; Mechanical complication due to peritoneal dialysis catheter; ; Unspecified disease of pericardium; Angioneurotic edema, not elsewhere classified; Abdominal pain, other specified site; Systemic lupus erythematosus; ; Anemia in chronic kidney disease; Dysthymic disorder; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of steroids; Long-term (current) use of anticoagulants; Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation; Other antihypertensive agents causing adverse effects in therapeutic use]","24 year old female with sle, esrd on hd and malignant +hypertension presents with abdominal pain and headache +consistent with her usual hypertensive urgency and was found to +be in hypertensive urgency in ed. she was given 10mg iv labetalol and started on a labatelol drip. nephrology was consulted and dialysis +initiated in the am. she received a total of 60 mg iv hydralazine over the course of +the morning as well as 0.1 mg po clonidine. she reports bilateral calf cramping but no +leg swelling. she took her am bp meds without difficulty. her +tekturna was discontinued for concern that it might be causing +angioedema. the patient +was maintained on her heparin drip for her svc syndrome. abdominal pain: the patient has had extensive prior workup +that has been unrevealing. the +patients tunneled dialysis catheter had a cuff that was out +and qas subsequently replaced with a temporary femoral line on +[**12-21**]. the patient was scheduled +to have dialysis on [**12-23**]. she was admitted with a +subtherpeutic inr of 1.2 she was started on a heparin drip. there was +no evidence of active, acute bleeding.","24 year old female with sle, esrd on hd presents with abdominal pain and headache consistent with her usual hypertensive urgency. she was found to be in hypertensive urgency in ed. she received hydralazine iv 10 mg once and 2 inches of nitropaste." 109,151240.0,14858,2142-05-18,14803,135923.0,2142-01-12,Discharge summary,"Admission Date: [**2142-1-8**] Discharge Date: [**2142-1-13**] Date of Birth: [**2117-8-7**] Sex: F @@ -77423,7 +79212,17 @@ clonazepam. level. follow-up with transplant surgery. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Hypoxemia; Other opiates and related narcotics causing adverse effects in therapeutic use; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Abdominal pain, other specified site; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Renal dialysis status; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Other postprocedural status]" +SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Hypoxemia; Other opiates and related narcotics causing adverse effects in therapeutic use; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Abdominal pain, other specified site; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Renal dialysis status; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Other postprocedural status]","24 yo woman with hx of sle, ersd on hd, admitted with +hypertensive urgency. # hypertension: pt with extensive history of repeated admissions +for hypertension. # sle: stable, continued prednisone at 4 mg po daily. patient was +oversedated on dilaudid and had episode of oxygen desaturation +which was reversed with narcan. first name (stitle) **] (transplant +surgery). she will be sent home with low-dose morphine ir and +tylenol prn pain. if l groin pain should become uncontrollable +on current meds, pt should return to the ed for re-evaluation. this is likely secondary to aocd +and renal failure. pt will +need an inr check in the next week at her follow-up with her +pcp.","24 yo woman with hx of sle, ersd on hd, admitted with hypertensive urgency. patient was stablized on home medicaitons, suggesting medication non-compliance. patient was oversedated on dilaudid and had episode of oxygen desaturation." 109,151240.0,14858,2142-05-18,14804,124657.0,2142-01-20,Discharge summary,"Admission Date: [**2142-1-14**] Discharge Date: [**2142-1-20**] Date of Birth: [**2117-8-7**] Sex: F @@ -77842,7 +79641,15 @@ prn. # contact: [**first name8 (namepattern2) **] [**name (ni) **] (mother) [**telephone/fax (1) 43503**] ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; ; Other vascular complications of medical care, not elsewhere classified; Systemic lupus erythematosus; Hyperpotassemia; Phlebitis and thrombophlebitis of upper extremities, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [End stage renal disease; ; Other vascular complications of medical care, not elsewhere classified; Systemic lupus erythematosus; Hyperpotassemia; Phlebitis and thrombophlebitis of upper extremities, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","24 yo woman with hx of sle, ersd on hd, admitted with +hypertensive urgency. in the micu, +nifedipine extended release was added in place of nicardipine as +pts blood pressures seemed to rise prior to nicardipine doses. pt was continued on +gabapentin, tylenol around the clock, and low-dose morphine as +needed for pain. # anemia: hct was mildly decreased from baseline during +admission. # hocm: pt has evidence of myocardial hypertrophy on recent +echo. # fen: repleted lytes prn / regular diet +. # contact: [**first name8 (namepattern2) **] [**name (ni) **] (mother) [**telephone/fax (1) 43503**]","24 yo woman with hx of sle, ersd on hd, admitted with hypertensive urgency. pt was transferred to the floor as blood pressure stabilized. pt reported that morphine did not help pain, and was switched to dilaudid po in the micu." 109,151240.0,14858,2142-05-18,14805,176760.0,2142-01-23,Discharge summary,"Admission Date: [**2142-1-21**] Discharge Date: [**2142-1-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -78284,7 +80091,13 @@ pericardial effusion. continued beta blocker ","PRIMARY: [Other vascular complications of medical care, not elsewhere classified] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; ; Systemic lupus erythematosus; Phlebitis and thrombophlebitis of upper extremities, unspecified]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; ; Systemic lupus erythematosus; Phlebitis and thrombophlebitis of upper extremities, unspecified]","24 yo woman with hx of sle, ersd on hd, admitted with +hypertensive urgency and left wrist pain. she was started on nicardipine drip and 1"" nitropaste +and admitted to the icu for further treatment. she was +continued on iv vanco with hd for 10day course. esrd: continued on regularly scheduled dialysis. her hct was mildly decreased from +baseline. hocm: evidence of myocardial hypertrophy on recent echo. echo without evidence of worsening +pericardial effusion. continued celexa, clonazepam 0.5mg [**hospital1 **] +.","24 yo woman with hx of sle, ersd on hd, admitted with hypertensive urgency and left wrist pain. she was started on nicardipine drip and 1"" nitropaste and admitted to the icu for further treatment. her bp quickly stabilized and she was called out to the medical floor where her sbp ranged 110-150." 109,151240.0,14858,2142-05-18,14806,113189.0,2142-02-17,Discharge summary,"Admission Date: [**2142-2-14**] Discharge Date: [**2142-2-17**] Date of Birth: [**2117-8-7**] Sex: F @@ -78605,7 +80418,11 @@ infusions were needed. # depression/anxiety: continued celexa, clonazepam 0.5mg [**hospital1 **] ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Thrombotic microangiopathy; Systemic lupus erythematosus; Anemia in chronic kidney disease; Thrombocytopenia, unspecified; Obstructive sleep apnea (adult)(pediatric); Nontraumatic hematoma of soft tissue; Dysthymic disorder; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]" +SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Thrombotic microangiopathy; Systemic lupus erythematosus; Anemia in chronic kidney disease; Thrombocytopenia, unspecified; Obstructive sleep apnea (adult)(pediatric); Nontraumatic hematoma of soft tissue; Dysthymic disorder; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]","24 y.o female with sle, esrd on hd and malignant hypertension +who presents with htn and sob aftering missing hd. pt was treated per omr +hypertensive protocol created by the patients primary +providers, with a goal sbp of 160-180. # coagulopathy/history of dvt: patient on lifetime +anticoagulation for hx of multiple thrombotic events.","24 y.o female with sle, esrd on hd and malignant hypertension who presents with htn and sob after missing hd. pt was treated per omr hypertensive protocol created by the patients primary providers, with a goal sbp of 160-180. she was well maintained on oral outpt regimen of clonidine, labetalol, aliskiren, nifedipine." 109,151240.0,14858,2142-05-18,14807,158995.0,2142-02-26,Discharge summary,"Admission Date: [**2142-2-25**] Discharge Date: [**2142-2-26**] Date of Birth: [**2117-8-7**] Sex: F @@ -78936,7 +80753,9 @@ sleep medicine. ","PRIMARY: [Poisoning by other opiates and related narcotics] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Thrombotic microangiopathy; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Altered mental status; Other iatrogenic hypotension; Accidental poisoning by other opiates and related narcotics; Hyperpotassemia; Anemia in chronic kidney disease; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Nontraumatic hematoma of soft tissue; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Thrombotic microangiopathy; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Altered mental status; Other iatrogenic hypotension; Accidental poisoning by other opiates and related narcotics; Hyperpotassemia; Anemia in chronic kidney disease; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Nontraumatic hematoma of soft tissue; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]","24 yo woman with hx of sle, ersd on hd, admitted hypotension and +decreased mental status. hypotension and altered mental status +were in the setting of excessive narcotic use. # hypotension: resolved, patient normotensive on arrival to icu. relative hypotension likely due to dilaudid. from previous peritoneal [**location 2286**] hematoma ??????","24 yo woman with hx of sle, ersd on hd, admitted hypotension and decreased mental status. narcotics were held, pressors returned to and patient was mentating fine. patient was encouraged to take less pain medications and to use morphine." 109,151240.0,14858,2142-05-18,14808,158943.0,2142-03-23,Discharge summary,"Admission Date: [**2142-3-21**] Discharge Date: [**2142-3-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -79288,7 +81107,13 @@ multiple thrombotic events. continued coumadin not symptomatic. continued labetalol. ","PRIMARY: [] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Compression of vein; Unspecified disease of pericardium; Infection and inflammatory reaction due to other vascular device, implant, and graft; Bacteremia; Primary hypercoagulable state; Other primary cardiomyopathies; ; Abdominal pain, unspecified site; Urinary tract infection, site not specified; Acidosis; Other chest pain; Other chronic pain; Systemic lupus erythematosus; Noncompliance with renal dialysis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Hyperpotassemia; Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus]; Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Methicillin resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Compression of vein; Unspecified disease of pericardium; Infection and inflammatory reaction due to other vascular device, implant, and graft; Bacteremia; Primary hypercoagulable state; Other primary cardiomyopathies; ; Abdominal pain, unspecified site; Urinary tract infection, site not specified; Acidosis; Other chest pain; Other chronic pain; Systemic lupus erythematosus; Noncompliance with renal dialysis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Hyperpotassemia; Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus]; Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Methicillin resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","this is a 24 y.o f with sle, esrd on hd and malignant +hypertension + presenting with abd pain, diarrhea, and htn. ct prelim neg +for small bowel obstruction. on +arrival to the floor, abd pain was back to baseline and well +controlled on dilaudid 2mg po q 4hrs +.","a 24 y.o f with sle, esrd on hd and malignant hypertension presenting with abd pain, diarrhea, and htn. initial attempts were made to control her bp with hydralazine and labetalol iv but after these failed to control her blood pressure. she was successfully transitioned to home medications of clonidine, labetalol, aliskiren, nifedipine" 109,151240.0,14858,2142-05-18,14809,124398.0,2142-03-31,Discharge summary,"Admission Date: [**2142-3-24**] Discharge Date: [**2142-3-31**] Date of Birth: [**2117-8-7**] Sex: F @@ -79610,7 +81435,12 @@ she was discharged to followup with her nephrologist, dr. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Systemic lupus erythematosus; Anemia in chronic kidney disease; Long-term (current) use of steroids; Other chronic pain; Obstructive sleep apnea (adult)(pediatric); Abdominal pain, generalized; Hyperpotassemia]" +SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Systemic lupus erythematosus; Anemia in chronic kidney disease; Long-term (current) use of steroids; Other chronic pain; Obstructive sleep apnea (adult)(pediatric); Abdominal pain, generalized; Hyperpotassemia]","the patient was admitted to the micu on a ntg gtt from the ed. her bp goal was for a systolic +of 180-200. instructions were +written for explicit am administration and nifedipine long +acting 30mg was added at night, in addition to the 90mg long +acting she was taking in the morning. she established a three three +times weekly dialysus regemin.","the patient was admitted to the micu on a nicardipine gtt from the ed. she was given her usual afternoon home medications, and transitioned to a nicardipine gtt, which has worked well for her in the past. on arrival to the floor, she in fact missed her morning medications on [**month/day/year 766**] this resulted in elevate blood pressures requiring iv hydralazing for control " 109,151240.0,14858,2142-05-18,14810,137510.0,2142-04-22,Discharge summary,"Admission Date: [**2142-4-20**] Discharge Date: [**2142-4-22**] Date of Birth: [**2117-8-7**] Sex: F @@ -79956,7 +81786,15 @@ anemia: hematocrit 24.5 initially. baseline 23 to 28. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Unspecified iridocyclitis; Other primary cardiomyopathies; Unspecified disease of pericardium; ; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Noncompliance with renal dialysis; Personal history of noncompliance with medical treatment, presenting hazards to health; Surgical or other procedure not carried out because of patient's decision; Abdominal pain, left lower quadrant; Renal dialysis status; Thrombocytopenia, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Peripheral vascular disease, unspecified; Acquired absence of organ, eye; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus]" +SECONDARY: [End stage renal disease; Unspecified iridocyclitis; Other primary cardiomyopathies; Unspecified disease of pericardium; ; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Noncompliance with renal dialysis; Personal history of noncompliance with medical treatment, presenting hazards to health; Surgical or other procedure not carried out because of patient's decision; Abdominal pain, left lower quadrant; Renal dialysis status; Thrombocytopenia, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Peripheral vascular disease, unspecified; Acquired absence of organ, eye; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus]","24 f with esrd on hemodialysis, sle, malignant hypertension, +history of svc syndrome, pres who presented to the icu for +hypertensive emergency, dyspnea, and headache, now resolved. known lastname **] [**last name (titles) 323**] refused to go to a ""home"" and +declined to talk to social work at this time. of note, she has +missed [**last name (titles) 2286**] sessions and often requests durations and flow +rates for her [**last name (titles) 2286**] that contradict recommendations by her +nephrologist. ultrafiltrate of 2 l on initial hd - continue +outpatient regimen +.","malignant hypertension, history of svc syndrome, pres who presented to the icu for hypertensive emergency, dyspnea, and headache, now resolved. she has received [**year/month/day 2286**] and her blood pressures remained at her baseline off the drips." 109,151240.0,14858,2142-05-18,14801,173633.0,2141-12-14,Discharge summary,"Admission Date: [**2141-12-8**] Discharge Date: [**2141-12-14**] Date of Birth: [**2117-8-7**] Sex: F @@ -80411,7 +82249,18 @@ transfused 1u prbc at hd on [**12-12**]. she was also given epo at hd. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Systemic lupus erythematosus; Other and unspecified noninfectious gastroenteritis and colitis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Other iatrogenic hypotension; Obstructive sleep apnea (adult)(pediatric); Hemangioma of intra-abdominal structures; Other chronic pain; Abdominal pain, unspecified site; Abnormal coagulation profile; Renal dialysis status; Personal history of venous thrombosis and embolism]" +SECONDARY: [End stage renal disease; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Systemic lupus erythematosus; Other and unspecified noninfectious gastroenteritis and colitis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Other iatrogenic hypotension; Obstructive sleep apnea (adult)(pediatric); Hemangioma of intra-abdominal structures; Other chronic pain; Abdominal pain, unspecified site; Abnormal coagulation profile; Renal dialysis status; Personal history of venous thrombosis and embolism]","24 year old woman with ckd v and severe hypertension due to sle +admitted with flare of chronic abdominal pain and hypertensive +urgency. initially her blood pressure over-corrected to +sbps in the 80s (patient was asymptomatic). the patient was +transferred to the floor on [**12-10**] after resolution of her +hypertensive urgency with a decreased blood pressure regimen due +to her hypotension in response to home doses of her medications. the patient was continuned on her +admission hypertensive regimen. a ct scan was +performed that showed bowel wall changes that are likely +secondary to recent peritoneal dialysis and unrelated to pain. ckd v from lupus nephritis: the patient was continued on hd +during her admission. she was therapetuic the same day and her heparin gtt +was stopped.",24 year old woman with ckd v and severe hypertension due to sle admitted. patient was initially maintained on a labetalol drip and hydralazine iv prn. initially her blood pressure over-corrected to sbps in the 80s (patient was asymptomatic) 109,136572.0,14860,2142-06-20,14810,137510.0,2142-04-22,Discharge summary,"Admission Date: [**2142-4-20**] Discharge Date: [**2142-4-22**] Date of Birth: [**2117-8-7**] Sex: F @@ -80757,7 +82606,15 @@ anemia: hematocrit 24.5 initially. baseline 23 to 28. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Unspecified iridocyclitis; Other primary cardiomyopathies; Unspecified disease of pericardium; ; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Noncompliance with renal dialysis; Personal history of noncompliance with medical treatment, presenting hazards to health; Surgical or other procedure not carried out because of patient's decision; Abdominal pain, left lower quadrant; Renal dialysis status; Thrombocytopenia, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Peripheral vascular disease, unspecified; Acquired absence of organ, eye; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus]" +SECONDARY: [End stage renal disease; Unspecified iridocyclitis; Other primary cardiomyopathies; Unspecified disease of pericardium; ; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Noncompliance with renal dialysis; Personal history of noncompliance with medical treatment, presenting hazards to health; Surgical or other procedure not carried out because of patient's decision; Abdominal pain, left lower quadrant; Renal dialysis status; Thrombocytopenia, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Peripheral vascular disease, unspecified; Acquired absence of organ, eye; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus]","24 f with esrd on hemodialysis, sle, malignant hypertension, +history of svc syndrome, pres who presented to the icu for +hypertensive emergency, dyspnea, and headache, now resolved. known lastname **] [**last name (titles) 323**] refused to go to a ""home"" and +declined to talk to social work at this time. of note, she has +missed [**last name (titles) 2286**] sessions and often requests durations and flow +rates for her [**last name (titles) 2286**] that contradict recommendations by her +nephrologist. ultrafiltrate of 2 l on initial hd - continue +outpatient regimen +.","malignant hypertension, history of svc syndrome, pres who presented to the icu for hypertensive emergency, dyspnea, and headache, now resolved. she has received [**year/month/day 2286**] and her blood pressures remained at her baseline off the drips." 109,174489.0,14861,2142-07-04,14858,151240.0,2142-05-18,Discharge summary,"Admission Date: [**2142-5-15**] Discharge Date: [**2142-5-18**] Date of Birth: [**2117-8-7**] Sex: F @@ -81082,7 +82939,14 @@ continued on this during her hospitalization. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Other primary cardiomyopathies; Unspecified disease of pericardium; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Hyperpotassemia; Nausea with vomiting; Diarrhea; Disorders of phosphorus metabolism; Anemia of other chronic disease; Abdominal pain, left lower quadrant; Other chronic pain; Thrombocytopenia, unspecified; Other specified peripheral vascular diseases; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus; Long-term (current) use of anticoagulants; Noncompliance with renal dialysis; Renal dialysis status; Personal history of noncompliance with medical treatment, presenting hazards to health]" +SECONDARY: [End stage renal disease; Other primary cardiomyopathies; Unspecified disease of pericardium; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Hyperpotassemia; Nausea with vomiting; Diarrhea; Disorders of phosphorus metabolism; Anemia of other chronic disease; Abdominal pain, left lower quadrant; Other chronic pain; Thrombocytopenia, unspecified; Other specified peripheral vascular diseases; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus; Long-term (current) use of anticoagulants; Noncompliance with renal dialysis; Renal dialysis status; Personal history of noncompliance with medical treatment, presenting hazards to health]","24 yo female with esrd on hd, malignant hypertension with hx of +intracerebral hemorrhage, sle, chronic abdominal pain, and svc +syndrome admitted due to hypertensive urgency after developing +n/v and being unable to take her po medications. she was able to tolerate po intake +prior to discharge. # esrd on hd: she was hyperkalemic in the emergency room and was +given kayexalate. previous documentation +in omr states she does not need to be bridged while +subtherapeutic.","24 yo female with esrd on hd, malignant hypertension with hx of intracerebral hemorrhage, sle, chronic abdominal pain, and svc syndrome admitted due to hypertensive urgency. she was continued on her home regimen of aliskiren 150 mg po bid, clonidine 0.4 mg/24 hr patch weekly, labetalol 1000 mg po tid, nifedipine 60 mg" 109,174489.0,14861,2142-07-04,14859,102024.0,2142-06-05,Discharge summary,"Admission Date: [**2142-5-20**] Discharge Date: [**2142-6-5**] Date of Birth: [**2117-8-7**] Sex: F @@ -81601,7 +83465,24 @@ this should be reassessed in 3 months. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction; Acute posthemorrhagic anemia; Unspecified intestinal obstruction; Other primary cardiomyopathies; Unspecified disease of pericardium; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Disorders of phosphorus metabolism; Hypotension, unspecified; Hyperpotassemia; Mononeuritis of unspecified site; Anemia of other chronic disease; Abdominal pain, left lower quadrant; Other chronic pain; Thrombocytopenia, unspecified; Diaphragmatic hernia without mention of obstruction or gangrene; Other specified peripheral vascular diseases; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus; Noncompliance with renal dialysis; Renal dialysis status; Long-term (current) use of anticoagulants; Personal history of noncompliance with medical treatment, presenting hazards to health]" +SECONDARY: [End stage renal disease; Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction; Acute posthemorrhagic anemia; Unspecified intestinal obstruction; Other primary cardiomyopathies; Unspecified disease of pericardium; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Disorders of phosphorus metabolism; Hypotension, unspecified; Hyperpotassemia; Mononeuritis of unspecified site; Anemia of other chronic disease; Abdominal pain, left lower quadrant; Other chronic pain; Thrombocytopenia, unspecified; Diaphragmatic hernia without mention of obstruction or gangrene; Other specified peripheral vascular diseases; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus; Noncompliance with renal dialysis; Renal dialysis status; Long-term (current) use of anticoagulants; Personal history of noncompliance with medical treatment, presenting hazards to health]","kub: sbo + +head ct: (prelim read from radiology). ct chest/abd: preliminary read +normal aorta without dissection or acute abnormality. bp meds were held and +then re-initiated as the pressure came back up once she was able +to eat. gi was c/s re: abd pain and rec +cta-abdomen to eval for mesenteric ischemia vs. partial sbo, +however with esrd did not initially want to get cta so kub was +ordered. a few hours later she had 3 +episodes of coffee-ground emesis. afterward the pain resolved and +her hct remained stable. gi felt that the patient would need +general anesthesia in order to undergo an egd which showed an +ulcer at the ge junction. her pain was controlled with +her outpatient regimen of po dilaudid. broad spectrum antibiotics were initiated (vanc +ctx) at meningeal dosing. she should be continued on keppra 1gm with +dialysis three times weekly. c3, c4 were equivocal for active lupus flare, and +[**doctor first name **] was positive, as would be expected in lupus. # anemia: has anemia of chronic renal disease and her hct was +high on admission and epo was held per renal.","sbo head ct was negative for intracranial hemorrhage. no intracranial hemorrhage ekg: nsr, right axis, lvh, nl intervals, st elevations v2-3 (old), tw inversion v6 (new) no acute abnormalities in the abdomen to explain epigastric pain." 109,174489.0,14861,2142-07-04,14860,136572.0,2142-06-20,Discharge summary,"Admission Date: [**2142-6-18**] Discharge Date: [**2142-6-20**] Date of Birth: [**2117-8-7**] Sex: F @@ -81931,7 +83812,14 @@ epogen. ","PRIMARY: [] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Other primary cardiomyopathies; Unspecified disease of pericardium; Anemia of other chronic disease; Hyperpotassemia; Systemic lupus erythematosus; Abdominal pain, other specified site; Other chronic pain; Hypotension, unspecified; Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction; Epilepsy, unspecified, without mention of intractable epilepsy; Depressive disorder, not elsewhere classified; Personal history of venous thrombosis and embolism; Noncompliance with renal dialysis]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Other primary cardiomyopathies; Unspecified disease of pericardium; Anemia of other chronic disease; Hyperpotassemia; Systemic lupus erythematosus; Abdominal pain, other specified site; Other chronic pain; Hypotension, unspecified; Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction; Epilepsy, unspecified, without mention of intractable epilepsy; Depressive disorder, not elsewhere classified; Personal history of venous thrombosis and embolism; Noncompliance with renal dialysis]","# dyspnea: pts dypsnea improved on admission to the ed prior to +hd. lipases were noted to be +mildl elevated however no other concerning physical exam signs +of pancreatitis. # sle: pt was continued on her home regimen of prednisone 4mg +daily + +# history of dvt: pt had a sub-therapeutic inr on admission. she +was discharged on warfarin 3mg daily. # depression: pt was continued on her home regimen of celexa.",pts dypsnea improved on admission to the ed prior to hd. dyspnea likely related to fluid overload (pt missed 2 weeks of dialysis) and her level of anemia. 109,136572.0,14860,2142-06-20,14809,124398.0,2142-03-31,Discharge summary,"Admission Date: [**2142-3-24**] Discharge Date: [**2142-3-31**] Date of Birth: [**2117-8-7**] Sex: F @@ -82253,7 +84141,12 @@ she was discharged to followup with her nephrologist, dr. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Systemic lupus erythematosus; Anemia in chronic kidney disease; Long-term (current) use of steroids; Other chronic pain; Obstructive sleep apnea (adult)(pediatric); Abdominal pain, generalized; Hyperpotassemia]" +SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Systemic lupus erythematosus; Anemia in chronic kidney disease; Long-term (current) use of steroids; Other chronic pain; Obstructive sleep apnea (adult)(pediatric); Abdominal pain, generalized; Hyperpotassemia]","the patient was admitted to the micu on a ntg gtt from the ed. her bp goal was for a systolic +of 180-200. instructions were +written for explicit am administration and nifedipine long +acting 30mg was added at night, in addition to the 90mg long +acting she was taking in the morning. she established a three three +times weekly dialysus regemin.","the patient was admitted to the micu on a nicardipine gtt from the ed. she was given her usual afternoon home medications, and transitioned to a nicardipine gtt, which has worked well for her in the past. on arrival to the floor, she in fact missed her morning medications on [**month/day/year 766**] this resulted in elevate blood pressures requiring iv hydralazing for control " 109,136572.0,14860,2142-06-20,14808,158943.0,2142-03-23,Discharge summary,"Admission Date: [**2142-3-21**] Discharge Date: [**2142-3-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -82605,7 +84498,13 @@ multiple thrombotic events. continued coumadin not symptomatic. continued labetalol. ","PRIMARY: [] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Compression of vein; Unspecified disease of pericardium; Infection and inflammatory reaction due to other vascular device, implant, and graft; Bacteremia; Primary hypercoagulable state; Other primary cardiomyopathies; ; Abdominal pain, unspecified site; Urinary tract infection, site not specified; Acidosis; Other chest pain; Other chronic pain; Systemic lupus erythematosus; Noncompliance with renal dialysis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Hyperpotassemia; Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus]; Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Methicillin resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Compression of vein; Unspecified disease of pericardium; Infection and inflammatory reaction due to other vascular device, implant, and graft; Bacteremia; Primary hypercoagulable state; Other primary cardiomyopathies; ; Abdominal pain, unspecified site; Urinary tract infection, site not specified; Acidosis; Other chest pain; Other chronic pain; Systemic lupus erythematosus; Noncompliance with renal dialysis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Hyperpotassemia; Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus]; Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Methicillin resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","this is a 24 y.o f with sle, esrd on hd and malignant +hypertension + presenting with abd pain, diarrhea, and htn. ct prelim neg +for small bowel obstruction. on +arrival to the floor, abd pain was back to baseline and well +controlled on dilaudid 2mg po q 4hrs +.","a 24 y.o f with sle, esrd on hd and malignant hypertension presenting with abd pain, diarrhea, and htn. initial attempts were made to control her bp with hydralazine and labetalol iv but after these failed to control her blood pressure. she was successfully transitioned to home medications of clonidine, labetalol, aliskiren, nifedipine" 109,136572.0,14860,2142-06-20,14807,158995.0,2142-02-26,Discharge summary,"Admission Date: [**2142-2-25**] Discharge Date: [**2142-2-26**] Date of Birth: [**2117-8-7**] Sex: F @@ -82936,7 +84835,9 @@ sleep medicine. ","PRIMARY: [Poisoning by other opiates and related narcotics] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Thrombotic microangiopathy; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Altered mental status; Other iatrogenic hypotension; Accidental poisoning by other opiates and related narcotics; Hyperpotassemia; Anemia in chronic kidney disease; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Nontraumatic hematoma of soft tissue; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Thrombotic microangiopathy; Other primary cardiomyopathies; Acidosis; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Altered mental status; Other iatrogenic hypotension; Accidental poisoning by other opiates and related narcotics; Hyperpotassemia; Anemia in chronic kidney disease; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Nontraumatic hematoma of soft tissue; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]","24 yo woman with hx of sle, ersd on hd, admitted hypotension and +decreased mental status. hypotension and altered mental status +were in the setting of excessive narcotic use. # hypotension: resolved, patient normotensive on arrival to icu. relative hypotension likely due to dilaudid. from previous peritoneal [**location 2286**] hematoma ??????","24 yo woman with hx of sle, ersd on hd, admitted hypotension and decreased mental status. narcotics were held, pressors returned to and patient was mentating fine. patient was encouraged to take less pain medications and to use morphine." 109,136572.0,14860,2142-06-20,14806,113189.0,2142-02-17,Discharge summary,"Admission Date: [**2142-2-14**] Discharge Date: [**2142-2-17**] Date of Birth: [**2117-8-7**] Sex: F @@ -83257,7 +85158,11 @@ infusions were needed. # depression/anxiety: continued celexa, clonazepam 0.5mg [**hospital1 **] ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Thrombotic microangiopathy; Systemic lupus erythematosus; Anemia in chronic kidney disease; Thrombocytopenia, unspecified; Obstructive sleep apnea (adult)(pediatric); Nontraumatic hematoma of soft tissue; Dysthymic disorder; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]" +SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Thrombotic microangiopathy; Systemic lupus erythematosus; Anemia in chronic kidney disease; Thrombocytopenia, unspecified; Obstructive sleep apnea (adult)(pediatric); Nontraumatic hematoma of soft tissue; Dysthymic disorder; Noncompliance with renal dialysis; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]","24 y.o female with sle, esrd on hd and malignant hypertension +who presents with htn and sob aftering missing hd. pt was treated per omr +hypertensive protocol created by the patients primary +providers, with a goal sbp of 160-180. # coagulopathy/history of dvt: patient on lifetime +anticoagulation for hx of multiple thrombotic events.","24 y.o female with sle, esrd on hd and malignant hypertension who presents with htn and sob after missing hd. pt was treated per omr hypertensive protocol created by the patients primary providers, with a goal sbp of 160-180. she was well maintained on oral outpt regimen of clonidine, labetalol, aliskiren, nifedipine." 109,136572.0,14860,2142-06-20,14858,151240.0,2142-05-18,Discharge summary,"Admission Date: [**2142-5-15**] Discharge Date: [**2142-5-18**] Date of Birth: [**2117-8-7**] Sex: F @@ -83582,7 +85487,14 @@ continued on this during her hospitalization. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Other primary cardiomyopathies; Unspecified disease of pericardium; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Hyperpotassemia; Nausea with vomiting; Diarrhea; Disorders of phosphorus metabolism; Anemia of other chronic disease; Abdominal pain, left lower quadrant; Other chronic pain; Thrombocytopenia, unspecified; Other specified peripheral vascular diseases; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus; Long-term (current) use of anticoagulants; Noncompliance with renal dialysis; Renal dialysis status; Personal history of noncompliance with medical treatment, presenting hazards to health]" +SECONDARY: [End stage renal disease; Other primary cardiomyopathies; Unspecified disease of pericardium; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Hyperpotassemia; Nausea with vomiting; Diarrhea; Disorders of phosphorus metabolism; Anemia of other chronic disease; Abdominal pain, left lower quadrant; Other chronic pain; Thrombocytopenia, unspecified; Other specified peripheral vascular diseases; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus; Long-term (current) use of anticoagulants; Noncompliance with renal dialysis; Renal dialysis status; Personal history of noncompliance with medical treatment, presenting hazards to health]","24 yo female with esrd on hd, malignant hypertension with hx of +intracerebral hemorrhage, sle, chronic abdominal pain, and svc +syndrome admitted due to hypertensive urgency after developing +n/v and being unable to take her po medications. she was able to tolerate po intake +prior to discharge. # esrd on hd: she was hyperkalemic in the emergency room and was +given kayexalate. previous documentation +in omr states she does not need to be bridged while +subtherapeutic.","24 yo female with esrd on hd, malignant hypertension with hx of intracerebral hemorrhage, sle, chronic abdominal pain, and svc syndrome admitted due to hypertensive urgency. she was continued on her home regimen of aliskiren 150 mg po bid, clonidine 0.4 mg/24 hr patch weekly, labetalol 1000 mg po tid, nifedipine 60 mg" 109,136572.0,14860,2142-06-20,14859,102024.0,2142-06-05,Discharge summary,"Admission Date: [**2142-5-20**] Discharge Date: [**2142-6-5**] Date of Birth: [**2117-8-7**] Sex: F @@ -84101,7 +86013,24 @@ this should be reassessed in 3 months. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction; Acute posthemorrhagic anemia; Unspecified intestinal obstruction; Other primary cardiomyopathies; Unspecified disease of pericardium; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Disorders of phosphorus metabolism; Hypotension, unspecified; Hyperpotassemia; Mononeuritis of unspecified site; Anemia of other chronic disease; Abdominal pain, left lower quadrant; Other chronic pain; Thrombocytopenia, unspecified; Diaphragmatic hernia without mention of obstruction or gangrene; Other specified peripheral vascular diseases; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus; Noncompliance with renal dialysis; Renal dialysis status; Long-term (current) use of anticoagulants; Personal history of noncompliance with medical treatment, presenting hazards to health]" +SECONDARY: [End stage renal disease; Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction; Acute posthemorrhagic anemia; Unspecified intestinal obstruction; Other primary cardiomyopathies; Unspecified disease of pericardium; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Disorders of phosphorus metabolism; Hypotension, unspecified; Hyperpotassemia; Mononeuritis of unspecified site; Anemia of other chronic disease; Abdominal pain, left lower quadrant; Other chronic pain; Thrombocytopenia, unspecified; Diaphragmatic hernia without mention of obstruction or gangrene; Other specified peripheral vascular diseases; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus; Noncompliance with renal dialysis; Renal dialysis status; Long-term (current) use of anticoagulants; Personal history of noncompliance with medical treatment, presenting hazards to health]","kub: sbo + +head ct: (prelim read from radiology). ct chest/abd: preliminary read +normal aorta without dissection or acute abnormality. bp meds were held and +then re-initiated as the pressure came back up once she was able +to eat. gi was c/s re: abd pain and rec +cta-abdomen to eval for mesenteric ischemia vs. partial sbo, +however with esrd did not initially want to get cta so kub was +ordered. a few hours later she had 3 +episodes of coffee-ground emesis. afterward the pain resolved and +her hct remained stable. gi felt that the patient would need +general anesthesia in order to undergo an egd which showed an +ulcer at the ge junction. her pain was controlled with +her outpatient regimen of po dilaudid. broad spectrum antibiotics were initiated (vanc +ctx) at meningeal dosing. she should be continued on keppra 1gm with +dialysis three times weekly. c3, c4 were equivocal for active lupus flare, and +[**doctor first name **] was positive, as would be expected in lupus. # anemia: has anemia of chronic renal disease and her hct was +high on admission and epo was held per renal.","sbo head ct was negative for intracranial hemorrhage. no intracranial hemorrhage ekg: nsr, right axis, lvh, nl intervals, st elevations v2-3 (old), tw inversion v6 (new) no acute abnormalities in the abdomen to explain epigastric pain." 109,136572.0,14860,2142-06-20,14802,140167.0,2141-12-23,Discharge summary,"Admission Date: [**2141-12-18**] Discharge Date: [**2141-12-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -84573,7 +86502,23 @@ pericarditis. she was continued on her home prednisone dose of ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Mechanical complication due to peritoneal dialysis catheter; ; Unspecified disease of pericardium; Angioneurotic edema, not elsewhere classified; Abdominal pain, other specified site; Systemic lupus erythematosus; ; Anemia in chronic kidney disease; Dysthymic disorder; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of steroids; Long-term (current) use of anticoagulants; Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation; Other antihypertensive agents causing adverse effects in therapeutic use]" +SECONDARY: [End stage renal disease; Mechanical complication due to peritoneal dialysis catheter; ; Unspecified disease of pericardium; Angioneurotic edema, not elsewhere classified; Abdominal pain, other specified site; Systemic lupus erythematosus; ; Anemia in chronic kidney disease; Dysthymic disorder; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of steroids; Long-term (current) use of anticoagulants; Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation; Other antihypertensive agents causing adverse effects in therapeutic use]","24 year old female with sle, esrd on hd and malignant +hypertension presents with abdominal pain and headache +consistent with her usual hypertensive urgency and was found to +be in hypertensive urgency in ed. she was given 10mg iv labetalol and started on a labatelol drip. nephrology was consulted and dialysis +initiated in the am. she received a total of 60 mg iv hydralazine over the course of +the morning as well as 0.1 mg po clonidine. she reports bilateral calf cramping but no +leg swelling. she took her am bp meds without difficulty. her +tekturna was discontinued for concern that it might be causing +angioedema. the patient +was maintained on her heparin drip for her svc syndrome. abdominal pain: the patient has had extensive prior workup +that has been unrevealing. the +patients tunneled dialysis catheter had a cuff that was out +and qas subsequently replaced with a temporary femoral line on +[**12-21**]. the patient was scheduled +to have dialysis on [**12-23**]. she was admitted with a +subtherpeutic inr of 1.2 she was started on a heparin drip. there was +no evidence of active, acute bleeding.","24 year old female with sle, esrd on hd presents with abdominal pain and headache consistent with her usual hypertensive urgency. she was found to be in hypertensive urgency in ed. she received hydralazine iv 10 mg once and 2 inches of nitropaste." 109,136572.0,14860,2142-06-20,14803,135923.0,2142-01-12,Discharge summary,"Admission Date: [**2142-1-8**] Discharge Date: [**2142-1-13**] Date of Birth: [**2117-8-7**] Sex: F @@ -84964,7 +86909,17 @@ clonazepam. level. follow-up with transplant surgery. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Hypoxemia; Other opiates and related narcotics causing adverse effects in therapeutic use; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Abdominal pain, other specified site; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Renal dialysis status; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Other postprocedural status]" +SECONDARY: [End stage renal disease; ; Systemic lupus erythematosus; Hypoxemia; Other opiates and related narcotics causing adverse effects in therapeutic use; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Abdominal pain, other specified site; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Renal dialysis status; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Other postprocedural status]","24 yo woman with hx of sle, ersd on hd, admitted with +hypertensive urgency. # hypertension: pt with extensive history of repeated admissions +for hypertension. # sle: stable, continued prednisone at 4 mg po daily. patient was +oversedated on dilaudid and had episode of oxygen desaturation +which was reversed with narcan. first name (stitle) **] (transplant +surgery). she will be sent home with low-dose morphine ir and +tylenol prn pain. if l groin pain should become uncontrollable +on current meds, pt should return to the ed for re-evaluation. this is likely secondary to aocd +and renal failure. pt will +need an inr check in the next week at her follow-up with her +pcp.","24 yo woman with hx of sle, ersd on hd, admitted with hypertensive urgency. patient was stablized on home medicaitons, suggesting medication non-compliance. patient was oversedated on dilaudid and had episode of oxygen desaturation." 109,136572.0,14860,2142-06-20,14804,124657.0,2142-01-20,Discharge summary,"Admission Date: [**2142-1-14**] Discharge Date: [**2142-1-20**] Date of Birth: [**2117-8-7**] Sex: F @@ -85383,7 +87338,15 @@ prn. # contact: [**first name8 (namepattern2) **] [**name (ni) **] (mother) [**telephone/fax (1) 43503**] ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; ; Other vascular complications of medical care, not elsewhere classified; Systemic lupus erythematosus; Hyperpotassemia; Phlebitis and thrombophlebitis of upper extremities, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [End stage renal disease; ; Other vascular complications of medical care, not elsewhere classified; Systemic lupus erythematosus; Hyperpotassemia; Phlebitis and thrombophlebitis of upper extremities, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","24 yo woman with hx of sle, ersd on hd, admitted with +hypertensive urgency. in the micu, +nifedipine extended release was added in place of nicardipine as +pts blood pressures seemed to rise prior to nicardipine doses. pt was continued on +gabapentin, tylenol around the clock, and low-dose morphine as +needed for pain. # anemia: hct was mildly decreased from baseline during +admission. # hocm: pt has evidence of myocardial hypertrophy on recent +echo. # fen: repleted lytes prn / regular diet +. # contact: [**first name8 (namepattern2) **] [**name (ni) **] (mother) [**telephone/fax (1) 43503**]","24 yo woman with hx of sle, ersd on hd, admitted with hypertensive urgency. pt was transferred to the floor as blood pressure stabilized. pt reported that morphine did not help pain, and was switched to dilaudid po in the micu." 109,136572.0,14860,2142-06-20,14805,176760.0,2142-01-23,Discharge summary,"Admission Date: [**2142-1-21**] Discharge Date: [**2142-1-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -85825,7 +87788,13 @@ pericardial effusion. continued beta blocker ","PRIMARY: [Other vascular complications of medical care, not elsewhere classified] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; ; Systemic lupus erythematosus; Phlebitis and thrombophlebitis of upper extremities, unspecified]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; ; Systemic lupus erythematosus; Phlebitis and thrombophlebitis of upper extremities, unspecified]","24 yo woman with hx of sle, ersd on hd, admitted with +hypertensive urgency and left wrist pain. she was started on nicardipine drip and 1"" nitropaste +and admitted to the icu for further treatment. she was +continued on iv vanco with hd for 10day course. esrd: continued on regularly scheduled dialysis. her hct was mildly decreased from +baseline. hocm: evidence of myocardial hypertrophy on recent echo. echo without evidence of worsening +pericardial effusion. continued celexa, clonazepam 0.5mg [**hospital1 **] +.","24 yo woman with hx of sle, ersd on hd, admitted with hypertensive urgency and left wrist pain. she was started on nicardipine drip and 1"" nitropaste and admitted to the icu for further treatment. her bp quickly stabilized and she was called out to the medical floor where her sbp ranged 110-150." 109,189332.0,14865,2142-08-30,14808,158943.0,2142-03-23,Discharge summary,"Admission Date: [**2142-3-21**] Discharge Date: [**2142-3-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -86177,7 +88146,13 @@ multiple thrombotic events. continued coumadin not symptomatic. continued labetalol. ","PRIMARY: [] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Compression of vein; Unspecified disease of pericardium; Infection and inflammatory reaction due to other vascular device, implant, and graft; Bacteremia; Primary hypercoagulable state; Other primary cardiomyopathies; ; Abdominal pain, unspecified site; Urinary tract infection, site not specified; Acidosis; Other chest pain; Other chronic pain; Systemic lupus erythematosus; Noncompliance with renal dialysis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Hyperpotassemia; Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus]; Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Methicillin resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Compression of vein; Unspecified disease of pericardium; Infection and inflammatory reaction due to other vascular device, implant, and graft; Bacteremia; Primary hypercoagulable state; Other primary cardiomyopathies; ; Abdominal pain, unspecified site; Urinary tract infection, site not specified; Acidosis; Other chest pain; Other chronic pain; Systemic lupus erythematosus; Noncompliance with renal dialysis; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Hyperpotassemia; Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus]; Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Methicillin resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site; Obstructive sleep apnea (adult)(pediatric); Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","this is a 24 y.o f with sle, esrd on hd and malignant +hypertension + presenting with abd pain, diarrhea, and htn. ct prelim neg +for small bowel obstruction. on +arrival to the floor, abd pain was back to baseline and well +controlled on dilaudid 2mg po q 4hrs +.","a 24 y.o f with sle, esrd on hd and malignant hypertension presenting with abd pain, diarrhea, and htn. initial attempts were made to control her bp with hydralazine and labetalol iv but after these failed to control her blood pressure. she was successfully transitioned to home medications of clonidine, labetalol, aliskiren, nifedipine" 109,189332.0,14865,2142-08-30,14809,124398.0,2142-03-31,Discharge summary,"Admission Date: [**2142-3-24**] Discharge Date: [**2142-3-31**] Date of Birth: [**2117-8-7**] Sex: F @@ -86499,7 +88474,12 @@ she was discharged to followup with her nephrologist, dr. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Systemic lupus erythematosus; Anemia in chronic kidney disease; Long-term (current) use of steroids; Other chronic pain; Obstructive sleep apnea (adult)(pediatric); Abdominal pain, generalized; Hyperpotassemia]" +SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; ; Systemic lupus erythematosus; Anemia in chronic kidney disease; Long-term (current) use of steroids; Other chronic pain; Obstructive sleep apnea (adult)(pediatric); Abdominal pain, generalized; Hyperpotassemia]","the patient was admitted to the micu on a ntg gtt from the ed. her bp goal was for a systolic +of 180-200. instructions were +written for explicit am administration and nifedipine long +acting 30mg was added at night, in addition to the 90mg long +acting she was taking in the morning. she established a three three +times weekly dialysus regemin.","the patient was admitted to the micu on a nicardipine gtt from the ed. she was given her usual afternoon home medications, and transitioned to a nicardipine gtt, which has worked well for her in the past. on arrival to the floor, she in fact missed her morning medications on [**month/day/year 766**] this resulted in elevate blood pressures requiring iv hydralazing for control " 109,189332.0,14865,2142-08-30,14810,137510.0,2142-04-22,Discharge summary,"Admission Date: [**2142-4-20**] Discharge Date: [**2142-4-22**] Date of Birth: [**2117-8-7**] Sex: F @@ -86845,7 +88825,15 @@ anemia: hematocrit 24.5 initially. baseline 23 to 28. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Unspecified iridocyclitis; Other primary cardiomyopathies; Unspecified disease of pericardium; ; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Noncompliance with renal dialysis; Personal history of noncompliance with medical treatment, presenting hazards to health; Surgical or other procedure not carried out because of patient's decision; Abdominal pain, left lower quadrant; Renal dialysis status; Thrombocytopenia, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Peripheral vascular disease, unspecified; Acquired absence of organ, eye; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus]" +SECONDARY: [End stage renal disease; Unspecified iridocyclitis; Other primary cardiomyopathies; Unspecified disease of pericardium; ; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Noncompliance with renal dialysis; Personal history of noncompliance with medical treatment, presenting hazards to health; Surgical or other procedure not carried out because of patient's decision; Abdominal pain, left lower quadrant; Renal dialysis status; Thrombocytopenia, unspecified; Anemia of other chronic disease; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Peripheral vascular disease, unspecified; Acquired absence of organ, eye; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus]","24 f with esrd on hemodialysis, sle, malignant hypertension, +history of svc syndrome, pres who presented to the icu for +hypertensive emergency, dyspnea, and headache, now resolved. known lastname **] [**last name (titles) 323**] refused to go to a ""home"" and +declined to talk to social work at this time. of note, she has +missed [**last name (titles) 2286**] sessions and often requests durations and flow +rates for her [**last name (titles) 2286**] that contradict recommendations by her +nephrologist. ultrafiltrate of 2 l on initial hd - continue +outpatient regimen +.","malignant hypertension, history of svc syndrome, pres who presented to the icu for hypertensive emergency, dyspnea, and headache, now resolved. she has received [**year/month/day 2286**] and her blood pressures remained at her baseline off the drips." 109,189332.0,14865,2142-08-30,14862,131376.0,2142-07-08,Discharge summary,"Admission Date: [**2142-7-7**] Discharge Date: [**2142-7-8**] Date of Birth: [**2117-8-7**] Sex: F @@ -87171,7 +89159,11 @@ celexa. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; Unspecified iridocyclitis; ; Other ascites; Other chronic pain; Abdominal pain, unspecified site; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Obstructive sleep apnea (adult)(pediatric); Other specified peripheral vascular diseases; Anemia of other chronic disease; Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction; Epilepsy, unspecified, without mention of intractable epilepsy; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism; Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits]" +SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; Unspecified iridocyclitis; ; Other ascites; Other chronic pain; Abdominal pain, unspecified site; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Obstructive sleep apnea (adult)(pediatric); Other specified peripheral vascular diseases; Anemia of other chronic disease; Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction; Epilepsy, unspecified, without mention of intractable epilepsy; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism; Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits]","# hypertensive urgency - at the time of admission, the patient +denied chest pain but continued to have mild headache. she stated that she did take her po meds. # abdominal pain - the patient also presented complaining of +adbominal pain. on admit, the patient was continued on her home does +of sevalemer. # h/o gastric ulcer - the patient was continued on her ppi [**hospital1 **]. # sle - the patient was continued on her home regimen of +prednisone 4mg po daily.","at the time of admission, the patient denied chest pain but continued to have mild headache. she also had resolving shortness of breath, likely secondary to hypertension. she had recently been treated for sbo; however, she was without nausea or vomiting." 109,189332.0,14865,2142-08-30,14860,136572.0,2142-06-20,Discharge summary,"Admission Date: [**2142-6-18**] Discharge Date: [**2142-6-20**] Date of Birth: [**2117-8-7**] Sex: F @@ -87501,7 +89493,14 @@ epogen. ","PRIMARY: [] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Other primary cardiomyopathies; Unspecified disease of pericardium; Anemia of other chronic disease; Hyperpotassemia; Systemic lupus erythematosus; Abdominal pain, other specified site; Other chronic pain; Hypotension, unspecified; Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction; Epilepsy, unspecified, without mention of intractable epilepsy; Depressive disorder, not elsewhere classified; Personal history of venous thrombosis and embolism; Noncompliance with renal dialysis]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Other primary cardiomyopathies; Unspecified disease of pericardium; Anemia of other chronic disease; Hyperpotassemia; Systemic lupus erythematosus; Abdominal pain, other specified site; Other chronic pain; Hypotension, unspecified; Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction; Epilepsy, unspecified, without mention of intractable epilepsy; Depressive disorder, not elsewhere classified; Personal history of venous thrombosis and embolism; Noncompliance with renal dialysis]","# dyspnea: pts dypsnea improved on admission to the ed prior to +hd. lipases were noted to be +mildl elevated however no other concerning physical exam signs +of pancreatitis. # sle: pt was continued on her home regimen of prednisone 4mg +daily + +# history of dvt: pt had a sub-therapeutic inr on admission. she +was discharged on warfarin 3mg daily. # depression: pt was continued on her home regimen of celexa.",pts dypsnea improved on admission to the ed prior to hd. dyspnea likely related to fluid overload (pt missed 2 weeks of dialysis) and her level of anemia. 109,189332.0,14865,2142-08-30,14861,174489.0,2142-07-04,Discharge summary,"Admission Date: [**2142-7-3**] Discharge Date: [**2142-7-4**] Date of Birth: [**2117-8-7**] Sex: F @@ -87844,7 +89843,13 @@ mg qdaily without heparin bridge. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Unspecified iridocyclitis; Other primary cardiomyopathies; Abdominal pain, unspecified site; Other chronic pain; Nausea with vomiting; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Other specified peripheral vascular diseases; Obstructive sleep apnea (adult)(pediatric); Anemia of other chronic disease; Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction; Epilepsy, unspecified, without mention of intractable epilepsy; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism; Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits]" +SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Unspecified iridocyclitis; Other primary cardiomyopathies; Abdominal pain, unspecified site; Other chronic pain; Nausea with vomiting; Systemic lupus erythematosus; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Other specified peripheral vascular diseases; Obstructive sleep apnea (adult)(pediatric); Anemia of other chronic disease; Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction; Epilepsy, unspecified, without mention of intractable epilepsy; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism; Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits]","24f with h/o sle, esrd on hd, malignant htn, h/o svc syndrome, +pres, prior ich, and recent sbo, p/w n/v, and hypertensive +urgency. she remained normotensive the following morning and +was taken to hemodialysis after which she was discharged home on +all of her old home medications. # abdominal pain - on presentation she was without n/v, soft +abdomen, passing flatus, and having daily bowel movements. # seizure disorder - continued on keppra 1000 mg po 3x/week +(tu,th,sa).","malignant htn, h/o svc syndrome, pres, prior ich, and recent sbo, p/w n/v, and hypertensive urgency. hypertensive urgency was treated as follows with nitro and labetalol gtt which were quickly weaned as blood pressures dropped below sbp 120. she evenutally became hypotensive to sbp of 90 which resolved on its own " 109,189332.0,14865,2142-08-30,14858,151240.0,2142-05-18,Discharge summary,"Admission Date: [**2142-5-15**] Discharge Date: [**2142-5-18**] Date of Birth: [**2117-8-7**] Sex: F @@ -88169,7 +90174,14 @@ continued on this during her hospitalization. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Other primary cardiomyopathies; Unspecified disease of pericardium; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Hyperpotassemia; Nausea with vomiting; Diarrhea; Disorders of phosphorus metabolism; Anemia of other chronic disease; Abdominal pain, left lower quadrant; Other chronic pain; Thrombocytopenia, unspecified; Other specified peripheral vascular diseases; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus; Long-term (current) use of anticoagulants; Noncompliance with renal dialysis; Renal dialysis status; Personal history of noncompliance with medical treatment, presenting hazards to health]" +SECONDARY: [End stage renal disease; Other primary cardiomyopathies; Unspecified disease of pericardium; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Hyperpotassemia; Nausea with vomiting; Diarrhea; Disorders of phosphorus metabolism; Anemia of other chronic disease; Abdominal pain, left lower quadrant; Other chronic pain; Thrombocytopenia, unspecified; Other specified peripheral vascular diseases; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus; Long-term (current) use of anticoagulants; Noncompliance with renal dialysis; Renal dialysis status; Personal history of noncompliance with medical treatment, presenting hazards to health]","24 yo female with esrd on hd, malignant hypertension with hx of +intracerebral hemorrhage, sle, chronic abdominal pain, and svc +syndrome admitted due to hypertensive urgency after developing +n/v and being unable to take her po medications. she was able to tolerate po intake +prior to discharge. # esrd on hd: she was hyperkalemic in the emergency room and was +given kayexalate. previous documentation +in omr states she does not need to be bridged while +subtherapeutic.","24 yo female with esrd on hd, malignant hypertension with hx of intracerebral hemorrhage, sle, chronic abdominal pain, and svc syndrome admitted due to hypertensive urgency. she was continued on her home regimen of aliskiren 150 mg po bid, clonidine 0.4 mg/24 hr patch weekly, labetalol 1000 mg po tid, nifedipine 60 mg" 109,189332.0,14865,2142-08-30,14863,196721.0,2142-07-23,Discharge summary,"Admission Date: [**2142-7-12**] Discharge Date: [**2142-7-23**] Date of Birth: [**2117-8-7**] Sex: F @@ -88614,7 +90626,17 @@ discontinue it altogether. . ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Other ascites; Infection and inflammatory reaction due to other vascular device, implant, and graft; Bacteremia; Other primary cardiomyopathies; Unspecified disease of pericardium; Compression of vein; Systemic lupus erythematosus; Abdominal pain, unspecified site; Other chronic pain; Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus; Stridor; Angioneurotic edema, not elsewhere classified; Unspecified accident; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Obstructive sleep apnea (adult)(pediatric); Other specified peripheral vascular diseases; Anemia of other chronic disease; Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction; Epilepsy, unspecified, without mention of intractable epilepsy; ; Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism; Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits]" +SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Other ascites; Infection and inflammatory reaction due to other vascular device, implant, and graft; Bacteremia; Other primary cardiomyopathies; Unspecified disease of pericardium; Compression of vein; Systemic lupus erythematosus; Abdominal pain, unspecified site; Other chronic pain; Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus; Stridor; Angioneurotic edema, not elsewhere classified; Unspecified accident; Thrombocytopenia, unspecified; Anemia in chronic kidney disease; Obstructive sleep apnea (adult)(pediatric); Other specified peripheral vascular diseases; Anemia of other chronic disease; Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction; Epilepsy, unspecified, without mention of intractable epilepsy; ; Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism; Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits]","24 y/o female with h/o sle, esrd on hd, malignant htn, h/o svc +syndrome, pres, prior ich, and recent sbo, presented to ed on +[**7-12**] for dyspnea and hypertensive urgency. she was taken to icu and +responded favorably to heliox. patient returned to floor and +has been comfortably breathing since. at time of transfer, pts dyspnea was largely resolved and these +findings were felt to be more consistent with edema given +hypertensive urgency. ascites - unclear etiology and new findings for her. h/o gastric ulcer - ppi was continued throughout +hospitalization. she frequently is outside +of therapeutic range on this medication and given the suspected +problems with medication compliance, it was felt it was safer to +discontinue it altogether.","24 y/o female with h/o sle, esrd on hd, malignant htn, h/o svc syndrome, pres, prior ich, and recent sbo, presented to ed on [**7-12**] for dyspnea and hypertensive urgency. she was started on her home bp regimen of oral labetalol on [**2142-7-15**], and nife" 109,189332.0,14865,2142-08-30,14864,155726.0,2142-08-16,Discharge summary,"Admission Date: [**2142-8-13**] Discharge Date: [**2142-8-16**] Date of Birth: [**2117-8-7**] Sex: F @@ -89047,7 +91069,16 @@ noncompliance with coumadin ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; Other ascites; Thrombocytopenia, unspecified; Compression of vein; ; Systemic lupus erythematosus; Abdominal pain, unspecified site; Other acute pain; Other chronic pain; Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction; Esophageal reflux; Depressive disorder, not elsewhere classified; Anemia in chronic kidney disease; Anemia of other chronic disease; Epilepsy, unspecified, without mention of intractable epilepsy; Other disorders of bone and cartilage; Obstructive sleep apnea (adult)(pediatric); Other specified peripheral vascular diseases; Mild dysplasia of cervix; Noncompliance with renal dialysis; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [End stage renal disease; Chronic glomerulonephritis in diseases classified elsewhere; Other primary cardiomyopathies; Other ascites; Thrombocytopenia, unspecified; Compression of vein; ; Systemic lupus erythematosus; Abdominal pain, unspecified site; Other acute pain; Other chronic pain; Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction; Esophageal reflux; Depressive disorder, not elsewhere classified; Anemia in chronic kidney disease; Anemia of other chronic disease; Epilepsy, unspecified, without mention of intractable epilepsy; Other disorders of bone and cartilage; Obstructive sleep apnea (adult)(pediatric); Other specified peripheral vascular diseases; Mild dysplasia of cervix; Noncompliance with renal dialysis; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","24f with h/o sle, esrd on hd, malignant htn, h/o svc syndrome +was admitted to the micu with dyspnea and hypertensive emergency +with sbp 280s. she has frequent admissions for hypertensive +emergency. for sbp > 200, she will have hydralazine +100mg po. there was concern for infection in the ed +and was given as above, likely secondary to pulmonary edema +/- +infection given fever, cough and infiltrate. blood cultures were negative at time of +discharge. other possible etiologies onclude +line infection given indwelling femoral hd line, however, the +femoral line had been exchanged during previous admission. # sle - continue home regimen of prednisone 4mg po qdaily.","malignant htn, h/o svc syndrome was admitted to the micu with dyspnea and hypertensive emergency with sbp 280s. she was started on a nitro gtt in the ed, but in the micu she was placed on a labetolol drip. lactate on admission was 0.9 and there was no evidence of new end organ damage. she was restarted on all of her home med" 109,189332.0,14865,2142-08-30,14859,102024.0,2142-06-05,Discharge summary,"Admission Date: [**2142-5-20**] Discharge Date: [**2142-6-5**] Date of Birth: [**2117-8-7**] Sex: F @@ -89566,7 +91597,24 @@ this should be reassessed in 3 months. ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease] -SECONDARY: [End stage renal disease; Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction; Acute posthemorrhagic anemia; Unspecified intestinal obstruction; Other primary cardiomyopathies; Unspecified disease of pericardium; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Disorders of phosphorus metabolism; Hypotension, unspecified; Hyperpotassemia; Mononeuritis of unspecified site; Anemia of other chronic disease; Abdominal pain, left lower quadrant; Other chronic pain; Thrombocytopenia, unspecified; Diaphragmatic hernia without mention of obstruction or gangrene; Other specified peripheral vascular diseases; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus; Noncompliance with renal dialysis; Renal dialysis status; Long-term (current) use of anticoagulants; Personal history of noncompliance with medical treatment, presenting hazards to health]" +SECONDARY: [End stage renal disease; Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction; Acute posthemorrhagic anemia; Unspecified intestinal obstruction; Other primary cardiomyopathies; Unspecified disease of pericardium; Systemic lupus erythematosus; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Disorders of phosphorus metabolism; Hypotension, unspecified; Hyperpotassemia; Mononeuritis of unspecified site; Anemia of other chronic disease; Abdominal pain, left lower quadrant; Other chronic pain; Thrombocytopenia, unspecified; Diaphragmatic hernia without mention of obstruction or gangrene; Other specified peripheral vascular diseases; Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus; Noncompliance with renal dialysis; Renal dialysis status; Long-term (current) use of anticoagulants; Personal history of noncompliance with medical treatment, presenting hazards to health]","kub: sbo + +head ct: (prelim read from radiology). ct chest/abd: preliminary read +normal aorta without dissection or acute abnormality. bp meds were held and +then re-initiated as the pressure came back up once she was able +to eat. gi was c/s re: abd pain and rec +cta-abdomen to eval for mesenteric ischemia vs. partial sbo, +however with esrd did not initially want to get cta so kub was +ordered. a few hours later she had 3 +episodes of coffee-ground emesis. afterward the pain resolved and +her hct remained stable. gi felt that the patient would need +general anesthesia in order to undergo an egd which showed an +ulcer at the ge junction. her pain was controlled with +her outpatient regimen of po dilaudid. broad spectrum antibiotics were initiated (vanc +ctx) at meningeal dosing. she should be continued on keppra 1gm with +dialysis three times weekly. c3, c4 were equivocal for active lupus flare, and +[**doctor first name **] was positive, as would be expected in lupus. # anemia: has anemia of chronic renal disease and her hct was +high on admission and epo was held per renal.","sbo head ct was negative for intracranial hemorrhage. no intracranial hemorrhage ekg: nsr, right axis, lvh, nl intervals, st elevations v2-3 (old), tw inversion v6 (new) no acute abnormalities in the abdomen to explain epigastric pain." 2208,144187.0,23610,2190-09-28,23609,162248.0,2190-08-24,Discharge summary,"Admission Date: [**2190-8-18**] Discharge Date: [**2190-8-24**] Date of Birth: [**2120-10-4**] Sex: M @@ -90019,7 +92067,16 @@ previously. he will be discharged back to the extended care facility from which he was admitted. ","PRIMARY: [Pneumonitis due to inhalation of food or vomitus] -SECONDARY: [Urinary tract infection, site not specified; Pressure ulcer, heel; Pressure ulcer, lower back; Alzheimer's disease; Dementia in conditions classified elsewhere without behavioral disturbance; Unspecified essential hypertension; Diabetes with peripheral circulatory disorders, type II or unspecified type, not stated as uncontrolled; Atherosclerosis of native arteries of the extremities, unspecified; Presence of cerebrospinal fluid drainage device; Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site; Hypovolemia; Tachycardia, unspecified; Anemia, unspecified; Gastrostomy status; Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled; Gastroparesis; Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site; Abnormal coagulation profile]" +SECONDARY: [Urinary tract infection, site not specified; Pressure ulcer, heel; Pressure ulcer, lower back; Alzheimer's disease; Dementia in conditions classified elsewhere without behavioral disturbance; Unspecified essential hypertension; Diabetes with peripheral circulatory disorders, type II or unspecified type, not stated as uncontrolled; Atherosclerosis of native arteries of the extremities, unspecified; Presence of cerebrospinal fluid drainage device; Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site; Hypovolemia; Tachycardia, unspecified; Anemia, unspecified; Gastrostomy status; Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled; Gastroparesis; Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site; Abnormal coagulation profile]","# aspiration pneumonia +initially febrile with leukocytosis. at time of discharge, his fevers and +leukocytosis have resolved, he continues to have spo2 in the +upper 90s on room air, and his secretions have improved. his ekg showed stable lvh and +new twi in the anteroseptal leads. this is nonspecific, but due +to the possibility of ischemia, cardiac markers were checked and +were not elevated when compared to his baseline. - also, his other antihypertensives are at lower doses - please +titrate to his prior regimen as tolerated. name (ni) **] son felt that his mental status was at +baseline. his foley was d/cd and replaced by a condom cath. it gradually trended down to a nadir of 23.1. # r ue swelling +doppler u/s performed and showed no evidence of dvt.","the patient was on aspiration precautions and treated with a regimen of vanco and ceftriaxone. his fevers and leukocytosis have resolved, he continues to have spo2 in the upper 90s on room air. he is unable to independently take pos, and had been vomiting." 2338,184485.0,9336,2159-09-19,9335,147143.0,2159-08-27,Discharge summary,"Admission Date: [**2159-8-24**] Discharge Date: [**2159-8-27**] Date of Birth: [**2097-9-24**] Sex: M @@ -90490,7 +92547,19 @@ lorazepam, midodrine). he should also have bp checked assessed - he may require increase in baseline lasix. ","PRIMARY: [Acute on chronic combined systolic and diastolic heart failure] -SECONDARY: [Acidosis; Other primary cardiomyopathies; Congestive heart failure, unspecified; Hepatitis, unspecified; Atrial fibrillation; Atherosclerosis of native arteries of the extremities with ulceration; Orthostatic hypotension; Ulcer of other part of foot; Unspecified acquired hypothyroidism; Impotence of organic origin; Other and unspecified hyperlipidemia; Aortocoronary bypass status; Dysthymic disorder; Automatic implantable cardiac defibrillator in situ]" +SECONDARY: [Acidosis; Other primary cardiomyopathies; Congestive heart failure, unspecified; Hepatitis, unspecified; Atrial fibrillation; Atherosclerosis of native arteries of the extremities with ulceration; Orthostatic hypotension; Ulcer of other part of foot; Unspecified acquired hypothyroidism; Impotence of organic origin; Other and unspecified hyperlipidemia; Aortocoronary bypass status; Dysthymic disorder; Automatic implantable cardiac defibrillator in situ]","patient was admitted on [**2159-8-24**] for acute onset dyspnea. elevated lactate: pt noted to have an elevated lactate of +13.7 on admission. dyspnea/chf exacerbation: pt presented to ed with complaint +of sob of sudden onset with no chest pain. chf exacerbation was immediately +suspected, flash pulmonary edema during episode of af with rvr. liver enzymes trended down over the course of the +admission. likely due to lactic acidosis given his +lactate of 13.7. they recommended starting amiodarone; +however, patient had allergic reaction to this [**date range 4085**] in +past. insomnia: patient was taking lorazepam and zolpidem qhs at +home. known lastname 31930**] will +see a health provider [**last name (namepattern4) **] 1 week, and should have his lfts, +electrolytes and cbc assessed at that time given the +abnormalities noted prior to discharge to confirm that these +values continue to stabilize.",pt noted to have elevated lactate of 13.7 on admission. lactate resulted from hypoperfusion stemming from prolonged svt with abberancy. pt responded well to iv lasix and given the concern for further excess fluid. 2338,114726.0,9337,2159-10-29,9335,147143.0,2159-08-27,Discharge summary,"Admission Date: [**2159-8-24**] Discharge Date: [**2159-8-27**] Date of Birth: [**2097-9-24**] Sex: M @@ -90961,7 +93030,19 @@ lorazepam, midodrine). he should also have bp checked assessed - he may require increase in baseline lasix. ","PRIMARY: [Acute on chronic combined systolic and diastolic heart failure] -SECONDARY: [Acidosis; Other primary cardiomyopathies; Congestive heart failure, unspecified; Hepatitis, unspecified; Atrial fibrillation; Atherosclerosis of native arteries of the extremities with ulceration; Orthostatic hypotension; Ulcer of other part of foot; Unspecified acquired hypothyroidism; Impotence of organic origin; Other and unspecified hyperlipidemia; Aortocoronary bypass status; Dysthymic disorder; Automatic implantable cardiac defibrillator in situ]" +SECONDARY: [Acidosis; Other primary cardiomyopathies; Congestive heart failure, unspecified; Hepatitis, unspecified; Atrial fibrillation; Atherosclerosis of native arteries of the extremities with ulceration; Orthostatic hypotension; Ulcer of other part of foot; Unspecified acquired hypothyroidism; Impotence of organic origin; Other and unspecified hyperlipidemia; Aortocoronary bypass status; Dysthymic disorder; Automatic implantable cardiac defibrillator in situ]","patient was admitted on [**2159-8-24**] for acute onset dyspnea. elevated lactate: pt noted to have an elevated lactate of +13.7 on admission. dyspnea/chf exacerbation: pt presented to ed with complaint +of sob of sudden onset with no chest pain. chf exacerbation was immediately +suspected, flash pulmonary edema during episode of af with rvr. liver enzymes trended down over the course of the +admission. likely due to lactic acidosis given his +lactate of 13.7. they recommended starting amiodarone; +however, patient had allergic reaction to this [**date range 4085**] in +past. insomnia: patient was taking lorazepam and zolpidem qhs at +home. known lastname 31930**] will +see a health provider [**last name (namepattern4) **] 1 week, and should have his lfts, +electrolytes and cbc assessed at that time given the +abnormalities noted prior to discharge to confirm that these +values continue to stabilize.",pt noted to have elevated lactate of 13.7 on admission. lactate resulted from hypoperfusion stemming from prolonged svt with abberancy. pt responded well to iv lasix and given the concern for further excess fluid. 2338,114726.0,9337,2159-10-29,9336,184485.0,2159-09-19,Discharge summary,"Admission Date: [**2159-9-14**] Discharge Date: [**2159-9-19**] Date of Birth: [**2097-9-24**] Sex: M @@ -91342,7 +93423,16 @@ consistent with fatty infiltration. was on sc heparin for dvt ppx. pt was full code. ","PRIMARY: [Acute on chronic systolic heart failure] -SECONDARY: [Acute kidney failure, unspecified; Paroxysmal ventricular tachycardia; Ulcer of heel and midfoot; Hyperosmolality and/or hypernatremia; Acquired coagulation factor deficiency; Other pulmonary insufficiency, not elsewhere classified; Chronic passive congestion of liver; Hyperpotassemia; Fitting and adjustment of other cardiac device; Personal history of noncompliance with medical treatment, presenting hazards to health; Congestive heart failure, unspecified; Old myocardial infarction; Atrial fibrillation; Other left bundle branch block; Other and unspecified hyperlipidemia; Unspecified acquired hypothyroidism; Depressive disorder, not elsewhere classified; Insomnia, unspecified; Anemia, unspecified; Aortocoronary bypass status]" +SECONDARY: [Acute kidney failure, unspecified; Paroxysmal ventricular tachycardia; Ulcer of heel and midfoot; Hyperosmolality and/or hypernatremia; Acquired coagulation factor deficiency; Other pulmonary insufficiency, not elsewhere classified; Chronic passive congestion of liver; Hyperpotassemia; Fitting and adjustment of other cardiac device; Personal history of noncompliance with medical treatment, presenting hazards to health; Congestive heart failure, unspecified; Old myocardial infarction; Atrial fibrillation; Other left bundle branch block; Other and unspecified hyperlipidemia; Unspecified acquired hypothyroidism; Depressive disorder, not elsewhere classified; Insomnia, unspecified; Anemia, unspecified; Aortocoronary bypass status]","61 year old male with a h/o cad s/p mi and cabg in [**2144**], chronic +systolic heart failure (ef 20%), recurrent vt s/p icd placement +and atrial fibrillation admitted now for recurrent icd firing +after not taking home sotalol for 2 weeks. heparin gtt for anticoagulation +was eventually dcd, and since pt has an elev inr at baseline, +it was decided not to start coumadin as it would be difficult to +monitor. pt was continued on amiodarone 400mg daily to maintain +sinus rhythm as per ep recs. on +telemetry, pt continued to have frequent pvcs, nsvt. # lle erythema and l heel ulcer: chronic, stable. # insomnia: stable, home ativan prn and ambien were continued. pt +could benefit from anemia work-up as outpatient.","61 year old male with afib, h/o vt, with several episodes of vt the night s/p shocks. on admission, pt was intubated, sedated, in sinus and hemodynamically stable. he was continued on amiodarone 400mg daily to maintain sinus rhythm." 5060,119255.0,24311,2182-12-13,24310,193317.0,2182-10-11,Discharge summary,"Admission Date: [**2182-10-10**] Discharge Date: [**2182-10-11**] Date of Birth: [**2144-9-28**] Sex: M @@ -91501,7 +93591,10 @@ pt left ama before further care was done for pt. ","PRIMARY: [Alcohol withdrawal] -SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Opioid abuse, unspecified; Chronic hepatitis C without mention of hepatic coma; Obsessive-compulsive disorders; Anxiety state, unspecified; Cerebral degeneration, unspecified; Lack of housing; Scabies; Alcoholic polyneuropathy]" +SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Opioid abuse, unspecified; Chronic hepatitis C without mention of hepatic coma; Obsessive-compulsive disorders; Anxiety state, unspecified; Cerebral degeneration, unspecified; Lack of housing; Scabies; Alcoholic polyneuropathy]","a/p: 38 yo m with pmh of etoh abuse/withdrawal and multiple +hospitalizations presented with acute intoxication and heroin +use requiring naloxone in ed. pt left ama before +paperwork could be completed (will take several days).",pt admitted to drinking rum and listerine. received valium 50mg total in ed for ciwa >10. left ama before further care was done for pt. 5060,193317.0,24310,2182-10-11,24309,143525.0,2182-10-08,Discharge summary,"Admission Date: [**2182-10-7**] Discharge Date: [**2182-10-8**] Date of Birth: [**2144-9-28**] Sex: M @@ -91675,7 +93768,13 @@ was secondary to etoh abuse. pt leave ama on the morning of [**2182-10-8**]. ","PRIMARY: [Alcohol withdrawal] -SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Suicidal ideation; Scabies; Other respiratory abnormalities; Obsessive-compulsive personality disorder; Chronic hepatitis C without mention of hepatic coma; Alcoholic polyneuropathy; Lack of housing; Dysthymic disorder]" +SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Suicidal ideation; Scabies; Other respiratory abnormalities; Obsessive-compulsive personality disorder; Chronic hepatitis C without mention of hepatic coma; Alcoholic polyneuropathy; Lack of housing; Dysthymic disorder]","pt is a 38 year old male with significant hx of +etoh/polysubstance abuse, who presented today with etoh +intoxication and developed respiratory distress, felt to be self +induced airway obstruction. # airway obstruction: required a code blue, and at first there +was concern about a allergic response, later thought to be +psychogenic. #.hep b/hep c: hep b infection cleared based on most recent +serologies.","pt is a 38 year old male with significant hx of etoh/polysubstance abuse. presented today with etoh intoxication and developed respiratory distress. received multiple doses of ativan and valium, no objective signs of withdrawal." 5060,193317.0,24310,2182-10-11,24308,156497.0,2182-06-18,Discharge summary,"Admission Date: [**2182-6-13**] Discharge Date: [**2182-6-18**] Date of Birth: [**2144-9-28**] Sex: M @@ -91924,7 +94023,12 @@ pain was controlled with analgesics. ","PRIMARY: [Alcohol withdrawal] -SECONDARY: [Hyperosmolality and/or hypernatremia; Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic hepatitis C without mention of hepatic coma; Unspecified essential hypertension; Anemia, unspecified; Pain in limb; Unarmed fight or brawl; Dysthymic disorder; Obsessive-compulsive disorders; Alcoholic polyneuropathy]" +SECONDARY: [Hyperosmolality and/or hypernatremia; Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic hepatitis C without mention of hepatic coma; Unspecified essential hypertension; Anemia, unspecified; Pain in limb; Unarmed fight or brawl; Dysthymic disorder; Obsessive-compulsive disorders; Alcoholic polyneuropathy]","known lastname 24927**] is a 37m with a pmh s/f severe alcoholism with +several icu admissions for management alchohol withdrawl in the +past, hcv, and hbv, admitted to the [**hospital unit name 153**] for alcohol withdrawal. he was +discharged in the company of police to court for section 35 with +the collaboration of psych/social work. the +patient self corrected with po intake and iv hydration.",a 37m man with a pmh s/f severe alcoholism was admitted to a hospital for alcohol withdrawal. he was kept on a ciwa scale which required active intervention until the evening of [**6-16**]. he was discharged in the company of police to court for section 35. 5060,156497.0,24308,2182-06-18,24307,174823.0,2182-04-07,Discharge summary,"Admission Date: [**2182-4-4**] Discharge Date: [**2182-4-7**] Date of Birth: [**2144-9-28**] Sex: M @@ -92166,7 +94270,15 @@ was found to have eloped from the hospital. this discharge summary is signed by [**first name4 (namepattern1) **] [**last name (namepattern1) **] as dr. [**name (stitle) 61607**] is no longer working at [**hospital1 18**]. ","PRIMARY: [Acute respiratory failure] -SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Acute pancreatitis; Alcohol withdrawal; Chronic hepatitis C without mention of hepatic coma; Depressive disorder, not elsewhere classified; Cocaine abuse, unspecified]" +SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Acute pancreatitis; Alcohol withdrawal; Chronic hepatitis C without mention of hepatic coma; Depressive disorder, not elsewhere classified; Cocaine abuse, unspecified]","known lastname 24927**] is a 37m with a pmh s/f severe alcoholism with +multiple icu admissions for management of airway +protection/withdrawl in the past, hcv, and hbv, found +unresponsive in the setting of alcohol intoxication, intubated +for airway protection and hypoxia prior to recieving benzos in +ed, with incidentally diagnosed leukocytosis on routine labs. altered mental status: ddx includes etoh intoxication with +level of 280, other toxic ingestion, intracranial bleed from his +fall, seizure from etoh withdrawl vs. trauma. he was given mvi, thiamine, and folic acid. # access: hx of difficulty with piv and pt combative, femoral +cvl placed in ed upon arrival.","mr. [**known lastname 24927**] is a 37m with a pmh s/f severe alcoholism with multiple icu admissions for management of airway protection/withdrawl in the past, hcv, and hbv. ddx includes etoh intoxication with level of 280, other toxic ingestion, intracranial bleed from his fall, seizure from etoh withdrawl vs. trauma " 5060,156497.0,24308,2182-06-18,24306,170299.0,2182-04-01,Discharge summary,"Admission Date: [**2182-3-30**] Discharge Date: [**2182-4-1**] Date of Birth: [**2144-9-28**] Sex: M @@ -92364,7 +94476,12 @@ that he be section 25d. ","PRIMARY: [Alcohol withdrawal] -SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic hepatitis C without mention of hepatic coma; Anemia, unspecified; Lack of housing; Dysthymic disorder; Obsessive-compulsive disorders]" +SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic hepatitis C without mention of hepatic coma; Anemia, unspecified; Lack of housing; Dysthymic disorder; Obsessive-compulsive disorders]","37yom hx alcoholism, multiple admits for detox and hx of +dts/withdrawal szs, presenting with intoxication and agitation, +admitted to micu for ethanol withdrawal and monitoring. the patient was aggressivley treated with +200 mg of valium in 9 hours and then determined to no longer +have any clinical evidence of etoh withdrawal (involuntary +tremors). however, the patient became very agitated and anxious.","37yom hx alcoholism, multiple admits for detox and hx of dts/withdrawal szs. he presented intoxicated and became very agitated in the ed. he was given a total of 40mg of valium in the ed and an additionl 5mg valium for anxiety." 5060,156497.0,24308,2182-06-18,24305,196749.0,2182-01-14,Discharge summary,"Admission Date: [**2182-1-4**] Discharge Date: [**2182-1-14**] Date of Birth: [**2144-9-28**] Sex: M @@ -92588,7 +94705,12 @@ unwitnessed and did not return (ama, although he left without risk/benefit). ","PRIMARY: [Alcohol withdrawal delirium] -SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic pancreatitis; Chronic hepatitis C without mention of hepatic coma; Acute alcoholic hepatitis; Acute alcoholic intoxication in alcoholism, continuous; Pain in joint, lower leg; Lack of housing; Anxiety state, unspecified; Other, mixed, or unspecified drug abuse, unspecified; ]" +SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic pancreatitis; Chronic hepatitis C without mention of hepatic coma; Acute alcoholic hepatitis; Acute alcoholic intoxication in alcoholism, continuous; Pain in joint, lower leg; Lack of housing; Anxiety state, unspecified; Other, mixed, or unspecified drug abuse, unspecified; ]","37 year-old male with a history of alcoholism with multiple +admissions for detox and history of dts/withdrawal seizures who +presents with intoxication followed by withdrawal. unfortunately, on the day of anticipated discharge to [**hospital1 **] +for inpatient alcohol rehabilitation, he left the floor +unwitnessed and did not return (ama, although he left without +risk/benefit).",37 year-old male with a history of alcoholism with multiple admissions for detox and history of dts/withdrawal seizures who presents with intoxication followed by withdrawal. received 30 mg valium in the emergency room and was placed on a q1h ciwa in the icu. this was transitioned to a standing valium order per his protocol on arrival to the floor. his lipase and transaminases were elevated during his admission 5060,148207.0,24313,2183-02-03,24309,143525.0,2182-10-08,Discharge summary,"Admission Date: [**2182-10-7**] Discharge Date: [**2182-10-8**] Date of Birth: [**2144-9-28**] Sex: M @@ -92762,7 +94884,13 @@ was secondary to etoh abuse. pt leave ama on the morning of [**2182-10-8**]. ","PRIMARY: [Alcohol withdrawal] -SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Suicidal ideation; Scabies; Other respiratory abnormalities; Obsessive-compulsive personality disorder; Chronic hepatitis C without mention of hepatic coma; Alcoholic polyneuropathy; Lack of housing; Dysthymic disorder]" +SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Suicidal ideation; Scabies; Other respiratory abnormalities; Obsessive-compulsive personality disorder; Chronic hepatitis C without mention of hepatic coma; Alcoholic polyneuropathy; Lack of housing; Dysthymic disorder]","pt is a 38 year old male with significant hx of +etoh/polysubstance abuse, who presented today with etoh +intoxication and developed respiratory distress, felt to be self +induced airway obstruction. # airway obstruction: required a code blue, and at first there +was concern about a allergic response, later thought to be +psychogenic. #.hep b/hep c: hep b infection cleared based on most recent +serologies.","pt is a 38 year old male with significant hx of etoh/polysubstance abuse. presented today with etoh intoxication and developed respiratory distress. received multiple doses of ativan and valium, no objective signs of withdrawal." 5060,174823.0,24307,2182-04-07,24302,184857.0,2181-11-20,Discharge summary,"Admission Date: [**2181-11-18**] Discharge Date: [**2181-11-20**] Date of Birth: [**2144-9-28**] Sex: M @@ -92963,7 +95091,9 @@ during admission, which was removed when patient signed out ama. 8. dispo: patient signed out ama. ","PRIMARY: [Alcohol withdrawal] -SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Open wound of forehead, without mention of complication; Unspecified fall; Chronic hepatitis C without mention of hepatic coma; Lack of housing; Anemia, unspecified; Acute alcoholic hepatitis; Alcoholic gastritis, without mention of hemorrhage; Hypovolemia]" +SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Open wound of forehead, without mention of complication; Unspecified fall; Chronic hepatitis C without mention of hepatic coma; Lack of housing; Anemia, unspecified; Acute alcoholic hepatitis; Alcoholic gastritis, without mention of hemorrhage; Hypovolemia]","36m with etoh dependence and frequent admissions for etoh +intoxication presents s/p fall with etoh withdrawal. alcohol withdrawal: no hypertension or tachycardia this +morning. ppx: patient treated with heparin sq for dvt prophylaxis.",36m with etoh dependence and frequent admissions for etoh intoxication present s/p fall with etoh withdrawal. no hypertension or tachycardia this morning. slightly agitated and with slight upper extremity tremor. 5060,174823.0,24307,2182-04-07,24303,197750.0,2181-12-11,Discharge summary,"Admission Date: [**2181-12-7**] Discharge Date: [**2181-12-11**] Date of Birth: [**2144-9-28**] Sex: M @@ -93167,7 +95297,12 @@ was monitored, pt was given po iron, folate and thiamine. ","PRIMARY: [Alcohol withdrawal] -SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic hepatitis C without mention of hepatic coma; Iron deficiency anemia, unspecified; Depressive disorder, not elsewhere classified; Lack of housing]" +SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic hepatitis C without mention of hepatic coma; Iron deficiency anemia, unspecified; Depressive disorder, not elsewhere classified; Lack of housing]","known lastname 24927**] is a 37m with etoh dependence and frequent +admissions for etoh intoxication who presents with etoh +withdrawal and global pain. lipase slightly increased from [**11-18**] (135 from +56). # alcoholic liver disease: ast/alt elevated in 2:1 ratio, this +is his baseline. hct drop from 34 to 28 in setting of 3l ivf upon +admission.",mr. [**known lastname 24927**] is a 37m with etoh dependence and frequent admissions for etoh intoxication. he presents with etoh withdrawal and global pain. he was given oxycodone 5-10mg q 4hrs prn. 5060,174823.0,24307,2182-04-07,24304,135773.0,2181-12-14,Discharge summary,"Admission Date: [**2181-12-12**] Discharge Date: [**2181-12-14**] Date of Birth: [**2144-9-28**] Sex: M @@ -93344,7 +95479,11 @@ seizures, delerium, and death. ","PRIMARY: [Alcohol withdrawal] -SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic hepatitis C without mention of hepatic coma; Iron deficiency anemia, unspecified; Alcoholic liver damage, unspecified; Lack of housing]" +SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic hepatitis C without mention of hepatic coma; Iron deficiency anemia, unspecified; Alcoholic liver damage, unspecified; Lack of housing]","known lastname 24927**] was admitted with alcohol intoxication and abdominal +pain. a ct of his abdomen was negative for any +abdominal pathology. an attempt was made to +transfer him to the floor and when he was told this, he held his +breath and o2 sats dropped to the 70s and he was tachycardic.",mr. [**known lastname 24927**] was admitted with alcohol intoxication and abdominal pain. he received approximately 200mg of po valium over a 24 hour period for alcohol withdrawal. he continued to complain of abdominal pain but his abdomen was benign. 5060,174823.0,24307,2182-04-07,24305,196749.0,2182-01-14,Discharge summary,"Admission Date: [**2182-1-4**] Discharge Date: [**2182-1-14**] Date of Birth: [**2144-9-28**] Sex: M @@ -93568,7 +95707,12 @@ unwitnessed and did not return (ama, although he left without risk/benefit). ","PRIMARY: [Alcohol withdrawal delirium] -SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic pancreatitis; Chronic hepatitis C without mention of hepatic coma; Acute alcoholic hepatitis; Acute alcoholic intoxication in alcoholism, continuous; Pain in joint, lower leg; Lack of housing; Anxiety state, unspecified; Other, mixed, or unspecified drug abuse, unspecified; ]" +SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic pancreatitis; Chronic hepatitis C without mention of hepatic coma; Acute alcoholic hepatitis; Acute alcoholic intoxication in alcoholism, continuous; Pain in joint, lower leg; Lack of housing; Anxiety state, unspecified; Other, mixed, or unspecified drug abuse, unspecified; ]","37 year-old male with a history of alcoholism with multiple +admissions for detox and history of dts/withdrawal seizures who +presents with intoxication followed by withdrawal. unfortunately, on the day of anticipated discharge to [**hospital1 **] +for inpatient alcohol rehabilitation, he left the floor +unwitnessed and did not return (ama, although he left without +risk/benefit).",37 year-old male with a history of alcoholism with multiple admissions for detox and history of dts/withdrawal seizures who presents with intoxication followed by withdrawal. received 30 mg valium in the emergency room and was placed on a q1h ciwa in the icu. this was transitioned to a standing valium order per his protocol on arrival to the floor. his lipase and transaminases were elevated during his admission 5060,174823.0,24307,2182-04-07,24306,170299.0,2182-04-01,Discharge summary,"Admission Date: [**2182-3-30**] Discharge Date: [**2182-4-1**] Date of Birth: [**2144-9-28**] Sex: M @@ -93766,7 +95910,12 @@ that he be section 25d. ","PRIMARY: [Alcohol withdrawal] -SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic hepatitis C without mention of hepatic coma; Anemia, unspecified; Lack of housing; Dysthymic disorder; Obsessive-compulsive disorders]" +SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic hepatitis C without mention of hepatic coma; Anemia, unspecified; Lack of housing; Dysthymic disorder; Obsessive-compulsive disorders]","37yom hx alcoholism, multiple admits for detox and hx of +dts/withdrawal szs, presenting with intoxication and agitation, +admitted to micu for ethanol withdrawal and monitoring. the patient was aggressivley treated with +200 mg of valium in 9 hours and then determined to no longer +have any clinical evidence of etoh withdrawal (involuntary +tremors). however, the patient became very agitated and anxious.","37yom hx alcoholism, multiple admits for detox and hx of dts/withdrawal szs. he presented intoxicated and became very agitated in the ed. he was given a total of 40mg of valium in the ed and an additionl 5mg valium for anxiety." 5060,174823.0,24307,2182-04-07,24301,153063.0,2181-10-24,Discharge summary,"Admission Date: [**2181-10-23**] Discharge Date: [**2181-10-24**] Date of Birth: [**2144-9-28**] Sex: M @@ -93912,7 +96061,9 @@ but he decided to leave. ","PRIMARY: [Alcohol withdrawal] -SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic hepatitis C without mention of hepatic coma; Alcoholic polyneuropathy; Lack of housing]" +SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic hepatitis C without mention of hepatic coma; Alcoholic polyneuropathy; Lack of housing]","known lastname 24927**] is a 37 yo male with history of etoh +abuse presents with acute etoh intoxication. patient +was initially on diazepam ciwa scale.","mr. [**known lastname 24927**] is a 37 yo male with history of etoh abuse. patient has a long history of alcohol abuse, with innumerable ed visits and hospitalizations for same. within twelve hours of admission, patient was requesting to leave ama. he was evaluated by psychiatry who felt he had competence to leave." 5060,143525.0,24309,2182-10-08,24308,156497.0,2182-06-18,Discharge summary,"Admission Date: [**2182-6-13**] Discharge Date: [**2182-6-18**] Date of Birth: [**2144-9-28**] Sex: M @@ -94161,7 +96312,12 @@ pain was controlled with analgesics. ","PRIMARY: [Alcohol withdrawal] -SECONDARY: [Hyperosmolality and/or hypernatremia; Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic hepatitis C without mention of hepatic coma; Unspecified essential hypertension; Anemia, unspecified; Pain in limb; Unarmed fight or brawl; Dysthymic disorder; Obsessive-compulsive disorders; Alcoholic polyneuropathy]" +SECONDARY: [Hyperosmolality and/or hypernatremia; Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic hepatitis C without mention of hepatic coma; Unspecified essential hypertension; Anemia, unspecified; Pain in limb; Unarmed fight or brawl; Dysthymic disorder; Obsessive-compulsive disorders; Alcoholic polyneuropathy]","known lastname 24927**] is a 37m with a pmh s/f severe alcoholism with +several icu admissions for management alchohol withdrawl in the +past, hcv, and hbv, admitted to the [**hospital unit name 153**] for alcohol withdrawal. he was +discharged in the company of police to court for section 35 with +the collaboration of psych/social work. the +patient self corrected with po intake and iv hydration.",a 37m man with a pmh s/f severe alcoholism was admitted to a hospital for alcohol withdrawal. he was kept on a ciwa scale which required active intervention until the evening of [**6-16**]. he was discharged in the company of police to court for section 35. 5060,148207.0,24313,2183-02-03,24311,119255.0,2182-12-13,Discharge summary,"Admission Date: [**2182-12-10**] Discharge Date: [**2182-12-13**] Date of Birth: [**2144-9-28**] Sex: M @@ -94413,7 +96569,16 @@ folate, replete vitamins ","PRIMARY: [Alcohol withdrawal] -SECONDARY: [Acidosis; Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; ; Hypovolemia; Closed fracture of middle or proximal phalanx or phalanges of hand; Unarmed fight or brawl; Sedative, hypnotic or anxiolytic dependence, continuous; Alcoholic polyneuropathy; Chronic hepatitis C without mention of hepatic coma; Dysthymic disorder; Lack of housing; Obsessive-compulsive disorders]" +SECONDARY: [Acidosis; Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; ; Hypovolemia; Closed fracture of middle or proximal phalanx or phalanges of hand; Unarmed fight or brawl; Sedative, hypnotic or anxiolytic dependence, continuous; Alcoholic polyneuropathy; Chronic hepatitis C without mention of hepatic coma; Dysthymic disorder; Lack of housing; Obsessive-compulsive disorders]","known lastname 24927**] is a 37 year-old gentleman w/ a pmh s/f severe +alcoholism with several icu admissions for management alchohol +withdrawl in the past, hcv, and hbv, admitted to the [**hospital unit name 153**] for +alcohol withdrawal. alcohol withdrawal: he was treated in the [**hospital unit name 153**] for alcohol +withdrawal. given his numerous +admissions for substance abuse, the psychiatry team was +consulted and given his poor insight among other considerations, +deteriorating health in particular, felt that that he did not +have capacity to decide to leave ama and a section 35 was +completed.",a 37 year-old gentleman w/ a pmh s/f severe alcoholism was admitted to the [**hospital unit name 153**] for alcohol withdrawal. he received 40 mg of valium (10 mg po x 4) thus receiving a total of 70 mg of valium over the course of 19 hours. he was noted to have apneic episodes where he would desat to the 80s and then his sats would improve with stimulation. 5060,148207.0,24313,2183-02-03,24310,193317.0,2182-10-11,Discharge summary,"Admission Date: [**2182-10-10**] Discharge Date: [**2182-10-11**] Date of Birth: [**2144-9-28**] Sex: M @@ -94572,7 +96737,10 @@ pt left ama before further care was done for pt. ","PRIMARY: [Alcohol withdrawal] -SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Opioid abuse, unspecified; Chronic hepatitis C without mention of hepatic coma; Obsessive-compulsive disorders; Anxiety state, unspecified; Cerebral degeneration, unspecified; Lack of housing; Scabies; Alcoholic polyneuropathy]" +SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Opioid abuse, unspecified; Chronic hepatitis C without mention of hepatic coma; Obsessive-compulsive disorders; Anxiety state, unspecified; Cerebral degeneration, unspecified; Lack of housing; Scabies; Alcoholic polyneuropathy]","a/p: 38 yo m with pmh of etoh abuse/withdrawal and multiple +hospitalizations presented with acute intoxication and heroin +use requiring naloxone in ed. pt left ama before +paperwork could be completed (will take several days).",pt admitted to drinking rum and listerine. received valium 50mg total in ed for ciwa >10. left ama before further care was done for pt. 5060,119255.0,24311,2182-12-13,24309,143525.0,2182-10-08,Discharge summary,"Admission Date: [**2182-10-7**] Discharge Date: [**2182-10-8**] Date of Birth: [**2144-9-28**] Sex: M @@ -94746,7 +96914,13 @@ was secondary to etoh abuse. pt leave ama on the morning of [**2182-10-8**]. ","PRIMARY: [Alcohol withdrawal] -SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Suicidal ideation; Scabies; Other respiratory abnormalities; Obsessive-compulsive personality disorder; Chronic hepatitis C without mention of hepatic coma; Alcoholic polyneuropathy; Lack of housing; Dysthymic disorder]" +SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Suicidal ideation; Scabies; Other respiratory abnormalities; Obsessive-compulsive personality disorder; Chronic hepatitis C without mention of hepatic coma; Alcoholic polyneuropathy; Lack of housing; Dysthymic disorder]","pt is a 38 year old male with significant hx of +etoh/polysubstance abuse, who presented today with etoh +intoxication and developed respiratory distress, felt to be self +induced airway obstruction. # airway obstruction: required a code blue, and at first there +was concern about a allergic response, later thought to be +psychogenic. #.hep b/hep c: hep b infection cleared based on most recent +serologies.","pt is a 38 year old male with significant hx of etoh/polysubstance abuse. presented today with etoh intoxication and developed respiratory distress. received multiple doses of ativan and valium, no objective signs of withdrawal." 5060,119255.0,24311,2182-12-13,24308,156497.0,2182-06-18,Discharge summary,"Admission Date: [**2182-6-13**] Discharge Date: [**2182-6-18**] Date of Birth: [**2144-9-28**] Sex: M @@ -94995,7 +97169,12 @@ pain was controlled with analgesics. ","PRIMARY: [Alcohol withdrawal] -SECONDARY: [Hyperosmolality and/or hypernatremia; Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic hepatitis C without mention of hepatic coma; Unspecified essential hypertension; Anemia, unspecified; Pain in limb; Unarmed fight or brawl; Dysthymic disorder; Obsessive-compulsive disorders; Alcoholic polyneuropathy]" +SECONDARY: [Hyperosmolality and/or hypernatremia; Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic hepatitis C without mention of hepatic coma; Unspecified essential hypertension; Anemia, unspecified; Pain in limb; Unarmed fight or brawl; Dysthymic disorder; Obsessive-compulsive disorders; Alcoholic polyneuropathy]","known lastname 24927**] is a 37m with a pmh s/f severe alcoholism with +several icu admissions for management alchohol withdrawl in the +past, hcv, and hbv, admitted to the [**hospital unit name 153**] for alcohol withdrawal. he was +discharged in the company of police to court for section 35 with +the collaboration of psych/social work. the +patient self corrected with po intake and iv hydration.",a 37m man with a pmh s/f severe alcoholism was admitted to a hospital for alcohol withdrawal. he was kept on a ciwa scale which required active intervention until the evening of [**6-16**]. he was discharged in the company of police to court for section 35. 5060,135773.0,24304,2181-12-14,24300,194191.0,2181-08-21,Discharge summary,"Admission Date: [**2181-8-20**] Discharge Date: [**2181-8-21**] Date of Birth: [**2144-9-28**] Sex: M @@ -95289,7 +97468,14 @@ lactate. repeat chemistries showed normal anion gap. ","PRIMARY: [Alcohol withdrawal] -SECONDARY: [Alkalosis; Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Acidosis; Chronic hepatitis C without mention of hepatic coma; Cocaine abuse, unspecified; Lack of housing; Anemia, unspecified; Other chest pain]" +SECONDARY: [Alkalosis; Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Acidosis; Chronic hepatitis C without mention of hepatic coma; Cocaine abuse, unspecified; Lack of housing; Anemia, unspecified; Other chest pain]","36m with etoh dependence and frequent admissions for etoh +intoxication presents with etoh withdrawal. - he received multivit, folate, thiamine in ivf then po +- social work was consulted the morning after admission when +patient was demanding to leave. he signed out +ama with plans to seek outpatient treatment. social wk was involved but +psychiatry was not consulted. # anion gap: ag 18 in the ed with a normal hco3 and alkalosis on +vbg. #anemia - normocytic anemia, hct at baseline +.","36m with etoh dependence and frequent admissions for etoh intoxication presents with etoh withdrawal. presented with signs of withdrawal with agitation, hypertension, tachycardia, and slight tremor of upper ex bilat. social work was consulted the morning after admission when patient was demanding to leave." 5060,135773.0,24304,2181-12-14,24301,153063.0,2181-10-24,Discharge summary,"Admission Date: [**2181-10-23**] Discharge Date: [**2181-10-24**] Date of Birth: [**2144-9-28**] Sex: M @@ -95435,7 +97621,9 @@ but he decided to leave. ","PRIMARY: [Alcohol withdrawal] -SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic hepatitis C without mention of hepatic coma; Alcoholic polyneuropathy; Lack of housing]" +SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic hepatitis C without mention of hepatic coma; Alcoholic polyneuropathy; Lack of housing]","known lastname 24927**] is a 37 yo male with history of etoh +abuse presents with acute etoh intoxication. patient +was initially on diazepam ciwa scale.","mr. [**known lastname 24927**] is a 37 yo male with history of etoh abuse. patient has a long history of alcohol abuse, with innumerable ed visits and hospitalizations for same. within twelve hours of admission, patient was requesting to leave ama. he was evaluated by psychiatry who felt he had competence to leave." 5060,135773.0,24304,2181-12-14,24302,184857.0,2181-11-20,Discharge summary,"Admission Date: [**2181-11-18**] Discharge Date: [**2181-11-20**] Date of Birth: [**2144-9-28**] Sex: M @@ -95636,7 +97824,9 @@ during admission, which was removed when patient signed out ama. 8. dispo: patient signed out ama. ","PRIMARY: [Alcohol withdrawal] -SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Open wound of forehead, without mention of complication; Unspecified fall; Chronic hepatitis C without mention of hepatic coma; Lack of housing; Anemia, unspecified; Acute alcoholic hepatitis; Alcoholic gastritis, without mention of hemorrhage; Hypovolemia]" +SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Open wound of forehead, without mention of complication; Unspecified fall; Chronic hepatitis C without mention of hepatic coma; Lack of housing; Anemia, unspecified; Acute alcoholic hepatitis; Alcoholic gastritis, without mention of hemorrhage; Hypovolemia]","36m with etoh dependence and frequent admissions for etoh +intoxication presents s/p fall with etoh withdrawal. alcohol withdrawal: no hypertension or tachycardia this +morning. ppx: patient treated with heparin sq for dvt prophylaxis.",36m with etoh dependence and frequent admissions for etoh intoxication present s/p fall with etoh withdrawal. no hypertension or tachycardia this morning. slightly agitated and with slight upper extremity tremor. 5060,135773.0,24304,2181-12-14,24303,197750.0,2181-12-11,Discharge summary,"Admission Date: [**2181-12-7**] Discharge Date: [**2181-12-11**] Date of Birth: [**2144-9-28**] Sex: M @@ -95840,7 +98030,12 @@ was monitored, pt was given po iron, folate and thiamine. ","PRIMARY: [Alcohol withdrawal] -SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic hepatitis C without mention of hepatic coma; Iron deficiency anemia, unspecified; Depressive disorder, not elsewhere classified; Lack of housing]" +SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic hepatitis C without mention of hepatic coma; Iron deficiency anemia, unspecified; Depressive disorder, not elsewhere classified; Lack of housing]","known lastname 24927**] is a 37m with etoh dependence and frequent +admissions for etoh intoxication who presents with etoh +withdrawal and global pain. lipase slightly increased from [**11-18**] (135 from +56). # alcoholic liver disease: ast/alt elevated in 2:1 ratio, this +is his baseline. hct drop from 34 to 28 in setting of 3l ivf upon +admission.",mr. [**known lastname 24927**] is a 37m with etoh dependence and frequent admissions for etoh intoxication. he presents with etoh withdrawal and global pain. he was given oxycodone 5-10mg q 4hrs prn. 5060,184857.0,24302,2181-11-20,24300,194191.0,2181-08-21,Discharge summary,"Admission Date: [**2181-8-20**] Discharge Date: [**2181-8-21**] Date of Birth: [**2144-9-28**] Sex: M @@ -96134,7 +98329,14 @@ lactate. repeat chemistries showed normal anion gap. ","PRIMARY: [Alcohol withdrawal] -SECONDARY: [Alkalosis; Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Acidosis; Chronic hepatitis C without mention of hepatic coma; Cocaine abuse, unspecified; Lack of housing; Anemia, unspecified; Other chest pain]" +SECONDARY: [Alkalosis; Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Acidosis; Chronic hepatitis C without mention of hepatic coma; Cocaine abuse, unspecified; Lack of housing; Anemia, unspecified; Other chest pain]","36m with etoh dependence and frequent admissions for etoh +intoxication presents with etoh withdrawal. - he received multivit, folate, thiamine in ivf then po +- social work was consulted the morning after admission when +patient was demanding to leave. he signed out +ama with plans to seek outpatient treatment. social wk was involved but +psychiatry was not consulted. # anion gap: ag 18 in the ed with a normal hco3 and alkalosis on +vbg. #anemia - normocytic anemia, hct at baseline +.","36m with etoh dependence and frequent admissions for etoh intoxication presents with etoh withdrawal. presented with signs of withdrawal with agitation, hypertension, tachycardia, and slight tremor of upper ex bilat. social work was consulted the morning after admission when patient was demanding to leave." 5060,184857.0,24302,2181-11-20,24301,153063.0,2181-10-24,Discharge summary,"Admission Date: [**2181-10-23**] Discharge Date: [**2181-10-24**] Date of Birth: [**2144-9-28**] Sex: M @@ -96280,7 +98482,9 @@ but he decided to leave. ","PRIMARY: [Alcohol withdrawal] -SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic hepatitis C without mention of hepatic coma; Alcoholic polyneuropathy; Lack of housing]" +SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic hepatitis C without mention of hepatic coma; Alcoholic polyneuropathy; Lack of housing]","known lastname 24927**] is a 37 yo male with history of etoh +abuse presents with acute etoh intoxication. patient +was initially on diazepam ciwa scale.","mr. [**known lastname 24927**] is a 37 yo male with history of etoh abuse. patient has a long history of alcohol abuse, with innumerable ed visits and hospitalizations for same. within twelve hours of admission, patient was requesting to leave ama. he was evaluated by psychiatry who felt he had competence to leave." 5060,170299.0,24306,2182-04-01,24301,153063.0,2181-10-24,Discharge summary,"Admission Date: [**2181-10-23**] Discharge Date: [**2181-10-24**] Date of Birth: [**2144-9-28**] Sex: M @@ -96426,7 +98630,9 @@ but he decided to leave. ","PRIMARY: [Alcohol withdrawal] -SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic hepatitis C without mention of hepatic coma; Alcoholic polyneuropathy; Lack of housing]" +SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic hepatitis C without mention of hepatic coma; Alcoholic polyneuropathy; Lack of housing]","known lastname 24927**] is a 37 yo male with history of etoh +abuse presents with acute etoh intoxication. patient +was initially on diazepam ciwa scale.","mr. [**known lastname 24927**] is a 37 yo male with history of etoh abuse. patient has a long history of alcohol abuse, with innumerable ed visits and hospitalizations for same. within twelve hours of admission, patient was requesting to leave ama. he was evaluated by psychiatry who felt he had competence to leave." 5060,170299.0,24306,2182-04-01,24302,184857.0,2181-11-20,Discharge summary,"Admission Date: [**2181-11-18**] Discharge Date: [**2181-11-20**] Date of Birth: [**2144-9-28**] Sex: M @@ -96627,7 +98833,9 @@ during admission, which was removed when patient signed out ama. 8. dispo: patient signed out ama. ","PRIMARY: [Alcohol withdrawal] -SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Open wound of forehead, without mention of complication; Unspecified fall; Chronic hepatitis C without mention of hepatic coma; Lack of housing; Anemia, unspecified; Acute alcoholic hepatitis; Alcoholic gastritis, without mention of hemorrhage; Hypovolemia]" +SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Open wound of forehead, without mention of complication; Unspecified fall; Chronic hepatitis C without mention of hepatic coma; Lack of housing; Anemia, unspecified; Acute alcoholic hepatitis; Alcoholic gastritis, without mention of hemorrhage; Hypovolemia]","36m with etoh dependence and frequent admissions for etoh +intoxication presents s/p fall with etoh withdrawal. alcohol withdrawal: no hypertension or tachycardia this +morning. ppx: patient treated with heparin sq for dvt prophylaxis.",36m with etoh dependence and frequent admissions for etoh intoxication present s/p fall with etoh withdrawal. no hypertension or tachycardia this morning. slightly agitated and with slight upper extremity tremor. 5060,170299.0,24306,2182-04-01,24303,197750.0,2181-12-11,Discharge summary,"Admission Date: [**2181-12-7**] Discharge Date: [**2181-12-11**] Date of Birth: [**2144-9-28**] Sex: M @@ -96831,7 +99039,12 @@ was monitored, pt was given po iron, folate and thiamine. ","PRIMARY: [Alcohol withdrawal] -SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic hepatitis C without mention of hepatic coma; Iron deficiency anemia, unspecified; Depressive disorder, not elsewhere classified; Lack of housing]" +SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic hepatitis C without mention of hepatic coma; Iron deficiency anemia, unspecified; Depressive disorder, not elsewhere classified; Lack of housing]","known lastname 24927**] is a 37m with etoh dependence and frequent +admissions for etoh intoxication who presents with etoh +withdrawal and global pain. lipase slightly increased from [**11-18**] (135 from +56). # alcoholic liver disease: ast/alt elevated in 2:1 ratio, this +is his baseline. hct drop from 34 to 28 in setting of 3l ivf upon +admission.",mr. [**known lastname 24927**] is a 37m with etoh dependence and frequent admissions for etoh intoxication. he presents with etoh withdrawal and global pain. he was given oxycodone 5-10mg q 4hrs prn. 5060,170299.0,24306,2182-04-01,24304,135773.0,2181-12-14,Discharge summary,"Admission Date: [**2181-12-12**] Discharge Date: [**2181-12-14**] Date of Birth: [**2144-9-28**] Sex: M @@ -97008,7 +99221,11 @@ seizures, delerium, and death. ","PRIMARY: [Alcohol withdrawal] -SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic hepatitis C without mention of hepatic coma; Iron deficiency anemia, unspecified; Alcoholic liver damage, unspecified; Lack of housing]" +SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic hepatitis C without mention of hepatic coma; Iron deficiency anemia, unspecified; Alcoholic liver damage, unspecified; Lack of housing]","known lastname 24927**] was admitted with alcohol intoxication and abdominal +pain. a ct of his abdomen was negative for any +abdominal pathology. an attempt was made to +transfer him to the floor and when he was told this, he held his +breath and o2 sats dropped to the 70s and he was tachycardic.",mr. [**known lastname 24927**] was admitted with alcohol intoxication and abdominal pain. he received approximately 200mg of po valium over a 24 hour period for alcohol withdrawal. he continued to complain of abdominal pain but his abdomen was benign. 5060,170299.0,24306,2182-04-01,24305,196749.0,2182-01-14,Discharge summary,"Admission Date: [**2182-1-4**] Discharge Date: [**2182-1-14**] Date of Birth: [**2144-9-28**] Sex: M @@ -97232,7 +99449,12 @@ unwitnessed and did not return (ama, although he left without risk/benefit). ","PRIMARY: [Alcohol withdrawal delirium] -SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic pancreatitis; Chronic hepatitis C without mention of hepatic coma; Acute alcoholic hepatitis; Acute alcoholic intoxication in alcoholism, continuous; Pain in joint, lower leg; Lack of housing; Anxiety state, unspecified; Other, mixed, or unspecified drug abuse, unspecified; ]" +SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic pancreatitis; Chronic hepatitis C without mention of hepatic coma; Acute alcoholic hepatitis; Acute alcoholic intoxication in alcoholism, continuous; Pain in joint, lower leg; Lack of housing; Anxiety state, unspecified; Other, mixed, or unspecified drug abuse, unspecified; ]","37 year-old male with a history of alcoholism with multiple +admissions for detox and history of dts/withdrawal seizures who +presents with intoxication followed by withdrawal. unfortunately, on the day of anticipated discharge to [**hospital1 **] +for inpatient alcohol rehabilitation, he left the floor +unwitnessed and did not return (ama, although he left without +risk/benefit).",37 year-old male with a history of alcoholism with multiple admissions for detox and history of dts/withdrawal seizures who presents with intoxication followed by withdrawal. received 30 mg valium in the emergency room and was placed on a q1h ciwa in the icu. this was transitioned to a standing valium order per his protocol on arrival to the floor. his lipase and transaminases were elevated during his admission 5060,196749.0,24305,2182-01-14,24300,194191.0,2181-08-21,Discharge summary,"Admission Date: [**2181-8-20**] Discharge Date: [**2181-8-21**] Date of Birth: [**2144-9-28**] Sex: M @@ -97526,7 +99748,14 @@ lactate. repeat chemistries showed normal anion gap. ","PRIMARY: [Alcohol withdrawal] -SECONDARY: [Alkalosis; Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Acidosis; Chronic hepatitis C without mention of hepatic coma; Cocaine abuse, unspecified; Lack of housing; Anemia, unspecified; Other chest pain]" +SECONDARY: [Alkalosis; Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Acidosis; Chronic hepatitis C without mention of hepatic coma; Cocaine abuse, unspecified; Lack of housing; Anemia, unspecified; Other chest pain]","36m with etoh dependence and frequent admissions for etoh +intoxication presents with etoh withdrawal. - he received multivit, folate, thiamine in ivf then po +- social work was consulted the morning after admission when +patient was demanding to leave. he signed out +ama with plans to seek outpatient treatment. social wk was involved but +psychiatry was not consulted. # anion gap: ag 18 in the ed with a normal hco3 and alkalosis on +vbg. #anemia - normocytic anemia, hct at baseline +.","36m with etoh dependence and frequent admissions for etoh intoxication presents with etoh withdrawal. presented with signs of withdrawal with agitation, hypertension, tachycardia, and slight tremor of upper ex bilat. social work was consulted the morning after admission when patient was demanding to leave." 5060,196749.0,24305,2182-01-14,24301,153063.0,2181-10-24,Discharge summary,"Admission Date: [**2181-10-23**] Discharge Date: [**2181-10-24**] Date of Birth: [**2144-9-28**] Sex: M @@ -97672,7 +99901,9 @@ but he decided to leave. ","PRIMARY: [Alcohol withdrawal] -SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic hepatitis C without mention of hepatic coma; Alcoholic polyneuropathy; Lack of housing]" +SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic hepatitis C without mention of hepatic coma; Alcoholic polyneuropathy; Lack of housing]","known lastname 24927**] is a 37 yo male with history of etoh +abuse presents with acute etoh intoxication. patient +was initially on diazepam ciwa scale.","mr. [**known lastname 24927**] is a 37 yo male with history of etoh abuse. patient has a long history of alcohol abuse, with innumerable ed visits and hospitalizations for same. within twelve hours of admission, patient was requesting to leave ama. he was evaluated by psychiatry who felt he had competence to leave." 5060,196749.0,24305,2182-01-14,24302,184857.0,2181-11-20,Discharge summary,"Admission Date: [**2181-11-18**] Discharge Date: [**2181-11-20**] Date of Birth: [**2144-9-28**] Sex: M @@ -97873,7 +100104,9 @@ during admission, which was removed when patient signed out ama. 8. dispo: patient signed out ama. ","PRIMARY: [Alcohol withdrawal] -SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Open wound of forehead, without mention of complication; Unspecified fall; Chronic hepatitis C without mention of hepatic coma; Lack of housing; Anemia, unspecified; Acute alcoholic hepatitis; Alcoholic gastritis, without mention of hemorrhage; Hypovolemia]" +SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Open wound of forehead, without mention of complication; Unspecified fall; Chronic hepatitis C without mention of hepatic coma; Lack of housing; Anemia, unspecified; Acute alcoholic hepatitis; Alcoholic gastritis, without mention of hemorrhage; Hypovolemia]","36m with etoh dependence and frequent admissions for etoh +intoxication presents s/p fall with etoh withdrawal. alcohol withdrawal: no hypertension or tachycardia this +morning. ppx: patient treated with heparin sq for dvt prophylaxis.",36m with etoh dependence and frequent admissions for etoh intoxication present s/p fall with etoh withdrawal. no hypertension or tachycardia this morning. slightly agitated and with slight upper extremity tremor. 5060,196749.0,24305,2182-01-14,24303,197750.0,2181-12-11,Discharge summary,"Admission Date: [**2181-12-7**] Discharge Date: [**2181-12-11**] Date of Birth: [**2144-9-28**] Sex: M @@ -98077,7 +100310,12 @@ was monitored, pt was given po iron, folate and thiamine. ","PRIMARY: [Alcohol withdrawal] -SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic hepatitis C without mention of hepatic coma; Iron deficiency anemia, unspecified; Depressive disorder, not elsewhere classified; Lack of housing]" +SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic hepatitis C without mention of hepatic coma; Iron deficiency anemia, unspecified; Depressive disorder, not elsewhere classified; Lack of housing]","known lastname 24927**] is a 37m with etoh dependence and frequent +admissions for etoh intoxication who presents with etoh +withdrawal and global pain. lipase slightly increased from [**11-18**] (135 from +56). # alcoholic liver disease: ast/alt elevated in 2:1 ratio, this +is his baseline. hct drop from 34 to 28 in setting of 3l ivf upon +admission.",mr. [**known lastname 24927**] is a 37m with etoh dependence and frequent admissions for etoh intoxication. he presents with etoh withdrawal and global pain. he was given oxycodone 5-10mg q 4hrs prn. 5060,196749.0,24305,2182-01-14,24304,135773.0,2181-12-14,Discharge summary,"Admission Date: [**2181-12-12**] Discharge Date: [**2181-12-14**] Date of Birth: [**2144-9-28**] Sex: M @@ -98254,7 +100492,11 @@ seizures, delerium, and death. ","PRIMARY: [Alcohol withdrawal] -SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic hepatitis C without mention of hepatic coma; Iron deficiency anemia, unspecified; Alcoholic liver damage, unspecified; Lack of housing]" +SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Chronic hepatitis C without mention of hepatic coma; Iron deficiency anemia, unspecified; Alcoholic liver damage, unspecified; Lack of housing]","known lastname 24927**] was admitted with alcohol intoxication and abdominal +pain. a ct of his abdomen was negative for any +abdominal pathology. an attempt was made to +transfer him to the floor and when he was told this, he held his +breath and o2 sats dropped to the 70s and he was tachycardic.",mr. [**known lastname 24927**] was admitted with alcohol intoxication and abdominal pain. he received approximately 200mg of po valium over a 24 hour period for alcohol withdrawal. he continued to complain of abdominal pain but his abdomen was benign. 5060,153063.0,24301,2181-10-24,24300,194191.0,2181-08-21,Discharge summary,"Admission Date: [**2181-8-20**] Discharge Date: [**2181-8-21**] Date of Birth: [**2144-9-28**] Sex: M @@ -98548,7 +100790,14 @@ lactate. repeat chemistries showed normal anion gap. ","PRIMARY: [Alcohol withdrawal] -SECONDARY: [Alkalosis; Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Acidosis; Chronic hepatitis C without mention of hepatic coma; Cocaine abuse, unspecified; Lack of housing; Anemia, unspecified; Other chest pain]" +SECONDARY: [Alkalosis; Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Acidosis; Chronic hepatitis C without mention of hepatic coma; Cocaine abuse, unspecified; Lack of housing; Anemia, unspecified; Other chest pain]","36m with etoh dependence and frequent admissions for etoh +intoxication presents with etoh withdrawal. - he received multivit, folate, thiamine in ivf then po +- social work was consulted the morning after admission when +patient was demanding to leave. he signed out +ama with plans to seek outpatient treatment. social wk was involved but +psychiatry was not consulted. # anion gap: ag 18 in the ed with a normal hco3 and alkalosis on +vbg. #anemia - normocytic anemia, hct at baseline +.","36m with etoh dependence and frequent admissions for etoh intoxication presents with etoh withdrawal. presented with signs of withdrawal with agitation, hypertension, tachycardia, and slight tremor of upper ex bilat. social work was consulted the morning after admission when patient was demanding to leave." 5060,194191.0,24300,2181-08-21,24299,117340.0,2181-03-05,Discharge summary,"Admission Date: [**2181-2-24**] Discharge Date: [**2181-3-5**] Date of Birth: [**2144-9-28**] Sex: M @@ -98719,7 +100968,10 @@ ama. ","PRIMARY: [Alcohol withdrawal] -SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Dehydration; Alcoholic polyneuropathy; Opioid abuse, unspecified; Sedative, hypnotic or anxiolytic abuse, unspecified; Chronic hepatitis C without mention of hepatic coma; Lack of housing]" +SECONDARY: [Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta; Dehydration; Alcoholic polyneuropathy; Opioid abuse, unspecified; Sedative, hypnotic or anxiolytic abuse, unspecified; Chronic hepatitis C without mention of hepatic coma; Lack of housing]","36m with etoh dependence and frequent admissions for etoh +intoxication presented with etoh intoxication/withdrawl. also recommended that patient +could follow-up at [**location (un) 61603**] house (bhchp day shelter) if he +complies to showing up to medical clinic after discharge.",36m with etoh dependence and frequent admissions for etoh intoxication. initially admitted to the icu for iv valium and required 120mg valium total. psychiatry consulted and recommended slow valium taper and referral. 6901,198044.0,16225,2133-09-03,16224,193108.0,2133-03-23,Discharge summary,"Admission Date: [**2133-3-14**] Discharge Date: [**2133-3-23**] @@ -99241,7 +101493,18 @@ with daily dresing changes. #) code: full ","PRIMARY: [Congestive heart failure, unspecified] -SECONDARY: [Acute kidney failure, unspecified; Urinary tract infection, site not specified; Rhabdomyolysis; Ulcer of calf; Acute on chronic systolic heart failure; Disorders of phosphorus metabolism; Atrial fibrillation; Unspecified essential hypertension; Esophageal reflux; Cardiac pacemaker in situ; Heart valve replaced by transplant]" +SECONDARY: [Acute kidney failure, unspecified; Urinary tract infection, site not specified; Rhabdomyolysis; Ulcer of calf; Acute on chronic systolic heart failure; Disorders of phosphorus metabolism; Atrial fibrillation; Unspecified essential hypertension; Esophageal reflux; Cardiac pacemaker in situ; Heart valve replaced by transplant]","male w/ pmh afib on coumadin, htn, as s/p porcine valve +replacement, dementia, found down at home, presenting with uti, +arf, rhabdomyolysis, and atrial fibrillation w/ aberancy. he was treated initially with fluids, as his +jvp was flat and he had negligible po intake over the +preceeding three days. echo showed lvef 25-30% with +severe global lv hypokinesis. by hospital day #2, he began to +develop crackles on lung exam and he was begun on a lasix drip +in an attempt to diurese his excess fluid. the +patient maintained adequate blood pressure throughout diuresis. he will need a follow-up echo in the next 6-8 weeks. given his left atrial dilation, he was not considered a good +condidate for electrical cardioversion. please give +results to staff physician and fax to pcp, [**last name (namepattern4) **]. [** he was evaluated by wound care and treated +with daily dresing changes.","a male with uti, arf, rhabdomyolysis, and atrial fibrillation found down at home. he was treated with fluids, as his jvp was flat and he was intravascularly fluid depleted. he was started on amiodarone in an attempt to cardiovert his rhythm." 7095,167836.0,8296,2200-03-26,8295,100931.0,2200-03-08,Discharge summary,"Admission Date: [**2200-3-7**] Discharge Date: [**2200-3-8**] Date of Birth: [**2123-7-21**] Sex: M @@ -99570,7 +101833,13 @@ carotid stenosis /infrarenal aaa/pvd: he was continued on asa, simvastatin, lisinopril. ","PRIMARY: [Atrioventricular block, complete] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease; Bacteremia; Renal dialysis status; Peripheral vascular disease, unspecified; Gout, unspecified; Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site; Personal history of malignant neoplasm of prostate; Other alteration of consciousness; Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled; Polyneuropathy in diabetes]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease; Bacteremia; Renal dialysis status; Peripheral vascular disease, unspecified; Gout, unspecified; Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site; Personal history of malignant neoplasm of prostate; Other alteration of consciousness; Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled; Polyneuropathy in diabetes]","76 yo m w/ pmhx of htn, dm, and esrd on hd who was known to have +second degree av block on prior ekg noted on admission to have +deteriorated to complete heart block. altered mental status: his course post pm placement was +complicated by delirium, in the setting of hypoglycemia to 17. he was delirious initially on the floor and per +discussions with his spouse he is confused at baseline. a plan was made for him to follow up with the device +clinic within one week of discharge. dialysis was deferred to his next scheduled session on +monday.","76 yo m w/ pmhx of htn, dm, and esrd on hd who was known to have second degree av block on prior ekg noted on admission to have deteriorated to complete heart block. he received an amp of d50 with improvement of his gfs to the 200s. his electrolytes were not markedly abnormal." 8559,105407.0,16314,2153-08-26,16313,145304.0,2153-05-08,Discharge summary,"Admission Date: [**2153-4-24**] Discharge Date: [**2153-5-8**] Date of Birth: [**2090-1-18**] Sex: M @@ -99916,7 +102185,13 @@ with podiatry as above. ","PRIMARY: [Malignant neoplasm of other specified part of esophagus] -SECONDARY: [Defibrination syndrome; Acute posthemorrhagic anemia; Hematemesis; Hyperosmolality and/or hypernatremia; Thrombocytopenia, unspecified; Ulcer of other part of foot; Atrial fibrillation; Fever, unspecified; Leukocytopenia, unspecified; Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use; Heart valve replaced by other means]" +SECONDARY: [Defibrination syndrome; Acute posthemorrhagic anemia; Hematemesis; Hyperosmolality and/or hypernatremia; Thrombocytopenia, unspecified; Ulcer of other part of foot; Atrial fibrillation; Fever, unspecified; Leukocytopenia, unspecified; Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use; Heart valve replaced by other means]","63 year old gentleman with newly diagnosed esophageal +adenocarcinoma and upper gi bleed. he was transfused +multiple units of platelets, ffp and cryoprecipitate. as his +bleeding subsided with xrt, his dic resolved as well. 4) afib: pt had episodes of afib with rvr in the [**hospital unit name 153**] responding +to diltizem but remained rate controlled on the floor in the +80s. he was continued on his previous metoprolol dosing at +discharge.",63 year old gentleman with newly diagnosed esophageal adenocarcinoma. he developed gi bleed and loss anemia due to bleeding from esophageal mass. patient underwent xrt which alleviated his bleeding. 10774,142104.0,8553,2140-10-30,8551,146298.0,2140-09-12,Discharge summary,"Admission Date: [**2140-9-7**] Discharge Date: [**2140-9-12**] Date of Birth: [**2068-2-28**] Sex: M @@ -100319,7 +102594,14 @@ sotalol, mexiletine were continued. prior to discharge. ","PRIMARY: [Hemorrhage of gastrointestinal tract, unspecified] -SECONDARY: [Paroxysmal ventricular tachycardia; Chronic systolic heart failure; Congestive heart failure, unspecified; Other chest pain; Esophageal reflux; Unspecified acquired hypothyroidism; Aortocoronary bypass status; Duodenitis, without mention of hemorrhage; Alzheimer's disease; Dementia in conditions classified elsewhere without behavioral disturbance; Asthma, unspecified type, unspecified; Other and unspecified hyperlipidemia; Chronic kidney disease, unspecified; Barrett's esophagus; Unspecified gastritis and gastroduodenitis, without mention of hemorrhage; Long-term (current) use of anticoagulants; Other specified forms of chronic ischemic heart disease; Automatic implantable cardiac defibrillator in situ; Atrial fibrillation]" +SECONDARY: [Paroxysmal ventricular tachycardia; Chronic systolic heart failure; Congestive heart failure, unspecified; Other chest pain; Esophageal reflux; Unspecified acquired hypothyroidism; Aortocoronary bypass status; Duodenitis, without mention of hemorrhage; Alzheimer's disease; Dementia in conditions classified elsewhere without behavioral disturbance; Asthma, unspecified type, unspecified; Other and unspecified hyperlipidemia; Chronic kidney disease, unspecified; Barrett's esophagus; Unspecified gastritis and gastroduodenitis, without mention of hemorrhage; Long-term (current) use of anticoagulants; Other specified forms of chronic ischemic heart disease; Automatic implantable cardiac defibrillator in situ; Atrial fibrillation]","72 year old male with cad s/p cabg, atrial fib on coumadin, s/p +vt/vf arrest now with biv pacer; chf with ef 15% who presented +with what appears to be non-cardiac chest pain, abdominal pain +and melena. last possibility is aortic chest pain as patient has history of +thoracic aortic aneurysm repair, small concern for dissection +although unlikely as patient remained stable throughout his +hopitalization and his cp resolved. inr was +reversed intially but coumadin was restarted prior to discharge. # vf/vt arrest: patient is s/p biv pacer/icd placement.","72 year old male with cad s/p cabg, atrial fib on coumadin, s/p vt/vf arrest now with biv pacer; chf with ef 15% who presented with what appears to be non-cardiac chest pain, abdominal pain and melena. aspirin and coumadin were held until after egd at which time they were restarted. iv ppi was given until egd" 10774,142104.0,8553,2140-10-30,8552,130230.0,2140-10-18,Discharge summary,"Admission Date: [**2140-10-11**] Discharge Date: [**2140-10-18**] Date of Birth: [**2068-2-28**] Sex: M @@ -100727,7 +103009,11 @@ communication: pt, wife [**doctor first name **] [**telephone/fax (1) 30058**]) ","PRIMARY: [Hemorrhage of gastrointestinal tract, unspecified] -SECONDARY: [Acute on chronic systolic heart failure; Atrial fibrillation; Other and unspecified angina pectoris; Hypovolemia; Aortic valve disorders; Asthma, unspecified type, unspecified; Chronic kidney disease, unspecified; Aortocoronary bypass status; Long-term (current) use of anticoagulants; Automatic implantable cardiac defibrillator in situ; Alzheimer's disease; Dementia in conditions classified elsewhere without behavioral disturbance; Congestive heart failure, unspecified; Unspecified analgesic and antipyretic causing adverse effects in therapeutic use; Anticoagulants causing adverse effects in therapeutic use; Other specified forms of chronic ischemic heart disease; Other and unspecified hyperlipidemia; Barrett's esophagus; Diverticulosis of colon (without mention of hemorrhage); Unspecified acquired hypothyroidism]" +SECONDARY: [Acute on chronic systolic heart failure; Atrial fibrillation; Other and unspecified angina pectoris; Hypovolemia; Aortic valve disorders; Asthma, unspecified type, unspecified; Chronic kidney disease, unspecified; Aortocoronary bypass status; Long-term (current) use of anticoagulants; Automatic implantable cardiac defibrillator in situ; Alzheimer's disease; Dementia in conditions classified elsewhere without behavioral disturbance; Congestive heart failure, unspecified; Unspecified analgesic and antipyretic causing adverse effects in therapeutic use; Anticoagulants causing adverse effects in therapeutic use; Other specified forms of chronic ischemic heart disease; Other and unspecified hyperlipidemia; Barrett's esophagus; Diverticulosis of colon (without mention of hemorrhage); Unspecified acquired hypothyroidism]","the patient was admitted to the micu for monitoring and serial +hcts. cardiac enzymes were cycled; the +first two sets were negative, the third troponin was 0.02 (has +been similar in the past), in the setting of constant chest pain +x 24 hours. # systolic heart failure: focal akinesia as above. # afib: medications were continued, coumadin was stopped.","the patient was admitted to the micu for monitoring and serial hcts. his bp was reamined in the 90-110 systolic range, which then stabilized. cardiac enzymes were cycled; the first two sets were negative. the third troponin was 0.02 (has been similar in the past) diuretics and anti-hypertensives were held." 10774,197363.0,8555,2141-04-05,8554,173586.0,2141-03-30,Discharge summary,"Admission Date: [**2141-3-8**] Discharge Date: [**2141-3-30**] Date of Birth: [**2068-2-28**] Sex: M @@ -101440,7 +103726,18 @@ neccessary but no compressions. this was reversed on [**2141-3-28**] when patient expressed desire to be full code. ","PRIMARY: [Acute pancreatitis] -SECONDARY: [Cardiac arrest; Paroxysmal ventricular tachycardia; Chronic systolic heart failure; Methicillin resistant pneumonia due to Staphylococcus aureus; Urinary tract infection, site not specified; ; Acute kidney failure with lesion of tubular necrosis; Ventricular fibrillation; Congestive heart failure, unspecified; Aortic valve disorders; Other specified forms of chronic ischemic heart disease; Atrial fibrillation; Long-term (current) use of anticoagulants; Asthma, unspecified type, unspecified; Other and unspecified hyperlipidemia; Chronic kidney disease, Stage III (moderate); Aortocoronary bypass status; Alzheimer's disease; Dementia in conditions classified elsewhere without behavioral disturbance; Unspecified acquired hypothyroidism; Diverticulosis of colon (without mention of hemorrhage); ; Fitting and adjustment of automatic implantable cardiac defibrillator]" +SECONDARY: [Cardiac arrest; Paroxysmal ventricular tachycardia; Chronic systolic heart failure; Methicillin resistant pneumonia due to Staphylococcus aureus; Urinary tract infection, site not specified; ; Acute kidney failure with lesion of tubular necrosis; Ventricular fibrillation; Congestive heart failure, unspecified; Aortic valve disorders; Other specified forms of chronic ischemic heart disease; Atrial fibrillation; Long-term (current) use of anticoagulants; Asthma, unspecified type, unspecified; Other and unspecified hyperlipidemia; Chronic kidney disease, Stage III (moderate); Aortocoronary bypass status; Alzheimer's disease; Dementia in conditions classified elsewhere without behavioral disturbance; Unspecified acquired hypothyroidism; Diverticulosis of colon (without mention of hemorrhage); ; Fitting and adjustment of automatic implantable cardiac defibrillator]","# vt: initially on home meds of mexilitine and sotalol. he was intubated during the +code, but rapidly extubated afterward. he was given ativan for sedation due to +the multiple shocks, and was reintubated [**3-19**] for airway +protection from sedation. he was transitioned to a final regimen of +oral mexilitene alone. after the study, he was kept sedated and +initially required phenylephrine and vasopressin. # dvt: lue had swelling and ultrasound was positive. also has known as, although +during admission patient was refusing avr and valvuloplasty. his +volume status improved and he was transitioned to his home dose +of lasix 40mg po daily. his digoxin was stopped due to +arrhythmogenic concerns. per discussion with his outpatient +cardiologist, this is acceptable for now and can be followed +after discharge, with med changes made as needed.","# vt patient on the floor, receiving a total of 4 shocks, 4mg of epinephrine. he was manually paced out of vt several times but with return to vt each time. he was weaned off pressors and extubated, and subsequently started on metoprolol." 10774,197363.0,8555,2141-04-05,8553,142104.0,2140-10-30,Discharge summary,"Admission Date: [**2140-10-23**] Discharge Date: [**2140-10-30**] Date of Birth: [**2068-2-28**] Sex: M @@ -101921,7 +104218,15 @@ proper use of steroid inhalers, as above. #propylaxis - pneumoboots, ppi ","PRIMARY: [Other specified gastritis, with hemorrhage] -SECONDARY: [Intestinal infection due to Clostridium difficile; Candidal esophagitis; Chronic systolic heart failure; Acute posthemorrhagic anemia; Congestive heart failure, unspecified; Atrial fibrillation; Long-term (current) use of anticoagulants; Alzheimer's disease; Dementia in conditions classified elsewhere without behavioral disturbance; Other and unspecified hyperlipidemia; Aortocoronary bypass status; Esophageal reflux; Unspecified acquired hypothyroidism; Chronic kidney disease, Stage III (moderate); Other specified forms of chronic ischemic heart disease; Asthma, unspecified type, unspecified; Automatic implantable cardiac defibrillator in situ; Aortic valve disorders; Barrett's esophagus; Diverticulosis of colon (without mention of hemorrhage); Unspecified analgesic and antipyretic causing adverse effects in therapeutic use]" +SECONDARY: [Intestinal infection due to Clostridium difficile; Candidal esophagitis; Chronic systolic heart failure; Acute posthemorrhagic anemia; Congestive heart failure, unspecified; Atrial fibrillation; Long-term (current) use of anticoagulants; Alzheimer's disease; Dementia in conditions classified elsewhere without behavioral disturbance; Other and unspecified hyperlipidemia; Aortocoronary bypass status; Esophageal reflux; Unspecified acquired hypothyroidism; Chronic kidney disease, Stage III (moderate); Other specified forms of chronic ischemic heart disease; Asthma, unspecified type, unspecified; Automatic implantable cardiac defibrillator in situ; Aortic valve disorders; Barrett's esophagus; Diverticulosis of colon (without mention of hemorrhage); Unspecified analgesic and antipyretic causing adverse effects in therapeutic use]","#acute gastritis - the patient was admitted to the icu overnight +for observation given reported hypotension prior to admission. #candidal esophagitis - egd also revealed candidal esophagitis +which had been present on endoscopy 6 months prior and perhaps +inadequately treated with a 10-day course of fluconazole. a 3-week course of oral +fluconazole was started with lfts to be rechecked 1 week after +discharge. name2 (ni) **] was +counseled not to drink alcohol while taking metronidazole. he was encouraged to follow up +with his cardiologist as soon as possible. #chronic kidney disease stage iii - creatinine remained at +baseline.",egd showed erosive gastritis and barretts esophagus but no active bleeding. aspirin was restarted in the setting of [**hospital1 **] ppi and carafate therapy which will be continued after discharge at the recommendation of the consulting gi team. egd also revealed candidal esophagitis which had been present on endoscopy 6 months prior and perhaps inadequately treated. 10774,197363.0,8555,2141-04-05,8552,130230.0,2140-10-18,Discharge summary,"Admission Date: [**2140-10-11**] Discharge Date: [**2140-10-18**] Date of Birth: [**2068-2-28**] Sex: M @@ -102329,7 +104634,11 @@ communication: pt, wife [**doctor first name **] [**telephone/fax (1) 30058**]) ","PRIMARY: [Hemorrhage of gastrointestinal tract, unspecified] -SECONDARY: [Acute on chronic systolic heart failure; Atrial fibrillation; Other and unspecified angina pectoris; Hypovolemia; Aortic valve disorders; Asthma, unspecified type, unspecified; Chronic kidney disease, unspecified; Aortocoronary bypass status; Long-term (current) use of anticoagulants; Automatic implantable cardiac defibrillator in situ; Alzheimer's disease; Dementia in conditions classified elsewhere without behavioral disturbance; Congestive heart failure, unspecified; Unspecified analgesic and antipyretic causing adverse effects in therapeutic use; Anticoagulants causing adverse effects in therapeutic use; Other specified forms of chronic ischemic heart disease; Other and unspecified hyperlipidemia; Barrett's esophagus; Diverticulosis of colon (without mention of hemorrhage); Unspecified acquired hypothyroidism]" +SECONDARY: [Acute on chronic systolic heart failure; Atrial fibrillation; Other and unspecified angina pectoris; Hypovolemia; Aortic valve disorders; Asthma, unspecified type, unspecified; Chronic kidney disease, unspecified; Aortocoronary bypass status; Long-term (current) use of anticoagulants; Automatic implantable cardiac defibrillator in situ; Alzheimer's disease; Dementia in conditions classified elsewhere without behavioral disturbance; Congestive heart failure, unspecified; Unspecified analgesic and antipyretic causing adverse effects in therapeutic use; Anticoagulants causing adverse effects in therapeutic use; Other specified forms of chronic ischemic heart disease; Other and unspecified hyperlipidemia; Barrett's esophagus; Diverticulosis of colon (without mention of hemorrhage); Unspecified acquired hypothyroidism]","the patient was admitted to the micu for monitoring and serial +hcts. cardiac enzymes were cycled; the +first two sets were negative, the third troponin was 0.02 (has +been similar in the past), in the setting of constant chest pain +x 24 hours. # systolic heart failure: focal akinesia as above. # afib: medications were continued, coumadin was stopped.","the patient was admitted to the micu for monitoring and serial hcts. his bp was reamined in the 90-110 systolic range, which then stabilized. cardiac enzymes were cycled; the first two sets were negative. the third troponin was 0.02 (has been similar in the past) diuretics and anti-hypertensives were held." 10774,173586.0,8554,2141-03-30,8552,130230.0,2140-10-18,Discharge summary,"Admission Date: [**2140-10-11**] Discharge Date: [**2140-10-18**] Date of Birth: [**2068-2-28**] Sex: M @@ -102737,7 +105046,11 @@ communication: pt, wife [**doctor first name **] [**telephone/fax (1) 30058**]) ","PRIMARY: [Hemorrhage of gastrointestinal tract, unspecified] -SECONDARY: [Acute on chronic systolic heart failure; Atrial fibrillation; Other and unspecified angina pectoris; Hypovolemia; Aortic valve disorders; Asthma, unspecified type, unspecified; Chronic kidney disease, unspecified; Aortocoronary bypass status; Long-term (current) use of anticoagulants; Automatic implantable cardiac defibrillator in situ; Alzheimer's disease; Dementia in conditions classified elsewhere without behavioral disturbance; Congestive heart failure, unspecified; Unspecified analgesic and antipyretic causing adverse effects in therapeutic use; Anticoagulants causing adverse effects in therapeutic use; Other specified forms of chronic ischemic heart disease; Other and unspecified hyperlipidemia; Barrett's esophagus; Diverticulosis of colon (without mention of hemorrhage); Unspecified acquired hypothyroidism]" +SECONDARY: [Acute on chronic systolic heart failure; Atrial fibrillation; Other and unspecified angina pectoris; Hypovolemia; Aortic valve disorders; Asthma, unspecified type, unspecified; Chronic kidney disease, unspecified; Aortocoronary bypass status; Long-term (current) use of anticoagulants; Automatic implantable cardiac defibrillator in situ; Alzheimer's disease; Dementia in conditions classified elsewhere without behavioral disturbance; Congestive heart failure, unspecified; Unspecified analgesic and antipyretic causing adverse effects in therapeutic use; Anticoagulants causing adverse effects in therapeutic use; Other specified forms of chronic ischemic heart disease; Other and unspecified hyperlipidemia; Barrett's esophagus; Diverticulosis of colon (without mention of hemorrhage); Unspecified acquired hypothyroidism]","the patient was admitted to the micu for monitoring and serial +hcts. cardiac enzymes were cycled; the +first two sets were negative, the third troponin was 0.02 (has +been similar in the past), in the setting of constant chest pain +x 24 hours. # systolic heart failure: focal akinesia as above. # afib: medications were continued, coumadin was stopped.","the patient was admitted to the micu for monitoring and serial hcts. his bp was reamined in the 90-110 systolic range, which then stabilized. cardiac enzymes were cycled; the first two sets were negative. the third troponin was 0.02 (has been similar in the past) diuretics and anti-hypertensives were held." 10774,173586.0,8554,2141-03-30,8553,142104.0,2140-10-30,Discharge summary,"Admission Date: [**2140-10-23**] Discharge Date: [**2140-10-30**] Date of Birth: [**2068-2-28**] Sex: M @@ -103218,7 +105531,15 @@ proper use of steroid inhalers, as above. #propylaxis - pneumoboots, ppi ","PRIMARY: [Other specified gastritis, with hemorrhage] -SECONDARY: [Intestinal infection due to Clostridium difficile; Candidal esophagitis; Chronic systolic heart failure; Acute posthemorrhagic anemia; Congestive heart failure, unspecified; Atrial fibrillation; Long-term (current) use of anticoagulants; Alzheimer's disease; Dementia in conditions classified elsewhere without behavioral disturbance; Other and unspecified hyperlipidemia; Aortocoronary bypass status; Esophageal reflux; Unspecified acquired hypothyroidism; Chronic kidney disease, Stage III (moderate); Other specified forms of chronic ischemic heart disease; Asthma, unspecified type, unspecified; Automatic implantable cardiac defibrillator in situ; Aortic valve disorders; Barrett's esophagus; Diverticulosis of colon (without mention of hemorrhage); Unspecified analgesic and antipyretic causing adverse effects in therapeutic use]" +SECONDARY: [Intestinal infection due to Clostridium difficile; Candidal esophagitis; Chronic systolic heart failure; Acute posthemorrhagic anemia; Congestive heart failure, unspecified; Atrial fibrillation; Long-term (current) use of anticoagulants; Alzheimer's disease; Dementia in conditions classified elsewhere without behavioral disturbance; Other and unspecified hyperlipidemia; Aortocoronary bypass status; Esophageal reflux; Unspecified acquired hypothyroidism; Chronic kidney disease, Stage III (moderate); Other specified forms of chronic ischemic heart disease; Asthma, unspecified type, unspecified; Automatic implantable cardiac defibrillator in situ; Aortic valve disorders; Barrett's esophagus; Diverticulosis of colon (without mention of hemorrhage); Unspecified analgesic and antipyretic causing adverse effects in therapeutic use]","#acute gastritis - the patient was admitted to the icu overnight +for observation given reported hypotension prior to admission. #candidal esophagitis - egd also revealed candidal esophagitis +which had been present on endoscopy 6 months prior and perhaps +inadequately treated with a 10-day course of fluconazole. a 3-week course of oral +fluconazole was started with lfts to be rechecked 1 week after +discharge. name2 (ni) **] was +counseled not to drink alcohol while taking metronidazole. he was encouraged to follow up +with his cardiologist as soon as possible. #chronic kidney disease stage iii - creatinine remained at +baseline.",egd showed erosive gastritis and barretts esophagus but no active bleeding. aspirin was restarted in the setting of [**hospital1 **] ppi and carafate therapy which will be continued after discharge at the recommendation of the consulting gi team. egd also revealed candidal esophagitis which had been present on endoscopy 6 months prior and perhaps inadequately treated. 10774,130230.0,8552,2140-10-18,8551,146298.0,2140-09-12,Discharge summary,"Admission Date: [**2140-9-7**] Discharge Date: [**2140-9-12**] Date of Birth: [**2068-2-28**] Sex: M @@ -103621,7 +105942,14 @@ sotalol, mexiletine were continued. prior to discharge. ","PRIMARY: [Hemorrhage of gastrointestinal tract, unspecified] -SECONDARY: [Paroxysmal ventricular tachycardia; Chronic systolic heart failure; Congestive heart failure, unspecified; Other chest pain; Esophageal reflux; Unspecified acquired hypothyroidism; Aortocoronary bypass status; Duodenitis, without mention of hemorrhage; Alzheimer's disease; Dementia in conditions classified elsewhere without behavioral disturbance; Asthma, unspecified type, unspecified; Other and unspecified hyperlipidemia; Chronic kidney disease, unspecified; Barrett's esophagus; Unspecified gastritis and gastroduodenitis, without mention of hemorrhage; Long-term (current) use of anticoagulants; Other specified forms of chronic ischemic heart disease; Automatic implantable cardiac defibrillator in situ; Atrial fibrillation]" +SECONDARY: [Paroxysmal ventricular tachycardia; Chronic systolic heart failure; Congestive heart failure, unspecified; Other chest pain; Esophageal reflux; Unspecified acquired hypothyroidism; Aortocoronary bypass status; Duodenitis, without mention of hemorrhage; Alzheimer's disease; Dementia in conditions classified elsewhere without behavioral disturbance; Asthma, unspecified type, unspecified; Other and unspecified hyperlipidemia; Chronic kidney disease, unspecified; Barrett's esophagus; Unspecified gastritis and gastroduodenitis, without mention of hemorrhage; Long-term (current) use of anticoagulants; Other specified forms of chronic ischemic heart disease; Automatic implantable cardiac defibrillator in situ; Atrial fibrillation]","72 year old male with cad s/p cabg, atrial fib on coumadin, s/p +vt/vf arrest now with biv pacer; chf with ef 15% who presented +with what appears to be non-cardiac chest pain, abdominal pain +and melena. last possibility is aortic chest pain as patient has history of +thoracic aortic aneurysm repair, small concern for dissection +although unlikely as patient remained stable throughout his +hopitalization and his cp resolved. inr was +reversed intially but coumadin was restarted prior to discharge. # vf/vt arrest: patient is s/p biv pacer/icd placement.","72 year old male with cad s/p cabg, atrial fib on coumadin, s/p vt/vf arrest now with biv pacer; chf with ef 15% who presented with what appears to be non-cardiac chest pain, abdominal pain and melena. aspirin and coumadin were held until after egd at which time they were restarted. iv ppi was given until egd" 11638,122879.0,15382,2179-12-03,15380,133678.0,2179-09-22,Discharge summary,"Admission Date: [**2179-9-16**] Discharge Date: [**2179-9-22**] Date of Birth: [**2108-5-29**] Sex: F @@ -104012,7 +106340,18 @@ contact[**name (ni) **] to see the pt as soon as possible, her sister, will help with setting this appt up in a timely manner. ","PRIMARY: [Acute on chronic systolic heart failure] -SECONDARY: [Acute kidney failure, unspecified; ; Ventricular septal defect; Congestive heart failure, unspecified; Other specified forms of chronic ischemic heart disease; Atrial fibrillation; Right bundle branch block; Mitral valve disorders; Other chronic pulmonary heart diseases; Diseases of tricuspid valve; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified; Chronic kidney disease, unspecified; Coronary atherosclerosis of native coronary artery; Splenomegaly; Unspecified acquired hypothyroidism; Peripheral vascular disease, unspecified; Obesity, unspecified; Osteoarthrosis, unspecified whether generalized or localized, site unspecified; Spasm of muscle; Swelling of limb; Automatic implantable cardiac defibrillator in situ; Personal history of venous thrombosis and embolism; Percutaneous transluminal coronary angioplasty status; Long-term (current) use of anticoagulants]" +SECONDARY: [Acute kidney failure, unspecified; ; Ventricular septal defect; Congestive heart failure, unspecified; Other specified forms of chronic ischemic heart disease; Atrial fibrillation; Right bundle branch block; Mitral valve disorders; Other chronic pulmonary heart diseases; Diseases of tricuspid valve; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified; Chronic kidney disease, unspecified; Coronary atherosclerosis of native coronary artery; Splenomegaly; Unspecified acquired hypothyroidism; Peripheral vascular disease, unspecified; Obesity, unspecified; Osteoarthrosis, unspecified whether generalized or localized, site unspecified; Spasm of muscle; Swelling of limb; Automatic implantable cardiac defibrillator in situ; Personal history of venous thrombosis and embolism; Percutaneous transluminal coronary angioplasty status; Long-term (current) use of anticoagulants]","70 year old female with severe biventricular failure with +profoundly reduced left ventricular ejection fraction of 15%, +moderate mitral regurgitation and tricuspid regurgitation with +moderate pulmonary hypertension presented to outside hospital +for fatigue and hypotension. on admission, pt +was 7 lbs below her dry weight (190) and with poor renal +function therefore there was some concern for over-diuresis. daily weights will need to be monitored and as her +wieght increases, she will need to have more diuretics added on. # rhythm: mrs [**known lastname **] is av paced with right bundle branch +block with underlying a fib. her +renal function improved with diuretics and encouraging po +intake. patient reports no recent instrumentation. unclear how much hospitalization and +deconditioning are contributing.",70 year old female with severe biventricular failure. profoundly reduced left ventricular ejection fraction of 15%. moderate mitral regurgitation and tricuspid regurgitation with moderate pulmonary hypertension. transferred to hospital for further treatment of her renal failure and heart failure. 11638,155878.0,15383,2180-01-21,15381,136238.0,2179-11-06,Discharge summary,"Admission Date: [**2179-10-26**] Discharge Date: [**2179-11-6**] Date of Birth: [**2108-5-29**] Sex: F @@ -104468,7 +106807,18 @@ persued during this hospital stay but may be introduced by dr. hospitalizations. ","PRIMARY: [Acute on chronic systolic heart failure] -SECONDARY: [Acute kidney failure, unspecified; Intestinal infection due to Clostridium difficile; Urinary tract infection, site not specified; Other ascites; Congestive heart failure, unspecified; Other specified forms of chronic ischemic heart disease; Coronary atherosclerosis of native coronary artery; Other chronic pulmonary heart diseases; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified; Chronic kidney disease, unspecified; Unspecified acquired hypothyroidism; Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site; Pressure ulcer, buttock; Pressure ulcer, stage II; Peripheral vascular disease, unspecified; Personal history of venous thrombosis and embolism; Automatic implantable cardiac defibrillator in situ]" +SECONDARY: [Acute kidney failure, unspecified; Intestinal infection due to Clostridium difficile; Urinary tract infection, site not specified; Other ascites; Congestive heart failure, unspecified; Other specified forms of chronic ischemic heart disease; Coronary atherosclerosis of native coronary artery; Other chronic pulmonary heart diseases; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified; Chronic kidney disease, unspecified; Unspecified acquired hypothyroidism; Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site; Pressure ulcer, buttock; Pressure ulcer, stage II; Peripheral vascular disease, unspecified; Personal history of venous thrombosis and embolism; Automatic implantable cardiac defibrillator in situ]","71-year-old woman with advanced end-stage ischemic +cardiomyopathy with severe left ventricular contractile function +with lvef of 10%-15%, atrial fibrillation, [**hospital1 **]-v icd, low cardiac +output state, chronic kidney disease with past history of dvt, +pe on coumadin. with +severe volume overloaded on examination on admission. a myocardial +viability study was performed and demonstrated inferior wall +myocardial viability. # uti - patient was found to have uti [**1-18**] klebsiella pneumoniae, +pansensitive except for intermediate sensitivity to +nitrofurantoin. asicites: she had significant ascities on exam and she was +s/p 6l tap two weeks ago. # code: she was full code during this hospitalization. palliative care was not +persued during this hospital stay but may be introduced by dr.",71-year-old woman with advanced end-stage ischemic cardiomyopathy. she had a low output state with known low ef and dilated ischemic cardiomyopathy. she was sent to the ccu for diuresis with milrinone gtt + lasix gtt + metolazone. 11638,155878.0,15383,2180-01-21,15382,122879.0,2179-12-03,Discharge summary,"Admission Date: [**2179-11-21**] Discharge Date: [**2179-12-3**] Date of Birth: [**2108-5-29**] Sex: F @@ -105069,7 +107419,27 @@ clot, however, she is on anticoagulation. 10. code status: full code on [**2179-12-3**] ","PRIMARY: [Methicillin resistant Staphylococcus aureus septicemia] -SECONDARY: [Acute respiratory failure; Acute kidney failure, unspecified; Septic shock; Acute on chronic systolic heart failure; Pyogenic arthritis, shoulder region; Hemarthrosis, shoulder region; Ventricular septal defect; Severe sepsis; Atrial fibrillation; Other ill-defined heart diseases; Other specified forms of chronic ischemic heart disease; Chronic kidney disease, unspecified; Coronary atherosclerosis of native coronary artery; Chronic total occlusion of coronary artery; Unspecified acquired hypothyroidism; Congestive heart failure, unspecified; Percutaneous transluminal coronary angioplasty status; Automatic implantable cardiac defibrillator in situ; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]" +SECONDARY: [Acute respiratory failure; Acute kidney failure, unspecified; Septic shock; Acute on chronic systolic heart failure; Pyogenic arthritis, shoulder region; Hemarthrosis, shoulder region; Ventricular septal defect; Severe sepsis; Atrial fibrillation; Other ill-defined heart diseases; Other specified forms of chronic ischemic heart disease; Chronic kidney disease, unspecified; Coronary atherosclerosis of native coronary artery; Chronic total occlusion of coronary artery; Unspecified acquired hypothyroidism; Congestive heart failure, unspecified; Percutaneous transluminal coronary angioplasty status; Automatic implantable cardiac defibrillator in situ; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism]","71 yo f w/ cad, ischemic cmy (ef 10%) s/p [**hospital1 **]-v icd, atrial +fibrillation, ckd, with past history of dvt and pe on coumadin +who was recently discharged from the ccu ([**11-6**]) for chf +exacerbation complicated by c.diff infection who was transferred +from an outside hospital with a septic shoulder joint and acute +respiratory failure requiring intubation. respiratory failure: patient has history of chf with ef 10% +which is the likely cause of her respiratory failure. septic joint: patient with + staph aureus in left shoulder +and later, blood cultures from the outside hospital also grew +mrsa. initially, it was +unclear if staph aureus in culture at osh was a contaminant, +given that physical exam was not entirely consistent with a +spetic joint. blood cultures were +followed daily and remained positive until [**2179-11-25**]. the patient will +need prolonged therapy with vancomycin. prior to discharge, patient was +restarted on her home medication regimen of torsemide, +lisinopril and metoprolol. of note, patient was also restarted +on digoxin after discontinuation of dopamine. rhythm: patient with h/o atrial fibrillation, s/p biv icd +([**company 1543**] concerto c154dwk) [**12-24**], on coumadin and amiodarone as +antiarrhythmic. presented with supratherapeutic inr and +hemarthosis of left shoulder. medications were renal dosed and renal function followed +carefully throughout hospital course.","71-year-old has history of chf with ef 10% which is likely cause of her respiratory failure. she was transferred from an outside hospital with a septic shoulder joint and acute respiratory failure requiring intubation. she reversed herself and decided she did want cpr, intubation and pressors for short term therapy only." 11638,122879.0,15382,2179-12-03,15381,136238.0,2179-11-06,Discharge summary,"Admission Date: [**2179-10-26**] Discharge Date: [**2179-11-6**] Date of Birth: [**2108-5-29**] Sex: F @@ -105525,7 +107895,18 @@ persued during this hospital stay but may be introduced by dr. hospitalizations. ","PRIMARY: [Acute on chronic systolic heart failure] -SECONDARY: [Acute kidney failure, unspecified; Intestinal infection due to Clostridium difficile; Urinary tract infection, site not specified; Other ascites; Congestive heart failure, unspecified; Other specified forms of chronic ischemic heart disease; Coronary atherosclerosis of native coronary artery; Other chronic pulmonary heart diseases; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified; Chronic kidney disease, unspecified; Unspecified acquired hypothyroidism; Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site; Pressure ulcer, buttock; Pressure ulcer, stage II; Peripheral vascular disease, unspecified; Personal history of venous thrombosis and embolism; Automatic implantable cardiac defibrillator in situ]" +SECONDARY: [Acute kidney failure, unspecified; Intestinal infection due to Clostridium difficile; Urinary tract infection, site not specified; Other ascites; Congestive heart failure, unspecified; Other specified forms of chronic ischemic heart disease; Coronary atherosclerosis of native coronary artery; Other chronic pulmonary heart diseases; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified; Chronic kidney disease, unspecified; Unspecified acquired hypothyroidism; Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site; Pressure ulcer, buttock; Pressure ulcer, stage II; Peripheral vascular disease, unspecified; Personal history of venous thrombosis and embolism; Automatic implantable cardiac defibrillator in situ]","71-year-old woman with advanced end-stage ischemic +cardiomyopathy with severe left ventricular contractile function +with lvef of 10%-15%, atrial fibrillation, [**hospital1 **]-v icd, low cardiac +output state, chronic kidney disease with past history of dvt, +pe on coumadin. with +severe volume overloaded on examination on admission. a myocardial +viability study was performed and demonstrated inferior wall +myocardial viability. # uti - patient was found to have uti [**1-18**] klebsiella pneumoniae, +pansensitive except for intermediate sensitivity to +nitrofurantoin. asicites: she had significant ascities on exam and she was +s/p 6l tap two weeks ago. # code: she was full code during this hospitalization. palliative care was not +persued during this hospital stay but may be introduced by dr.",71-year-old woman with advanced end-stage ischemic cardiomyopathy. she had a low output state with known low ef and dilated ischemic cardiomyopathy. she was sent to the ccu for diuresis with milrinone gtt + lasix gtt + metolazone. 11638,155878.0,15383,2180-01-21,15380,133678.0,2179-09-22,Discharge summary,"Admission Date: [**2179-9-16**] Discharge Date: [**2179-9-22**] Date of Birth: [**2108-5-29**] Sex: F @@ -105916,7 +108297,18 @@ contact[**name (ni) **] to see the pt as soon as possible, her sister, will help with setting this appt up in a timely manner. ","PRIMARY: [Acute on chronic systolic heart failure] -SECONDARY: [Acute kidney failure, unspecified; ; Ventricular septal defect; Congestive heart failure, unspecified; Other specified forms of chronic ischemic heart disease; Atrial fibrillation; Right bundle branch block; Mitral valve disorders; Other chronic pulmonary heart diseases; Diseases of tricuspid valve; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified; Chronic kidney disease, unspecified; Coronary atherosclerosis of native coronary artery; Splenomegaly; Unspecified acquired hypothyroidism; Peripheral vascular disease, unspecified; Obesity, unspecified; Osteoarthrosis, unspecified whether generalized or localized, site unspecified; Spasm of muscle; Swelling of limb; Automatic implantable cardiac defibrillator in situ; Personal history of venous thrombosis and embolism; Percutaneous transluminal coronary angioplasty status; Long-term (current) use of anticoagulants]" +SECONDARY: [Acute kidney failure, unspecified; ; Ventricular septal defect; Congestive heart failure, unspecified; Other specified forms of chronic ischemic heart disease; Atrial fibrillation; Right bundle branch block; Mitral valve disorders; Other chronic pulmonary heart diseases; Diseases of tricuspid valve; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified; Chronic kidney disease, unspecified; Coronary atherosclerosis of native coronary artery; Splenomegaly; Unspecified acquired hypothyroidism; Peripheral vascular disease, unspecified; Obesity, unspecified; Osteoarthrosis, unspecified whether generalized or localized, site unspecified; Spasm of muscle; Swelling of limb; Automatic implantable cardiac defibrillator in situ; Personal history of venous thrombosis and embolism; Percutaneous transluminal coronary angioplasty status; Long-term (current) use of anticoagulants]","70 year old female with severe biventricular failure with +profoundly reduced left ventricular ejection fraction of 15%, +moderate mitral regurgitation and tricuspid regurgitation with +moderate pulmonary hypertension presented to outside hospital +for fatigue and hypotension. on admission, pt +was 7 lbs below her dry weight (190) and with poor renal +function therefore there was some concern for over-diuresis. daily weights will need to be monitored and as her +wieght increases, she will need to have more diuretics added on. # rhythm: mrs [**known lastname **] is av paced with right bundle branch +block with underlying a fib. her +renal function improved with diuretics and encouraging po +intake. patient reports no recent instrumentation. unclear how much hospitalization and +deconditioning are contributing.",70 year old female with severe biventricular failure. profoundly reduced left ventricular ejection fraction of 15%. moderate mitral regurgitation and tricuspid regurgitation with moderate pulmonary hypertension. transferred to hospital for further treatment of her renal failure and heart failure. 11860,158547.0,22991,2203-06-07,22990,162521.0,2203-05-21,Discharge summary,"Admission Date: [**2203-5-14**] Discharge Date: [**2203-5-21**] Date of Birth: [**2134-9-28**] Sex: F @@ -106384,7 +108776,17 @@ dose of levothyroxine. ","PRIMARY: [Hypertensive heart and chronic kidney disease, unspecified, with heart failure and chronic kidney disease stage V or end stage renal disease] -SECONDARY: [Acute combined systolic and diastolic heart failure; Chronic kidney disease, Stage V; Herpes zoster with other nervous system complications; Complications of transplanted bone marrow; Chronic graft-versus-host disease; Compression of vein; Hyposmolality and/or hyponatremia; Other specified cardiac dysrhythmias; Hyperpotassemia; Personal history of other lymphatic and hematopoietic neoplasms; Coronary atherosclerosis of native coronary artery; Congestive heart failure, unspecified; Other restorative surgery causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation; Unspecified acquired hypothyroidism; Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use; Polyneuropathy due to drugs; Hyperpigmentation of eyelid]" +SECONDARY: [Acute combined systolic and diastolic heart failure; Chronic kidney disease, Stage V; Herpes zoster with other nervous system complications; Complications of transplanted bone marrow; Chronic graft-versus-host disease; Compression of vein; Hyposmolality and/or hyponatremia; Other specified cardiac dysrhythmias; Hyperpotassemia; Personal history of other lymphatic and hematopoietic neoplasms; Coronary atherosclerosis of native coronary artery; Congestive heart failure, unspecified; Other restorative surgery causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation; Unspecified acquired hypothyroidism; Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use; Polyneuropathy due to drugs; Hyperpigmentation of eyelid]","ms [**known lastname 59332**] is a 68yo woman with h/o non-hodgkins lymphoma s/p +sct in [**2199**] and stage v ckd who presented with acute dyspnea in +the setting of pain, hypertension, and volume overload. # dyspnea and hypoxia: she most likely developed flash +pulmonary edema from sudden hypertension from the pain in the +setting of chronic renal disease. she takes her pentamidine +faithfully, so was unlikely to be pcp. [**initials (namepattern4) **] [**last name (namepattern4) **] was done during +her admission to evaluate for suspected diastolic dysfunction, +however showed new inferior basal wall motion abnormality and +new moderate to severe mitral regurgitation, see below. likely secondary to ischemic event, either from plaque rupture +given family history, hyperlipidemia, or vasospasm. pt was continued on home +dose of levothyroxine.","ms [**known last name 59332**] is a 68yo woman with h/o non-hodgkins lymphoma s/p sct. she presented with acute dyspnea in the setting of pain, hypertension, and volume overload. she was empirically started on a heparin gtt, but stopped when she was no longer hypoxic." 13305,106092.0,14242,2180-01-06,14241,122062.0,2179-11-27,Discharge summary,"Admission Date: [**2179-11-21**] Discharge Date: [**2179-11-27**] Date of Birth: [**2123-3-4**] Sex: M @@ -106751,7 +109153,16 @@ but this was restarted prior to discharge. use. no signs of bleeding, stable at discharge. ","PRIMARY: [Hepatic encephalopathy] -SECONDARY: [Pneumonia, organism unspecified; Alcohol withdrawal; Alcoholic cirrhosis of liver; Portal hypertension; Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled; Depressive disorder, not elsewhere classified; Thrombocytopenia, unspecified; Hypopotassemia; Anemia of other chronic disease; Tobacco use disorder]" +SECONDARY: [Pneumonia, organism unspecified; Alcohol withdrawal; Alcoholic cirrhosis of liver; Portal hypertension; Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled; Depressive disorder, not elsewhere classified; Thrombocytopenia, unspecified; Hypopotassemia; Anemia of other chronic disease; Tobacco use disorder]","pt is a 56 yo m with h/o etoh cirrhosis s/p tips with multiple +revisions here with confusion/ agitation. on the afternoon of [**11-22**], he became +briefly unresponsive on the floor. on +the morning of [**11-23**] he was transferred back to the floor with +an ngt in place through which he was recieving lactulose. thus, withdrawl was also likely +contributing to some confusion as could benzos used to treat +withdrwal. he was discharged home on +levofloxacin, lactulose and rifaximin. lasix and spironolactone were held [**3-13**] hypernatremia +early in the admission. thrombocytopenia- likely [**3-13**] liver pathology, recent etoh +use.","pt is a 56 yo m with h/o etoh cirrhosis s/p tips with multiple revisions here with confusion/ agitation. he was admitted and started on lactulose however [**3-13**] agitation and non-compliance he had to be given lactulose via enema. on the afternoon of [**11-22**], he became briefly unresponsive on the floor." 13305,122062.0,14241,2179-11-27,14240,181328.0,2179-08-31,Discharge summary,"Admission Date: [**2179-8-27**] Discharge Date: [**2179-8-31**] Date of Birth: [**2123-3-4**] Sex: M @@ -107052,7 +109463,12 @@ given instructions to follow-up with his primary care physician regarding maintenance of this medication. ","PRIMARY: [Hematemesis] -SECONDARY: [Pneumonia, organism unspecified; Other complications due to other vascular device, implant, and graft; Chronic pancreatitis; Portal hypertension; Alcoholic cirrhosis of liver; Other and unspecified alcohol dependence, unspecified; Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled; Polyneuropathy in diabetes; Hypopotassemia; Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Anemia of other chronic disease; Thrombocytopenia, unspecified; Depressive disorder, not elsewhere classified; Umbilical hernia without mention of obstruction or gangrene; Long-term (current) use of insulin; Awaiting organ transplant status; Hypotension, unspecified; Hypoxemia; Esophageal varices in diseases classified elsewhere, without mention of bleeding]" +SECONDARY: [Pneumonia, organism unspecified; Other complications due to other vascular device, implant, and graft; Chronic pancreatitis; Portal hypertension; Alcoholic cirrhosis of liver; Other and unspecified alcohol dependence, unspecified; Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled; Polyneuropathy in diabetes; Hypopotassemia; Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Anemia of other chronic disease; Thrombocytopenia, unspecified; Depressive disorder, not elsewhere classified; Umbilical hernia without mention of obstruction or gangrene; Long-term (current) use of insulin; Awaiting organ transplant status; Hypotension, unspecified; Hypoxemia; Esophageal varices in diseases classified elsewhere, without mention of bleeding]","56 yo m with ethanol induced cirrhosis, upper gi bleed s/p tips +who was admitted for hematemesis. he had +no further episodes of vomiting and was tolerating clears +without difficulty. # ethanol induced cirrhosis: the patient had a history of tips +and these were evaluated on admission. he was discharged with +follow-up in the [**hospital **] clinic.","56 yo m with ethanol induced cirrhosis, upper gi bleed s/p tips who was admitted for hematemesis. on initial presentation in the ed, vitals were 98.7, 129/73, 82, 18, 97% ra. he was found to be guaiac negative. he was given pantoprazole 40 mg iv x 1 and zofran x 1." 13305,122062.0,14241,2179-11-27,14239,126212.0,2179-07-07,Discharge summary,"Admission Date: [**2179-7-5**] Discharge Date: [**2179-7-7**] Date of Birth: [**2123-3-4**] Sex: M @@ -107303,7 +109719,8 @@ were discontinued. patient should continue on mvi, folic acid. ","PRIMARY: [Hematemesis] -SECONDARY: [Chronic pancreatitis; Alcoholic cirrhosis of liver; Thrombocytopenia, unspecified; Anemia, unspecified; Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled]" +SECONDARY: [Chronic pancreatitis; Alcoholic cirrhosis of liver; Thrombocytopenia, unspecified; Anemia, unspecified; Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled]","a/p: 56m with etoh cirrhosis s/p tips presents for hematemesis +. patient should continue on mvi, folic acid.",56m with etoh cirrhosis s/p tips presents for hematemesis. bleeding was due to erosions and microtears. patient should continue on ppi and sucrafate. 13305,106092.0,14242,2180-01-06,14240,181328.0,2179-08-31,Discharge summary,"Admission Date: [**2179-8-27**] Discharge Date: [**2179-8-31**] Date of Birth: [**2123-3-4**] Sex: M @@ -107604,7 +110021,12 @@ given instructions to follow-up with his primary care physician regarding maintenance of this medication. ","PRIMARY: [Hematemesis] -SECONDARY: [Pneumonia, organism unspecified; Other complications due to other vascular device, implant, and graft; Chronic pancreatitis; Portal hypertension; Alcoholic cirrhosis of liver; Other and unspecified alcohol dependence, unspecified; Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled; Polyneuropathy in diabetes; Hypopotassemia; Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Anemia of other chronic disease; Thrombocytopenia, unspecified; Depressive disorder, not elsewhere classified; Umbilical hernia without mention of obstruction or gangrene; Long-term (current) use of insulin; Awaiting organ transplant status; Hypotension, unspecified; Hypoxemia; Esophageal varices in diseases classified elsewhere, without mention of bleeding]" +SECONDARY: [Pneumonia, organism unspecified; Other complications due to other vascular device, implant, and graft; Chronic pancreatitis; Portal hypertension; Alcoholic cirrhosis of liver; Other and unspecified alcohol dependence, unspecified; Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled; Polyneuropathy in diabetes; Hypopotassemia; Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Anemia of other chronic disease; Thrombocytopenia, unspecified; Depressive disorder, not elsewhere classified; Umbilical hernia without mention of obstruction or gangrene; Long-term (current) use of insulin; Awaiting organ transplant status; Hypotension, unspecified; Hypoxemia; Esophageal varices in diseases classified elsewhere, without mention of bleeding]","56 yo m with ethanol induced cirrhosis, upper gi bleed s/p tips +who was admitted for hematemesis. he had +no further episodes of vomiting and was tolerating clears +without difficulty. # ethanol induced cirrhosis: the patient had a history of tips +and these were evaluated on admission. he was discharged with +follow-up in the [**hospital **] clinic.","56 yo m with ethanol induced cirrhosis, upper gi bleed s/p tips who was admitted for hematemesis. on initial presentation in the ed, vitals were 98.7, 129/73, 82, 18, 97% ra. he was found to be guaiac negative. he was given pantoprazole 40 mg iv x 1 and zofran x 1." 15853,111874.0,23002,2174-12-02,23001,199461.0,2174-11-25,Discharge summary,"Admission Date: [**2174-11-21**] Discharge Date: [**2174-11-25**] Date of Birth: [**2098-2-28**] Sex: M @@ -107876,7 +110298,14 @@ medical staff agreed on a plan for him to return home with regular visits from his several friends listed above. ","PRIMARY: [Ventral, unspecified, hernia with obstruction] -SECONDARY: [Aortic valve disorders; Atrial fibrillation; Unspecified psychosis; Chronic kidney disease, unspecified; Other and unspecified hyperlipidemia; Lumbago; Other chronic pain; Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS); Personal history of venous thrombosis and embolism]" +SECONDARY: [Aortic valve disorders; Atrial fibrillation; Unspecified psychosis; Chronic kidney disease, unspecified; Other and unspecified hyperlipidemia; Lumbago; Other chronic pain; Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS); Personal history of venous thrombosis and embolism]","patient was admitted to the general surgery service from the +emergency room on [**11-21**] with symptoms of a small bowel +obstruction secondary to a large ventral hernia. on hospital day 2 the patient stated he was feeling better and +self-d/cd his ng tube, he refused to have another placed. cardiology performed a tte that revealed severe +aortic valve stenosis with a valvular area of 0.6cm, and stated +he would be a very high risk operative candidate, recommending a +valvuloplasty prior to any elective surgery. he was evaluated by psychiatry and deemed +competent to make such decisions on his own.","a patient was admitted to the general surgery service with symptoms of a small bowel obstruction secondary to a large ventral hernia. on hospital day 2 the patient stated he was feeling better and self-d/cd his ng tube, he refused to have another placed. he was evaluated by psychiatry and deemed competent to make such decisions on his own." 18082,181163.0,11814,2156-03-29,11813,164053.0,2155-11-29,Discharge summary,"Admission Date: [**2155-10-29**] Discharge Date: [**2155-11-29**] @@ -108299,7 +110728,16 @@ family, a g/j tube was placed. ","PRIMARY: [Diabetes with peripheral circulatory disorders, type II or unspecified type, not stated as uncontrolled] -SECONDARY: [Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with no loss of consciousness; Cellulitis and abscess of foot, except toes; Unspecified osteomyelitis, ankle and foot; Pneumonitis due to inhalation of food or vomitus; Chronic diastolic heart failure; Atherosclerosis of native arteries of the extremities with ulceration; Anemia of other chronic disease; Congestive heart failure, unspecified; Ulcer of other part of foot; Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled; Other bone involvement in diseases classified elsewhere; Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site; Infection with microorganisms resistant to penicillins; Unspecified fall; Accidents occurring in residential institution; Esophageal reflux; Osteoporosis, unspecified; Dysthymic disorder; Coronary atherosclerosis of native coronary artery; Chronic airway obstruction, not elsewhere classified; Diarrhea; Epistaxis; Other iatrogenic hypotension; Other antihypertensive agents causing adverse effects in therapeutic use]" +SECONDARY: [Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with no loss of consciousness; Cellulitis and abscess of foot, except toes; Unspecified osteomyelitis, ankle and foot; Pneumonitis due to inhalation of food or vomitus; Chronic diastolic heart failure; Atherosclerosis of native arteries of the extremities with ulceration; Anemia of other chronic disease; Congestive heart failure, unspecified; Ulcer of other part of foot; Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled; Other bone involvement in diseases classified elsewhere; Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site; Infection with microorganisms resistant to penicillins; Unspecified fall; Accidents occurring in residential institution; Esophageal reflux; Osteoporosis, unspecified; Dysthymic disorder; Coronary atherosclerosis of native coronary artery; Chronic airway obstruction, not elsewhere classified; Diarrhea; Epistaxis; Other iatrogenic hypotension; Other antihypertensive agents causing adverse effects in therapeutic use]","[**age over 90 **] f with with copd on home 02, h/o cva, dm ii, diastolic chf, +mrsa +, admitted with foot ulcer, hospitalization complicated by +fall w/ sdh, fevers, & worsening mental status. [**2155-11-8**] +am not responding to painful stimuli. # hypotension: patient had episode of hypotension while in the +hospital. she was transfered to the icu briefly where she +recieved fluids and was briefly on dopamine. thought to be +related to hypovolemia / antihypertension medications. she will need to complete a 10 day course +(last day should be [**2155-12-6**]). #foot ulcer: mri w/o definitive evidence of osteo. she was continued on nebs and o2 as needed while hospitalized. no +gross hemorrhage, apart from sdh, which is stable. her metoprolol was restarted on the day of discharge. sodium responded to gentle iv hydration +with normal saline.","pt has been ""unresponsive""/ minimally responsive for two days, since her fall. pt is interactive & talkative, though demented. no metabolic abnormalities to explain change." 19827,199336.0,15704,2106-06-11,15703,166475.0,2106-05-20,Discharge summary,"Admission Date: [**2106-5-13**] Discharge Date: [**2106-5-20**] Date of Birth: [**2038-4-1**] Sex: M @@ -108781,7 +111219,23 @@ course for consideration of choleycystectomy ","PRIMARY: [Unspecified septicemia] -SECONDARY: [Septic shock; Acute systolic heart failure; Paraplegia; Pressure ulcer, buttock; Pressure ulcer, lower back; Pressure ulcer, hip; Severe sepsis; Chronic airway obstruction, not elsewhere classified; Congestive heart failure, unspecified; Esophageal reflux; Personal history of venous thrombosis and embolism]" +SECONDARY: [Septic shock; Acute systolic heart failure; Paraplegia; Pressure ulcer, buttock; Pressure ulcer, lower back; Pressure ulcer, hip; Severe sepsis; Chronic airway obstruction, not elsewhere classified; Congestive heart failure, unspecified; Esophageal reflux; Personal history of venous thrombosis and embolism]","68m t4 paraplegia, cad, systolic chf, sacral decubitus ulcers, +multiple utis, pe with ivc filter on anticoagulation admitted +with hypotension. pt was +started on vancomycin for mrsa, meropenem for pseudomonas, +ciprofloxacin for double gnr coverage, and metronidazole for +anaerobic coverage. 7more days vanc/meropenm +and 14 days flagyl. ********please note, after this course, patient should have +serial blood cultures, urine cultures and evaluation/wound +culture by plastic surgery as he has had multiple admissions for +septicemia of unclear etiology. on discharge, bp 80s to 100s on low dose +lisinopril and carvedilol +. with aggressive +fluids/pressors, no pulmonary edema. low dose lisinopril and +carvedilol re-started by [**5-18**]. if ongoing pain, patietn should +be evaluated by surgery once he has completed his antibioitic +course for consideration of choleycystectomy +.","pt was started on vancomycin for mrsa, meropenem for pseudomonas, ciprofloxacin for double gnr coverage, and metronidazole for anaerobic coverage. pt was taken off pressors two days after admission and remained afebrile throughout. plastic surgery evaluated sacral decubs and did not feel they were likely source of sepsis." 19827,199336.0,15704,2106-06-11,15702,178197.0,2106-04-15,Discharge summary,"Admission Date: [**2106-4-6**] Discharge Date: [**2106-4-15**] Date of Birth: [**2038-4-1**] Sex: M @@ -109204,7 +111658,13 @@ other chronic medical issues as outlined in pmhx. and in medication list below. ","PRIMARY: [Infection and inflammatory reaction due to indwelling urinary catheter] -SECONDARY: [Unspecified septicemia; Sepsis; Paraplegia; Pressure ulcer, lower back; Pressure ulcer, hip; Chronic systolic heart failure; Urinary tract infection, site not specified; Aortocoronary bypass status; Congestive heart failure, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [Unspecified septicemia; Sepsis; Paraplegia; Pressure ulcer, lower back; Pressure ulcer, hip; Chronic systolic heart failure; Urinary tract infection, site not specified; Aortocoronary bypass status; Congestive heart failure, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","a/p: 67m h/o t4 paraplegia, recurrent utis [**3-13**] indwelling foley, +multiple stage 4 decubs was admitted to icu initially with fever +to 101.8, transient hypotension that resolved with 3-4l ivf but +continued on sepsis protocol. all neg, +but swab suggested colonization with mrsa; also seen on swab, +pseudomonas and enterococcus. follow up with +[**month/day (2) **] arranged for evaluation for suprapubic catheter.","67m h/o t4 paraplegia, recurrent utis was admitted to icu initially with fever to 101.8, transient hypotension that resolved with 3-4l ivf but continued on sepsis protocol. emperically treated with vancomycin and zosyn given this information and prior culture data that was reviewed here." 19827,166475.0,15703,2106-05-20,15702,178197.0,2106-04-15,Discharge summary,"Admission Date: [**2106-4-6**] Discharge Date: [**2106-4-15**] Date of Birth: [**2038-4-1**] Sex: M @@ -109627,7 +112087,13 @@ other chronic medical issues as outlined in pmhx. and in medication list below. ","PRIMARY: [Infection and inflammatory reaction due to indwelling urinary catheter] -SECONDARY: [Unspecified septicemia; Sepsis; Paraplegia; Pressure ulcer, lower back; Pressure ulcer, hip; Chronic systolic heart failure; Urinary tract infection, site not specified; Aortocoronary bypass status; Congestive heart failure, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]" +SECONDARY: [Unspecified septicemia; Sepsis; Paraplegia; Pressure ulcer, lower back; Pressure ulcer, hip; Chronic systolic heart failure; Urinary tract infection, site not specified; Aortocoronary bypass status; Congestive heart failure, unspecified; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants]","a/p: 67m h/o t4 paraplegia, recurrent utis [**3-13**] indwelling foley, +multiple stage 4 decubs was admitted to icu initially with fever +to 101.8, transient hypotension that resolved with 3-4l ivf but +continued on sepsis protocol. all neg, +but swab suggested colonization with mrsa; also seen on swab, +pseudomonas and enterococcus. follow up with +[**month/day (2) **] arranged for evaluation for suprapubic catheter.","67m h/o t4 paraplegia, recurrent utis was admitted to icu initially with fever to 101.8, transient hypotension that resolved with 3-4l ivf but continued on sepsis protocol. emperically treated with vancomycin and zosyn given this information and prior culture data that was reviewed here." 21202,155154.0,30385,2146-02-24,30384,106349.0,2145-09-12,Discharge summary,"Admission Date: [**2145-9-7**] Discharge Date: [**2145-9-12**] Date of Birth: [**2090-7-16**] Sex: M @@ -110058,7 +112524,12 @@ to explain epigastric pain. this pain has resolved on discharge. monitoring and diabetic diet. ","PRIMARY: [Unspecified septicemia] -SECONDARY: [Acute kidney failure, unspecified; Glucocorticoid deficiency; Acute myeloid leukemia, in remission; Complications of transplanted bone marrow; Chronic graft-versus-host disease; Severe sepsis; Adrenal cortical steroids causing adverse effects in therapeutic use; Acute bronchitis; Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation; Personal history of venous thrombosis and embolism; Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled; Long-term (current) use of steroids]" +SECONDARY: [Acute kidney failure, unspecified; Glucocorticoid deficiency; Acute myeloid leukemia, in remission; Complications of transplanted bone marrow; Chronic graft-versus-host disease; Severe sepsis; Adrenal cortical steroids causing adverse effects in therapeutic use; Acute bronchitis; Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation; Personal history of venous thrombosis and embolism; Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled; Long-term (current) use of steroids]","viral syndrome vs. other atypical infection +with hypotension that is suspected to be hypovolemia or adrenal +insufficiency, with acute renal failure. # dyspnea/cough: concern for infectious process. # hypotension: a bedside ""shock"" ultrasound us in ed showed no +cardiac effusion, no evidence of gross rv overload. initially given stress dose steroids with plans to +resume home dose. # pulmonary embolism [**11-23**]: continued coumadin with inr goal +[**1-19**].","pts lethargy improved with ivfs, antibiotics, and stress dose steroids. pts lethargy improved with ivfs, antibiotics, and stress dose steroids." 23161,115895.0,17796,2138-08-03,17795,168634.0,2138-07-27,Discharge summary,"Admission Date: [**2138-7-18**] Discharge Date: [**2138-7-27**] Date of Birth: [**2055-3-1**] Sex: M @@ -110614,7 +113085,22 @@ precose were held during his admission and was covered with an iss. ","PRIMARY: [Subendocardial infarction, subsequent episode of care] -SECONDARY: [Acute kidney failure, unspecified; Pneumonitis due to inhalation of food or vomitus; Urinary tract infection, site not specified; Chronic combined systolic and diastolic heart failure; Injury to bladder and urethra, without mention of open wound into cavity; Acute posthemorrhagic anemia; Blood in stool; Coronary atherosclerosis of native coronary artery; Intermediate coronary syndrome; Congestive heart failure, unspecified; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified; Chronic kidney disease, unspecified; Bronchiectasis without acute exacerbation; Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled; Polyneuropathy in diabetes; Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled; Atherosclerosis of native arteries of the extremities with ulceration; Diabetes with peripheral circulatory disorders, type II or unspecified type, not stated as uncontrolled; Peripheral angiopathy in diseases classified elsewhere; Mitral valve insufficiency and aortic valve stenosis; ; Hematuria, unspecified; Iron deficiency anemia, unspecified; Chronic total occlusion of coronary artery; Other constipation; Atrial fibrillation; Unspecified accident; Long-term (current) use of insulin]" +SECONDARY: [Acute kidney failure, unspecified; Pneumonitis due to inhalation of food or vomitus; Urinary tract infection, site not specified; Chronic combined systolic and diastolic heart failure; Injury to bladder and urethra, without mention of open wound into cavity; Acute posthemorrhagic anemia; Blood in stool; Coronary atherosclerosis of native coronary artery; Intermediate coronary syndrome; Congestive heart failure, unspecified; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified; Chronic kidney disease, unspecified; Bronchiectasis without acute exacerbation; Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled; Polyneuropathy in diabetes; Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled; Atherosclerosis of native arteries of the extremities with ulceration; Diabetes with peripheral circulatory disorders, type II or unspecified type, not stated as uncontrolled; Peripheral angiopathy in diseases classified elsewhere; Mitral valve insufficiency and aortic valve stenosis; ; Hematuria, unspecified; Iron deficiency anemia, unspecified; Chronic total occlusion of coronary artery; Other constipation; Atrial fibrillation; Unspecified accident; Long-term (current) use of insulin]","83 year old man with complex medical issues including diasolic +and systolic chf, severe as, ckd, copd and dm-2, pvd and chronic +ulcers presents from nursing facility after taking ntg for his +chest pain that resulted in hypotension that subsequently +resolved spontanously. at [**hospital3 **] the patient underwent cath that demonstrated +clean lm, lad total occulsion, lcx 50%, rca 60%, lad collaterals +being filled by rca and anatomy was not ammendable to stenting. he was started on an amiodorone gtt at osh +and discharged to rehab on 200mg [**hospital1 **]. his dose was further +reduced to 200 mg daily during this hospitalization. # chronic systolic congestive heart failure: the patient +underwent echo that showed and ef of 30%. he was started on cipro on [**7-26**], +but cx grew e. coli resistant to cipro. 1:1 assist with meals to maintain aspiration precautions +they also recommend f/u by swallow therapy in rehab setting and +will require videoswallow study in [**2-7**] weeks to consider diet +upgrade. the patient was continued on +ppi and iron. #) hematuria: on admission the patient had hematuria that had +started during his prior admission to [**hospital3 **].","83 year old man presents from nursing facility with complex medical issues including diasolic and systolic chf, severe as, ckd, copd and dm-2, pvd and chronic ulcers. pt also has new af at [**hospital3 5097**], started on amiodarone, persistant hematuria and anemia." 23657,164590.0,13516,2143-04-08,13515,134743.0,2142-10-25,Discharge summary,"Admission Date: [**2142-10-22**] Discharge Date: [**2142-10-25**] Date of Birth: [**2112-11-14**] Sex: M @@ -110904,7 +113390,10 @@ with gastroparesis - bowel regimen ","PRIMARY: [Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage I through stage IV, or unspecified] -SECONDARY: [Diabetes with ketoacidosis, type I [juvenile type], uncontrolled; Acute kidney failure, unspecified; Chronic kidney disease, unspecified; Gastroparesis; Personal history of noncompliance with medical treatment, presenting hazards to health; Polyneuropathy in diabetes; Other specified gastritis, without mention of hemorrhage; Esophageal reflux; Depressive disorder, not elsewhere classified; Alcohol abuse, unspecified; Diabetes with neurological manifestations, type I [juvenile type], uncontrolled; Diabetes with renal manifestations, type I [juvenile type], uncontrolled]" +SECONDARY: [Diabetes with ketoacidosis, type I [juvenile type], uncontrolled; Acute kidney failure, unspecified; Chronic kidney disease, unspecified; Gastroparesis; Personal history of noncompliance with medical treatment, presenting hazards to health; Polyneuropathy in diabetes; Other specified gastritis, without mention of hemorrhage; Esophageal reflux; Depressive disorder, not elsewhere classified; Alcohol abuse, unspecified; Diabetes with neurological manifestations, type I [juvenile type], uncontrolled; Diabetes with renal manifestations, type I [juvenile type], uncontrolled]","29 m with dm1, dka, hypertensive urgency likely secondary to +noncompliance. # hypertensive urgency - also likely [**2-9**] noncompliance, as pt +missed his ams dose of bp medications before admission. - should follow up worsening renal function at [**hospital **] clinic on +f/u apt as outpatient.","29 m with dm1, dka, hypertensive urgency likely secondary to noncompliance. cxr neg, ua with 0-2 wbc, low grade fevers initially which have cleared. pt transitioned to iv reglan and then po reglan with good results." 23657,176997.0,13519,2145-04-18,13518,169263.0,2145-03-24,Discharge summary,"Admission Date: [**2145-3-21**] Discharge Date: [**2145-3-24**] Date of Birth: [**2112-11-14**] Sex: M @@ -111428,7 +113917,17 @@ dose. blood sugar ranged from 161-204. no anion gap on routine labs to suggest ketoacidosis. ","PRIMARY: [Acute diastolic heart failure] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Unspecified disease of pericardium; Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled; Other chronic pulmonary heart diseases; Diabetes with ophthalmic manifestations, type I [juvenile type], not stated as uncontrolled; Congestive heart failure, unspecified; Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled; Hyperpotassemia; Renal dialysis status; Background diabetic retinopathy; Gastroparesis; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Long-term (current) use of insulin; Anemia in chronic kidney disease; Iron deficiency anemia, unspecified; Depressive disorder, not elsewhere classified; Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH]; Other postprocedural status]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Unspecified disease of pericardium; Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled; Other chronic pulmonary heart diseases; Diabetes with ophthalmic manifestations, type I [juvenile type], not stated as uncontrolled; Congestive heart failure, unspecified; Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled; Hyperpotassemia; Renal dialysis status; Background diabetic retinopathy; Gastroparesis; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Long-term (current) use of insulin; Anemia in chronic kidney disease; Iron deficiency anemia, unspecified; Depressive disorder, not elsewhere classified; Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH]; Other postprocedural status]","32yom w t1dm, esrd on hemodialysis, htn presented with sudden +onset dyspnea, likely due to flash pulmonary edema in setting of +severe hypertension. in the micu, pt was +treated with a nitro drip, lasix (with good urine output), and +supplmental o2 via nasal cannula. # end stage renal failure: renal followed patient, and he was +able to remain on his regular t/th/sat dialysis schedule while +in house. # anemia: on transfer to micu, hct was 27, which was above +baseline of 23. no clinical evidence of bleeding during his stay. # transaminitis: on admission, mildly elevated ast and alt in +70s. liver function +tests were trended and came down with improvement in his +clinical status.",32yom esrd presented with sudden onset dyspnea. likely due to flash pulmonary edema in setting of severe hypertension. echo showed new findings of mild lv systolic dysfunction (ef 52%) 23657,176997.0,13519,2145-04-18,13517,125544.0,2145-02-27,Discharge summary,"Admission Date: [**2145-2-18**] Discharge Date: [**2145-2-27**] Date of Birth: [**2112-11-14**] Sex: M @@ -111880,7 +114379,25 @@ and that his blood cultures remained negative. mr. [**known lastname 21822**] refused, and signed out against medical advice. ","PRIMARY: [Diabetes with ketoacidosis, type I [juvenile type], uncontrolled] -SECONDARY: [Acute kidney failure, unspecified; End stage renal disease; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease; Secondary hyperparathyroidism (of renal origin); Intestinal infection due to other organism, not elsewhere classified; Diabetes with renal manifestations, type I [juvenile type], uncontrolled; Diabetes with neurological manifestations, type I [juvenile type], uncontrolled; Gastroparesis; Diabetes with ophthalmic manifestations, type I [juvenile type], uncontrolled; Background diabetic retinopathy; Dehydration; Anemia in chronic kidney disease; Iron deficiency anemia, unspecified; Depressive disorder, not elsewhere classified; Long-term (current) use of insulin]" +SECONDARY: [Acute kidney failure, unspecified; End stage renal disease; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease; Secondary hyperparathyroidism (of renal origin); Intestinal infection due to other organism, not elsewhere classified; Diabetes with renal manifestations, type I [juvenile type], uncontrolled; Diabetes with neurological manifestations, type I [juvenile type], uncontrolled; Gastroparesis; Diabetes with ophthalmic manifestations, type I [juvenile type], uncontrolled; Background diabetic retinopathy; Dehydration; Anemia in chronic kidney disease; Iron deficiency anemia, unspecified; Depressive disorder, not elsewhere classified; Long-term (current) use of insulin]","in the er on [**2-18**], his vitals were: t 100.1, p 98, bp 164/90, rr +16, o2 sat 100%. his tachypnea resolved with +diuresis (lasix 20 mg iv). his gap was back +down to 21 by 23:00 that evening. in the early am of [**2-21**] +he developed nausea, vomiting, a glucose of 436 and dka. for +systolic blood pressures from 190-210 he received iv doses of +his home po antihypertensives (hydralazine and metoprolol). by [**2-24**] he had been transitioned from insulin drip to insulin +boluses. he was +transferred out of the icu to the medicine floor. but after brief stay on the regular medicine floor, his +blood sugar elevated into the 200-300s and anion gap increased; +acetone found in serum and ketones seen in urinalysis, +concerning for dka. mild +elevation of lfts gradually resolved. patients diarrhea resolved while in micu +and as per above, developed appetite and was able to tolerate po +medications/diet. patient did not have emesis or blood in +his stools. he was continued on iron supplements and may benefit +from epogen with hemodialysis in the future. patient was ultimately +transitioned to a regimen of metoprolol 100mg twice daily, +amlodipine 10mg daily and hydralazine 50mg three times daily.","on transfer to the floor his vitals were t 99.2, hr 100, bp 171/90, rr 12, o2sat 97% on room air. on the medicine floor he had worsening nausea, vomiting and abdominal pain. his glucose rose to 305, his gap increased to 21 and his ph was 7.27. he declined his renal diet all day, then at midnight had fried chicken brought in from outside." 23657,169263.0,13518,2145-03-24,13517,125544.0,2145-02-27,Discharge summary,"Admission Date: [**2145-2-18**] Discharge Date: [**2145-2-27**] Date of Birth: [**2112-11-14**] Sex: M @@ -112332,7 +114849,25 @@ and that his blood cultures remained negative. mr. [**known lastname 21822**] refused, and signed out against medical advice. ","PRIMARY: [Diabetes with ketoacidosis, type I [juvenile type], uncontrolled] -SECONDARY: [Acute kidney failure, unspecified; End stage renal disease; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease; Secondary hyperparathyroidism (of renal origin); Intestinal infection due to other organism, not elsewhere classified; Diabetes with renal manifestations, type I [juvenile type], uncontrolled; Diabetes with neurological manifestations, type I [juvenile type], uncontrolled; Gastroparesis; Diabetes with ophthalmic manifestations, type I [juvenile type], uncontrolled; Background diabetic retinopathy; Dehydration; Anemia in chronic kidney disease; Iron deficiency anemia, unspecified; Depressive disorder, not elsewhere classified; Long-term (current) use of insulin]" +SECONDARY: [Acute kidney failure, unspecified; End stage renal disease; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease; Secondary hyperparathyroidism (of renal origin); Intestinal infection due to other organism, not elsewhere classified; Diabetes with renal manifestations, type I [juvenile type], uncontrolled; Diabetes with neurological manifestations, type I [juvenile type], uncontrolled; Gastroparesis; Diabetes with ophthalmic manifestations, type I [juvenile type], uncontrolled; Background diabetic retinopathy; Dehydration; Anemia in chronic kidney disease; Iron deficiency anemia, unspecified; Depressive disorder, not elsewhere classified; Long-term (current) use of insulin]","in the er on [**2-18**], his vitals were: t 100.1, p 98, bp 164/90, rr +16, o2 sat 100%. his tachypnea resolved with +diuresis (lasix 20 mg iv). his gap was back +down to 21 by 23:00 that evening. in the early am of [**2-21**] +he developed nausea, vomiting, a glucose of 436 and dka. for +systolic blood pressures from 190-210 he received iv doses of +his home po antihypertensives (hydralazine and metoprolol). by [**2-24**] he had been transitioned from insulin drip to insulin +boluses. he was +transferred out of the icu to the medicine floor. but after brief stay on the regular medicine floor, his +blood sugar elevated into the 200-300s and anion gap increased; +acetone found in serum and ketones seen in urinalysis, +concerning for dka. mild +elevation of lfts gradually resolved. patients diarrhea resolved while in micu +and as per above, developed appetite and was able to tolerate po +medications/diet. patient did not have emesis or blood in +his stools. he was continued on iron supplements and may benefit +from epogen with hemodialysis in the future. patient was ultimately +transitioned to a regimen of metoprolol 100mg twice daily, +amlodipine 10mg daily and hydralazine 50mg three times daily.","on transfer to the floor his vitals were t 99.2, hr 100, bp 171/90, rr 12, o2sat 97% on room air. on the medicine floor he had worsening nausea, vomiting and abdominal pain. his glucose rose to 305, his gap increased to 21 and his ph was 7.27. he declined his renal diet all day, then at midnight had fried chicken brought in from outside." 25256,144551.0,12435,2162-04-02,12434,170994.0,2162-03-16,Discharge summary,"Admission Date: [**2162-2-4**] Discharge Date: [**2162-3-16**] Date of Birth: [**2123-3-28**] Sex: M @@ -112913,7 +115448,20 @@ adequate po intake. code status: full code (confirmed) ","PRIMARY: [Acute and chronic respiratory failure] -SECONDARY: [Pneumonia, organism unspecified; Pneumonia due to Klebsiella pneumoniae; Pneumonitis due to inhalation of food or vomitus; Dependence on respirator, status; Complications of transplanted bone marrow; Chronic graft-versus-host disease; Nodular lymphoma, unspecified site, extranodal and solid organ sites; Portal hypertension; Esophageal varices in diseases classified elsewhere, without mention of bleeding; Other specified alveolar and parietoalveolar pneumonopathies; Unspecified intestinal malabsorption; Paroxysmal supraventricular tachycardia; Unspecified pleural effusion; Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation; Accidents occurring in other specified places; Varices of other sites; Unspecified acquired hypothyroidism; Secondary diabetes mellitus without mention of complication, not stated as uncontrolled, or unspecified; Adrenal cortical steroids causing adverse effects in therapeutic use; Hypoxemia; Nonspecific low blood pressure reading; Iron deficiency anemia, unspecified; Cirrhosis of liver without mention of alcohol]" +SECONDARY: [Pneumonia, organism unspecified; Pneumonia due to Klebsiella pneumoniae; Pneumonitis due to inhalation of food or vomitus; Dependence on respirator, status; Complications of transplanted bone marrow; Chronic graft-versus-host disease; Nodular lymphoma, unspecified site, extranodal and solid organ sites; Portal hypertension; Esophageal varices in diseases classified elsewhere, without mention of bleeding; Other specified alveolar and parietoalveolar pneumonopathies; Unspecified intestinal malabsorption; Paroxysmal supraventricular tachycardia; Unspecified pleural effusion; Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation; Accidents occurring in other specified places; Varices of other sites; Unspecified acquired hypothyroidism; Secondary diabetes mellitus without mention of complication, not stated as uncontrolled, or unspecified; Adrenal cortical steroids causing adverse effects in therapeutic use; Hypoxemia; Nonspecific low blood pressure reading; Iron deficiency anemia, unspecified; Cirrhosis of liver without mention of alcohol]","38m with nhl s/p allobmt complicated by multi-organ gvhd and bo +with severe baseline lung disease and co2 retention, presenting +with dyspnea and cough, now transfered to [**hospital unit name 153**] for hypercarbic +respiratory failure. after discussion +with his oncologist and the primary medical team, ct surgery was +consulted for tracheostomy and gi was consulted about placing a +peg tube. he was kept on broad spectrum +antibiotic coverage and was switched to meropenem when bal +cultures showed klebsiella pneumoniae sensitive to this +antibiotic. the patient was noted to have increasing leukocytosis +and low grade temps on [**2162-3-2**]. [** normotensive prior to intubation but had some +prolonged low bps most likely secondary to positive pressure +effects and sedation. occurring on [**month/year (2) 3242**] floor prior to events, though ? new this admission, though to be [**1-26**] ivfs. # non-hodgkins lymphoma s/p allo [**month (only) 3242**]: most recent pet scan with +no evidence of recurrent disease and he remains in remission.","38m with nhl s/p allobmt complicated by multi-organ gvhd and bo. presenting with dyspnea and cough, now transferred to [**hospital unit name 153**] for hypercarbic respiratory failure." 25696,188176.0,11473,2170-11-12,11472,192616.0,2170-05-21,Discharge summary,"Admission Date: [**2170-5-5**] Discharge Date: [**2170-5-21**] Date of Birth: [**2118-2-1**] Sex: M @@ -113228,7 +115776,12 @@ sucralfate. # code: full ","PRIMARY: [Acute venous embolism and thrombosis of deep vessels of proximal lower extremity] -SECONDARY: [Secondary malignant neoplasm of bone and bone marrow; Urinary tract infection, site not specified; Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site; Delirium due to conditions classified elsewhere; Anemia, unspecified; Neoplasm related pain (acute) (chronic); Pure hypercholesterolemia; Obstructive sleep apnea (adult)(pediatric); Other psoriasis; Personal history of malignant neoplasm of prostate]" +SECONDARY: [Secondary malignant neoplasm of bone and bone marrow; Urinary tract infection, site not specified; Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site; Delirium due to conditions classified elsewhere; Anemia, unspecified; Neoplasm related pain (acute) (chronic); Pure hypercholesterolemia; Obstructive sleep apnea (adult)(pediatric); Other psoriasis; Personal history of malignant neoplasm of prostate]","52-year-old man with metastatic prostate cancer, not on active +chemo with recurrent dvts/pes despite anticoagulation, also with +recent gib, presented with le swelling, found to have rle dvt. # dvt: the patient presented with worse clot burden. # metastatic prostate cancer: with bone mets. after a discussion with his outpatient +oncologist, he was discharged with a plan for possible samarium +as outpatient. # anemia: during his last admission, avm seen on egd was +cauterized on [**2170-4-24**] during last admission.","52-year-old man with metastatic prostate cancer, not on active chemo with recurrent dvts/pes despite anticoagulation, also with recent gib, found to have rle dvt. he underwent an ivc venogram and mechanical thrombolysis with local tpa on [**2170-5-7**]. he was started on enoxaparin 120 mg [**hospital1 **] on [**2170-" 26212,159674.0,22772,2190-01-22,22771,117561.0,2189-08-24,Discharge summary,"Admission Date: [**2189-8-20**] Discharge Date: [**2189-8-24**] Date of Birth: [**2133-11-10**] Sex: M @@ -113547,7 +116100,18 @@ need vancomycin dosed per hd protocol. and at baseline. ","PRIMARY: [Abscess of anal and rectal regions] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled; Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled; Background diabetic retinopathy; Anemia in chronic kidney disease]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease; Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled; Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled; Background diabetic retinopathy; Anemia in chronic kidney disease]","known lastname 724**] is a 55 year old man with a pmh significant for esrd on +mwf hd, cad, dm, anemia, poorly controlled htn, and anemia +transferred from the surgical service for monitoring s/p +perirectal i/d. + +1. a follow-up +appointment was scheduled for the patient with dr. [** his home medications were continued and +he was also placed on a nitroglycerin drip which was continued +until his hemodialysis on [**8-21**], at which point he became +hypotensive and the nitroglycerin was discontinued. esrd: patient on mwf hemodialysis, which was continued during +his hospital course. the patient will +need vancomycin dosed per hd protocol.","mr. [**known lastname 724**] is a 55 year old man with a pmh significant for esrd on mwf hd, cad, dm, anemia, poorly controlled htn, and anemia." 26901,179730.0,24113,2185-10-17,24112,160675.0,2185-07-04,Discharge summary,"Admission Date: [**2185-7-1**] Discharge Date: [**2185-7-4**] Date of Birth: [**2160-11-6**] Sex: M @@ -113734,7 +116298,12 @@ empiric iron. ","PRIMARY: [Diabetes with ketoacidosis, type I [juvenile type], uncontrolled] -SECONDARY: [Influenza with pneumonia; Chronic kidney disease, Stage IV (severe); Acute kidney failure, unspecified; Diabetes with ophthalmic manifestations, type I [juvenile type], uncontrolled; Background diabetic retinopathy; Diabetes with renal manifestations, type I [juvenile type], uncontrolled; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Constipation, unspecified; Anemia in chronic kidney disease; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified; Gastroparesis; Personal history of noncompliance with medical treatment, presenting hazards to health]" +SECONDARY: [Influenza with pneumonia; Chronic kidney disease, Stage IV (severe); Acute kidney failure, unspecified; Diabetes with ophthalmic manifestations, type I [juvenile type], uncontrolled; Background diabetic retinopathy; Diabetes with renal manifestations, type I [juvenile type], uncontrolled; Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere; Constipation, unspecified; Anemia in chronic kidney disease; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified; Gastroparesis; Personal history of noncompliance with medical treatment, presenting hazards to health]","24 year old man with poorly controlled dm and htn with esrd not +yet on hd presents with dka in setting of insulin noncompliance +and an underlying viral pneumonia versus viral uri. he was +admitted to the icu and started on an insulin drip. the anion +gap closed and he was transitioned to glargine in the morning +(22 units) and maintained on a sliding scale.",24 year old man with poorly controlled dm and htn with esrd not yet on hd. he was admitted to the icu and started on an insulin drip. his flu swab came back positive for influenza a and antibiotics were discontinued. 27790,162585.0,18577,2113-08-18,18576,127130.0,2113-07-21,Discharge summary,"Admission Date: [**2113-7-12**] Discharge Date: [**2113-7-21**] @@ -113980,7 +116549,10 @@ operative intervention, and determined to be appropriate for rehabilitation. ","PRIMARY: [Subdural hemorrhage] -SECONDARY: [Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness; Urinary tract infection, site not specified; Compression of brain; Atrial fibrillation; Cardiac pacemaker in situ; Malignant neoplasm of prostate]" +SECONDARY: [Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness; Urinary tract infection, site not specified; Compression of brain; Atrial fibrillation; Cardiac pacemaker in situ; Malignant neoplasm of prostate]","the patient on [**7-14**] was brought to the or for a craniotomy for +a large left sdh. his pressure was kept below 140 and after the +procedure his stayed overnight in pacu and on [**7-15**] his was +transferred to stepdown.","the patient was brought to the or for a craniotomy for a large left sdh. due to the nature of his urine culture, he was mrsa screened. his neurlogical examination has been stable since his operative intervention." 27960,179767.0,15207,2196-01-28,15205,119407.0,2195-09-04,Discharge summary,"Admission Date: [**2195-9-3**] Discharge Date: [**2195-9-4**] Date of Birth: [**2171-11-13**] Sex: F @@ -114222,7 +116794,9 @@ aftrer 24 hours in the icu, the patient was discharged home in stable condition. ","PRIMARY: [Angioneurotic edema, not elsewhere classified] -SECONDARY: [Iron deficiency anemia, unspecified; Asthma, unspecified type, unspecified; Esophageal reflux; Unspecified accident]" +SECONDARY: [Iron deficiency anemia, unspecified; Asthma, unspecified type, unspecified; Esophageal reflux; Unspecified accident]","pt was treated for an acute episode of angioedema with a +question of anaphylaxis. aftrer 24 hours in the icu, the patient was discharged home in +stable condition.",pt was treated for an acute episode of angioedema with a question of anaphylaxis. the patient has a history of presumed idiopathic chronic urticaria and angioedema. the patient was discharged home in stable condition after 24 hours in the icu. 27960,179767.0,15207,2196-01-28,15206,191411.0,2195-11-26,Discharge summary,"Admission Date: [**2195-11-21**] Discharge Date: [**2195-11-26**] Date of Birth: [**2171-11-13**] Sex: F @@ -114497,7 +117071,15 @@ do not see patient at same time. ** mom [**telephone/fax (1) 44273**] ","PRIMARY: [Angioneurotic edema, not elsewhere classified] -SECONDARY: [Acute respiratory failure; Asthma, unspecified type, unspecified; Iron deficiency anemia, unspecified; Hypopotassemia; Essential thrombocythemia; Unspecified accident]" +SECONDARY: [Acute respiratory failure; Asthma, unspecified type, unspecified; Iron deficiency anemia, unspecified; Hypopotassemia; Essential thrombocythemia; Unspecified accident]","female with history of idiopathic urticaria and +angioedema who presents with tongue swelling, unresponsive to h2 +blocker, steroids, epinephrine and benadryl, electively +intubated to protect airway and admitted to the micu for further +management. extubated on [**11-24**] after 2 days with cuff leak. name2 (ni) **] does not have a +significant amount of atopy in personal history and has been +worked up, at least partially for c1 esterase deficiency with +c4. known lastname 44268**] - ([**telephone/fax (1) 44269**] (c), ([**telephone/fax (1) 44270**] +(h), ([**telephone/fax (1) 44271**] (cell phone of rev. [**","female with history of idiopathic urticaria and angioedema. unresponsive to h2 blocker, steroids, epinephrine and benadryl. extubated on [**11-24**] after 2 days with cuff leak." 28043,127710.0,14227,2176-08-07,14223,149969.0,2176-06-12,Discharge summary,"Admission Date: [**2176-6-3**] Discharge Date: [**2176-6-12**] @@ -115186,7 +117768,30 @@ signed: ","PRIMARY: [Septicemia due to pseudomonas] -SECONDARY: [Septic shock; Accidental puncture or laceration during a procedure, not elsewhere classified; Other suppurative peritonitis; Urinary tract infection, site not specified; Pulmonary congestion and hypostasis; Acute posthemorrhagic anemia; Rupture of bladder, nontraumatic; Severe sepsis; Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled; Atrial fibrillation; Personal history of malignant neoplasm of prostate; Long-term (current) use of insulin; Gross hematuria; Unspecified essential hypertension; Depressive disorder, not elsewhere classified; Mononeuritis of lower limb, unspecified; Late effect of radiation; ; Other specified antibiotics causing adverse effects in therapeutic use; Pressure ulcer, lower back; Pressure ulcer, heel; Pressure ulcer, stage II; Pressure ulcer, stage I; Candidiasis of skin and nails; Edema of male genital organs]" +SECONDARY: [Septic shock; Accidental puncture or laceration during a procedure, not elsewhere classified; Other suppurative peritonitis; Urinary tract infection, site not specified; Pulmonary congestion and hypostasis; Acute posthemorrhagic anemia; Rupture of bladder, nontraumatic; Severe sepsis; Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled; Atrial fibrillation; Personal history of malignant neoplasm of prostate; Long-term (current) use of insulin; Gross hematuria; Unspecified essential hypertension; Depressive disorder, not elsewhere classified; Mononeuritis of lower limb, unspecified; Late effect of radiation; ; Other specified antibiotics causing adverse effects in therapeutic use; Pressure ulcer, lower back; Pressure ulcer, heel; Pressure ulcer, stage II; Pressure ulcer, stage I; Candidiasis of skin and nails; Edema of male genital organs]","87 yo man with history of prostate cancer s/p xrt, prior bladder +rupture, and dementia who was treated in the [**hospital1 18**] micu for a +second bladder rupture, bladder rupture repair and suprapubic +catheter placement, uti, sepsis, and peritonitis who was +transfered to the medicine service for management of his +post-surgical pain, resolving peritonitis, delirium, and heart +rate control. # bladder rupture, urosepsis, peritonitis +. he was bolused with iv fluids overnight in the micu and went to +the or on the first hospital day. after the surgery, +the output from the jp drain continued to decrease. his surgical incision remained +clean, dry, and intact. he was +continued on his regimen of iv cefepim, vancomycin, and +gentamycin for 10 days to ensure adequate tx of his uti and +peritonitis, but was switched to solely cefepim coverage on +[**2176-6-12**] when the culture sensitivities returns. he had a picc +line placed on [**2176-6-12**] for the completion of his 14 day course +of cefepime. last name (stitle) 770**] +for in 2 weeks. 2176-6-7**] was the last time that the pt received zyprexa +for agitation/delirium, and he became alert and oriented to +person, hospital name, and month/year since [**6-9**] and has been at +his baseline since then (he has some known dementia). while in the hospital he had multiple +episodes of atrial fibrillation with rvr to 130-160s, typically +related to pain and stress. as he recovered from hypotension and sepsis, +his blood pressure came up. for now he has a feed rate of 40ml/hr but his goal is 60ml/hr. instrucitons are to hold for residuals over 150ml.","87 yo man with history of prostate cancer s/p xrt, prior bladder rupture, and dementia. treated in the micu for a second bladder rupture, bladder rupture repair and suprapubic catheter placement, uti, sepsis, and peritonitis. post-operatively, he was treated with iv morphine and acetaminophen for pain control." 28043,127710.0,14227,2176-08-07,14224,135417.0,2176-07-04,Discharge summary,"Admission Date: [**2176-6-17**] Discharge Date: [**2176-7-4**] @@ -115679,7 +118284,17 @@ was started on asa 81 mg daily prior to admission. blood pressure control was good on this regimen. ","PRIMARY: [Meningitis, unspecified] -SECONDARY: [Grand mal status; Acute kidney failure, unspecified; Acute respiratory failure; Acidosis; Other complications due to other internal prosthetic device, implant, and graft; ; Atrial fibrillation; ; Other urinary incontinence; Hypotension, unspecified; Peripheral vascular disease, unspecified; Benign essential hypertension; Anemia of other chronic disease; Hyperpotassemia; Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled; Pressure ulcer, lower back; Pressure ulcer, unspecified stage; Brachial plexus lesions; Neuralgia, neuritis, and radiculitis, unspecified; Other acquired deformities of ankle and foot; Aortic valve disorders; Other persistent mental disorders due to conditions classified elsewhere; Other postprocedural status; Personal history of malignant neoplasm of prostate; Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits; Personal history of Methicillin resistant Staphylococcus aureus; Long-term (current) use of insulin; Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure]" +SECONDARY: [Grand mal status; Acute kidney failure, unspecified; Acute respiratory failure; Acidosis; Other complications due to other internal prosthetic device, implant, and graft; ; Atrial fibrillation; ; Other urinary incontinence; Hypotension, unspecified; Peripheral vascular disease, unspecified; Benign essential hypertension; Anemia of other chronic disease; Hyperpotassemia; Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled; Pressure ulcer, lower back; Pressure ulcer, unspecified stage; Brachial plexus lesions; Neuralgia, neuritis, and radiculitis, unspecified; Other acquired deformities of ankle and foot; Aortic valve disorders; Other persistent mental disorders due to conditions classified elsewhere; Other postprocedural status; Personal history of malignant neoplasm of prostate; Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits; Personal history of Methicillin resistant Staphylococcus aureus; Long-term (current) use of insulin; Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure]","in summary an 87 year-old man with history of atrial +fibrillation, diabetes mellitus ii, dementia, history of +prostate cancer s/p xrt c/b bladder rupture x2 with recent +surgical repair, mdr utis, who presents from rehab with altered +mental status. he had a leukocytosis of 23 with neutrophilic +predominance at admission. eeg showed possible non-convulsive status epilepticus while in +the intensive care unit. he was loaded on phenytoin and levels were followed +until therapeutic. # acute renal failure: his creatinine was up to 2.3 during this +admission from previous baseline 0.5-1.0. this was thought +secondary to gentamicin toxicity during prior admission or +possibly precipitated by infection/sepsis. # diabetes mellitus ii: bood sugars were stable. blood pressure control was good on this regimen.","mdr utis presented from rehab with altered mental status. he had a leukocytosis of 23 with neutrophilic predominance at admission. he was treated empirically for meningitis with ceftriaxone, vancomycin, and bactrim." 28043,135417.0,14224,2176-07-04,14223,149969.0,2176-06-12,Discharge summary,"Admission Date: [**2176-6-3**] Discharge Date: [**2176-6-12**] @@ -116368,7 +118983,30 @@ signed: ","PRIMARY: [Septicemia due to pseudomonas] -SECONDARY: [Septic shock; Accidental puncture or laceration during a procedure, not elsewhere classified; Other suppurative peritonitis; Urinary tract infection, site not specified; Pulmonary congestion and hypostasis; Acute posthemorrhagic anemia; Rupture of bladder, nontraumatic; Severe sepsis; Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled; Atrial fibrillation; Personal history of malignant neoplasm of prostate; Long-term (current) use of insulin; Gross hematuria; Unspecified essential hypertension; Depressive disorder, not elsewhere classified; Mononeuritis of lower limb, unspecified; Late effect of radiation; ; Other specified antibiotics causing adverse effects in therapeutic use; Pressure ulcer, lower back; Pressure ulcer, heel; Pressure ulcer, stage II; Pressure ulcer, stage I; Candidiasis of skin and nails; Edema of male genital organs]" +SECONDARY: [Septic shock; Accidental puncture or laceration during a procedure, not elsewhere classified; Other suppurative peritonitis; Urinary tract infection, site not specified; Pulmonary congestion and hypostasis; Acute posthemorrhagic anemia; Rupture of bladder, nontraumatic; Severe sepsis; Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled; Atrial fibrillation; Personal history of malignant neoplasm of prostate; Long-term (current) use of insulin; Gross hematuria; Unspecified essential hypertension; Depressive disorder, not elsewhere classified; Mononeuritis of lower limb, unspecified; Late effect of radiation; ; Other specified antibiotics causing adverse effects in therapeutic use; Pressure ulcer, lower back; Pressure ulcer, heel; Pressure ulcer, stage II; Pressure ulcer, stage I; Candidiasis of skin and nails; Edema of male genital organs]","87 yo man with history of prostate cancer s/p xrt, prior bladder +rupture, and dementia who was treated in the [**hospital1 18**] micu for a +second bladder rupture, bladder rupture repair and suprapubic +catheter placement, uti, sepsis, and peritonitis who was +transfered to the medicine service for management of his +post-surgical pain, resolving peritonitis, delirium, and heart +rate control. # bladder rupture, urosepsis, peritonitis +. he was bolused with iv fluids overnight in the micu and went to +the or on the first hospital day. after the surgery, +the output from the jp drain continued to decrease. his surgical incision remained +clean, dry, and intact. he was +continued on his regimen of iv cefepim, vancomycin, and +gentamycin for 10 days to ensure adequate tx of his uti and +peritonitis, but was switched to solely cefepim coverage on +[**2176-6-12**] when the culture sensitivities returns. he had a picc +line placed on [**2176-6-12**] for the completion of his 14 day course +of cefepime. last name (stitle) 770**] +for in 2 weeks. 2176-6-7**] was the last time that the pt received zyprexa +for agitation/delirium, and he became alert and oriented to +person, hospital name, and month/year since [**6-9**] and has been at +his baseline since then (he has some known dementia). while in the hospital he had multiple +episodes of atrial fibrillation with rvr to 130-160s, typically +related to pain and stress. as he recovered from hypotension and sepsis, +his blood pressure came up. for now he has a feed rate of 40ml/hr but his goal is 60ml/hr. instrucitons are to hold for residuals over 150ml.","87 yo man with history of prostate cancer s/p xrt, prior bladder rupture, and dementia. treated in the micu for a second bladder rupture, bladder rupture repair and suprapubic catheter placement, uti, sepsis, and peritonitis. post-operatively, he was treated with iv morphine and acetaminophen for pain control." 28223,121068.0,12930,2190-09-12,12929,187916.0,2190-05-30,Discharge summary,"Admission Date: [**2190-5-20**] Discharge Date: [**2190-5-30**] @@ -116982,7 +119620,22 @@ well as a hospital bed and vna. # communication: wife [**name (ni) 382**] [**name (ni) **] [**telephone/fax (1) 39715**]. # ","PRIMARY: [Atherosclerosis of native arteries of the extremities with gangrene] -SECONDARY: [Acute respiratory failure; Urinary tract infection, site not specified; Chronic diastolic heart failure; Acute kidney failure, unspecified; Malignant essential hypertension; Drug-induced delirium; Hyperosmolality and/or hypernatremia; Congestive heart failure, unspecified; Chronic kidney disease, unspecified; Other specified analgesics and antipyretics causing adverse effects in therapeutic use; Other nonspecific abnormal serum enzyme levels; Pure hypercholesterolemia; Gout, unspecified; Anemia of other chronic disease; Atrial fibrillation; Cardiac pacemaker in situ; Pneumoconiosis due to other silica or silicates; Other amputation stump complication]" +SECONDARY: [Acute respiratory failure; Urinary tract infection, site not specified; Chronic diastolic heart failure; Acute kidney failure, unspecified; Malignant essential hypertension; Drug-induced delirium; Hyperosmolality and/or hypernatremia; Congestive heart failure, unspecified; Chronic kidney disease, unspecified; Other specified analgesics and antipyretics causing adverse effects in therapeutic use; Other nonspecific abnormal serum enzyme levels; Pure hypercholesterolemia; Gout, unspecified; Anemia of other chronic disease; Atrial fibrillation; Cardiac pacemaker in situ; Pneumoconiosis due to other silica or silicates; Other amputation stump complication]","89yo gentleman with dementia, htn, pvd, cad, afib (s/p ppm for +tachy-brady syndrome), and ckd who admitted with gangrenous toe, +found to have mental status changes upon arrival to the floor. # acute renal failure on chronic renal insufficiency/ acute on +chronic diastolic heart failure: +patients baseline creatinine ranges 1.5-2.0. he was kept in the hospital after the +angiogram for diuresis. he will likely need to be put back on +40mg lasix daily once his lower extremity has improved.** the patient should follow-up with dr. [** the trigger for his elevated bps was not clear, though +his systolic blood pressure was noted to be elevated 150s-170s +even before he became acutely hypertensive to 200 and was +transferred to the ccu. his metoprolol was increased and he was started on norvasc. his blood pressure regimen should continue to be adjusted as +needed as an outpatient. he +had a ruq ultrasound that showed gallstones but no evidence of +cholecystitis. his asa, +atorvastatin, and metoprolol were continued. his coumadin was initially held in anticipation of angiography. # dementia/delirium: +after his extubation, the patient was felt to be at his baseline +as discussed above.","89yo gentleman with dementia, htn, pvd, cad, afib, and ckd admitted with gangrenous toe. he was found to have mental status changes upon arrival to the floor. within 48 hours of intubation, the patient self-extubated during a spontaneous breathing trial." 28259,111485.0,12626,2188-10-02,12610,113482.0,2188-09-08,Discharge summary,"Admission Date: [**2188-8-21**] Discharge Date: [**2188-9-8**] Date of Birth: [**2111-12-1**] Sex: M @@ -117342,7 +119995,14 @@ conversion. patient recently had ablation in [**6-29**]. pacemaker placement not an ideal option as patient will require multiple mri for meningioma resection follow-up. - ","PRIMARY: [Benign neoplasm of cerebral meninges] -SECONDARY: [Cerebral edema; Atrial flutter; Hemorrhage complicating a procedure; Unspecified protein-calorie malnutrition; Injury to bladder and urethra, without mention of open wound into cavity; Hyperosmolality and/or hypernatremia; Atrial fibrillation; Sinoatrial node dysfunction; Congestive heart failure, unspecified; ; Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled; Unspecified essential hypertension; Unspecified acquired hypothyroidism; Esophageal reflux; Osteoarthrosis, localized, not specified whether primary or secondary, lower leg; Long-term (current) use of anticoagulants; Unspecified accident; Personal history of irradiation, presenting hazards to health; Personal history of tobacco use; Anemia, unspecified; Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation]" +SECONDARY: [Cerebral edema; Atrial flutter; Hemorrhage complicating a procedure; Unspecified protein-calorie malnutrition; Injury to bladder and urethra, without mention of open wound into cavity; Hyperosmolality and/or hypernatremia; Atrial fibrillation; Sinoatrial node dysfunction; Congestive heart failure, unspecified; ; Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled; Unspecified essential hypertension; Unspecified acquired hypothyroidism; Esophageal reflux; Osteoarthrosis, localized, not specified whether primary or secondary, lower leg; Long-term (current) use of anticoagulants; Unspecified accident; Personal history of irradiation, presenting hazards to health; Personal history of tobacco use; Anemia, unspecified; Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation]","patient was electively admitted on [**8-21**] for a planned surgical +resection and esthetic reconstruction of his left cranium for +recurrent meningioma. this was done +uneventfully, and surgery proceded. on [**8-27**]: back into afib on esmolol. on [**2188-8-29**], +patient was transferred from trauma sicu to medicine cardiology +service. on the +morning of [**2188-8-30**], patient was given metoprolol iv 5mg x1 for +atrial flutter with heart rate in 130s.","patient had several episodes of atrial fibrillation with rapid ventricular response. he was started on an amiodarone drip and diltiazem drips which eventually converted him. on [**2188-8-30**], patient was given metoprolol iv 5mg x1 for atrial flutter." 28933,118513.0,21653,2170-08-07,21652,190604.0,2170-04-20,Discharge summary,"Admission Date: [**2170-4-7**] Discharge Date: [**2170-4-20**] Date of Birth: [**2136-7-24**] Sex: M @@ -117729,7 +120389,15 @@ of admission was negative for additional pe. his home lovenox was continued. ","PRIMARY: [Pneumococcal septicemia [Streptococcus pneumoniae septicemia]] -SECONDARY: [Pneumococcal pneumonia [Streptococcus pneumoniae pneumonia]; Septic shock; Unspecified pleural effusion; Iatrogenic pneumothorax; Complications of transplanted bone marrow; Other primary cardiomyopathies; Hyposmolality and/or hyponatremia; Severe sepsis; Unspecified essential hypertension]" +SECONDARY: [Pneumococcal pneumonia [Streptococcus pneumoniae pneumonia]; Septic shock; Unspecified pleural effusion; Iatrogenic pneumothorax; Complications of transplanted bone marrow; Other primary cardiomyopathies; Hyposmolality and/or hyponatremia; Severe sepsis; Unspecified essential hypertension]","patient presented to outpatient clinic with hypotension and +tachycardia. attempted stabilization on floor, but then +admitted to the icu for management. patient was +aggressively volume resuscitated with improvement in his bp and +hr. the pt +developed a small ptx as a result of the thoracentesis however +he was asymptomatic with this and it improved with supportive +care. prophylaxis with bactrim, acyclovir, and posaconazole +was continued. #hypertension: the pts metoprolol was held on arrival to icu.","patient presented to outpatient clinic with hypotension and tachycardia. attempted stabilization on floor, but then admitted to the icu for management. impression on admission was for sepsis. patient was aggressively volume resuscitated with improvement in his bp and hr." 28999,128539.0,16343,2179-03-03,16341,118414.0,2178-11-10,Discharge summary,"Admission Date: [**2178-11-2**] Discharge Date: [**2178-11-10**] Date of Birth: [**2116-7-30**] Sex: M @@ -117997,7 +120665,9 @@ wednesday (one week post op). his follow up appts are detailed in the discharge instructions. ","PRIMARY: [Obstructive hydrocephalus] -SECONDARY: [Secondary malignant neoplasm of brain and spinal cord; Other specified visual disturbances; Unspecified sleep apnea; Personal history of malignant neoplasm of renal pelvis; Personal history of irradiation, presenting hazards to health]" +SECONDARY: [Secondary malignant neoplasm of brain and spinal cord; Other specified visual disturbances; Unspecified sleep apnea; Personal history of malignant neoplasm of renal pelvis; Personal history of irradiation, presenting hazards to health]","the patient is a 62 year-old male who presented with tactile +tumor and renal cell carcinoma and hydrocephalus. last name (stitle) **] about his sutent and megace in +the peri-operative phase.",a 62 year-old male presented with tactile tumor and renal cell carcinoma and hydrocephalus. he underwent a vp shunt successfully and was taken back to the recovery room. he was noted to be neurologically improved from his preoperative condition. 29035,152710.0,17989,2154-02-11,17959,124081.0,2153-10-03,Discharge summary,"Admission Date: [**2153-10-1**] [**Month/Day/Year **] Date: [**2153-10-3**] Date of Birth: [**2089-12-13**] Sex: F @@ -118281,7 +120951,13 @@ the lasix dose was increased while she was hospitalized. ","PRIMARY: [Unspecified pleural effusion] -SECONDARY: [Acidosis; Urinary tract infection, site not specified; Kidney replaced by transplant; Liver replaced by transplant; Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled; Background diabetic retinopathy; Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled; Polyneuropathy in diabetes; Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled; Epilepsy, unspecified, without mention of intractable epilepsy; Unspecified essential hypertension; Esophageal reflux; Obstructive sleep apnea (adult)(pediatric)]" +SECONDARY: [Acidosis; Urinary tract infection, site not specified; Kidney replaced by transplant; Liver replaced by transplant; Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled; Background diabetic retinopathy; Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled; Polyneuropathy in diabetes; Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled; Epilepsy, unspecified, without mention of intractable epilepsy; Unspecified essential hypertension; Esophageal reflux; Obstructive sleep apnea (adult)(pediatric)]","63 y/o female s/p liver/kidney [**month/day/year **] who returns with +ongoing issues of vague abdominal pain and also some dyspnea. on [**10-2**] she underwent a thoracentesis and [**2144**] cc clear straw +colored drainage was removed by the interventional pulmonology +team. the patient was transferred to the regular surgical floor and +continued to feel subjectively better with decreasing o2 +requirements, and by post procedure day one she was on room air +with no evidence of desats and routinely 94% on room air. she continues to atelectasis on the right.",63 y/o female s/p liver/kidney returns with ongoing issues of vague abdominal pain and dyspnea. she presented with low grade fever and dyspnea and was de-satting into the high 80s. she received iv lasix with good resulting urine output. 29035,152710.0,17989,2154-02-11,17958,108831.0,2153-08-21,Discharge summary,"Admission Date: [**2153-7-9**] [**Month/Day/Year **] Date: [**2153-8-21**] Date of Birth: [**2089-12-13**] Sex: F @@ -118662,7 +121338,17 @@ requiring some supplementation via [**location 40056**]. ","PRIMARY: [Other specified disorders of stomach and duodenum] -SECONDARY: [End stage renal disease; Hemorrhage of gastrointestinal tract, unspecified; Portal hypertension; Esophageal varices in diseases classified elsewhere, without mention of bleeding; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease; Other ascites; Unspecified pleural effusion; Pneumonia, organism unspecified; Urinary tract infection, site not specified; Other complications due to renal dialysis device, implant, and graft; Paroxysmal ventricular tachycardia; Hepatic encephalopathy; ; Cardiac arrest; Cirrhosis of liver without mention of alcohol; Other chronic nonalcoholic liver disease; Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled; Polyneuropathy in diabetes; Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled; Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled; Background diabetic retinopathy; Anemia in chronic kidney disease; Epilepsy, unspecified, without mention of intractable epilepsy; Esophageal reflux; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site; Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation]" +SECONDARY: [End stage renal disease; Hemorrhage of gastrointestinal tract, unspecified; Portal hypertension; Esophageal varices in diseases classified elsewhere, without mention of bleeding; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease; Other ascites; Unspecified pleural effusion; Pneumonia, organism unspecified; Urinary tract infection, site not specified; Other complications due to renal dialysis device, implant, and graft; Paroxysmal ventricular tachycardia; Hepatic encephalopathy; ; Cardiac arrest; Cirrhosis of liver without mention of alcohol; Other chronic nonalcoholic liver disease; Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled; Polyneuropathy in diabetes; Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled; Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled; Background diabetic retinopathy; Anemia in chronic kidney disease; Epilepsy, unspecified, without mention of intractable epilepsy; Esophageal reflux; Obstructive sleep apnea (adult)(pediatric); Dysthymic disorder; Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site; Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation]","63 y/o female with nash cirrhosis, c/b portal hypertension, +grade [**2-9**] esophageal varices s/p tips, encephalopathy, recurrent +pleural effusions requiring weekly thoracentesis, and esrd on hd +who was admitted with gi bleed. egd showed clotted blood and +known varices/gastropathy with no active bleeding. ? # fever: patient was intermittently febrile while on the +medicine service prior to [**month/day (2) **]. received +liver/kidney [**month/year (2) **].because she was highly sensitized, she +received plasmapheresis and thymoglobulin. # nash cirrhosis: on the medicine service, patient was continued +on lactulose, rifaximin, midodrine, ursodiol, nadolol and +bactrim ds for sbp prophylaxis prior to [**month/year (2) **]. splenectomy was +also done to assist with increased pra for the kidney.","63 y/o female with nash cirrhosis, c/b portal hypertension, grade [**2-9**] esophageal varicies s/p tips, encephalopathy, recurrent pleural effusions requiring weekly thoracentesis, and esrd on hd who was admitted with gi bleed. presented with melenotic stools and hematocrit drop unresponsive to transfusion " 29035,108831.0,17958,2153-08-21,17957,115770.0,2153-05-16,Discharge summary,"Admission Date: [**2153-5-14**] [**Year/Month/Day **] Date: [**2153-5-16**] Date of Birth: [**2089-12-13**] Sex: F @@ -119007,7 +121693,18 @@ this hospitalization code status: confimred full code ","PRIMARY: [Acute edema of lung, unspecified] -SECONDARY: [Unspecified pleural effusion; Portal hypertension; End stage renal disease; Esophageal varices in diseases classified elsewhere, without mention of bleeding; Acute respiratory failure; Cirrhosis of liver without mention of alcohol; Other chronic nonalcoholic liver disease; Other iatrogenic hypotension; Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation; Obstructive sleep apnea (adult)(pediatric); Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled; Polyneuropathy in diabetes; Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled; Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled; Background diabetic retinopathy; Esophageal reflux; Anemia in chronic kidney disease]" +SECONDARY: [Unspecified pleural effusion; Portal hypertension; End stage renal disease; Esophageal varices in diseases classified elsewhere, without mention of bleeding; Acute respiratory failure; Cirrhosis of liver without mention of alcohol; Other chronic nonalcoholic liver disease; Other iatrogenic hypotension; Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation; Obstructive sleep apnea (adult)(pediatric); Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled; Polyneuropathy in diabetes; Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled; Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled; Background diabetic retinopathy; Esophageal reflux; Anemia in chronic kidney disease]","63 f with cirrhosis, esrd s/p thoracentesis who presents with +hypoxia and hypotension in setting likely re-expansion pulmonary +edema +. # hypotension- patient back to baseline, suspect transient +hypotension in setting volume shifts after thoracentesis. # cirrhosis- on transplant list +- encephalopathy- continued lactulose and rifaximin +- sbp- h/o prior sbp, continued bactrim ds ppx +- ascites- off diuretics, intermittent pc as indicated, none +this hospitalization +- varices- nadolol +- anemia- cont ppi +.","cirrhosis, esrd s/p thoracentesis who presents with hypoxia and hypotension in setting likely re-expansion pulmonary edema. she should have future thoracentesis by interventional pulmonary in order to follow trans pulmonary pressures to avoid re-expansion pulmonary edema." 29495,182822.0,23427,2126-01-30,23403,152287.0,2125-11-13,Discharge summary,"Admission Date: [**2125-11-6**] Discharge Date: [**2125-11-13**] Date of Birth: [**2062-4-14**] Sex: F @@ -119375,7 +122072,15 @@ gas pattern with gas in the sigmoid colon. by pod2, the pt was passing flatus and her distention had reduced. ","PRIMARY: [Other postoperative infection] -SECONDARY: [Septicemia due to escherichia coli [E. coli]; Severe sepsis; Septic shock; Defibrination syndrome; Cardiac complications, not elsewhere classified; Atrial fibrillation; ; Cardiac pacemaker in situ; Unspecified essential hypertension; Calculus of kidney]" +SECONDARY: [Septicemia due to escherichia coli [E. coli]; Severe sepsis; Septic shock; Defibrination syndrome; Cardiac complications, not elsewhere classified; Atrial fibrillation; ; Cardiac pacemaker in situ; Unspecified essential hypertension; Calculus of kidney]","here for semi-elective ureteroscopy and laser lithotripsy for +>1cm renal pelvis stone. by the end of pod1, blood cx grew out gnr +in the anaerobic bottle, resistant to ceftriaxone, cipro, levo. pod4, vanc and flagyl were +discontinued and the pt was maintained on meropenem until +discharge, after cultures grew e.coli with extended resistance, +but susceptibility to [**last name (un) 2830**] and ertapenem. the day of discharge +pod7, the pt received one dose of ertapenem in house; it was +arranged for her to receive daily dosing as an outpatient. follow up after antibiotics with urology was arranged. by the following morning, after being diuresed with iv lasix, +the pt was on 4l via nasal cannula and sating 95-100%. gi: on pod1, the pt complained of moderate lower abdominal pain.","pre-op vs were t 99.1, p 71, bp 149/80, rr 20, 100% on ra. post-operatively she was hypertensive with bp 190/100 which responded to 5mg iv labetalol. at 2100 she was febrile to 101.8 and had severe nausea and vomiting." 30341,121351.0,30890,2145-07-31,30889,174592.0,2145-06-18,Discharge summary,"Admission Date: [**2145-5-28**] Discharge Date: [**2145-6-18**] Date of Birth: [**2084-3-2**] Sex: M @@ -119817,7 +122522,17 @@ was initiated via his port. he also had an elevated inr that was likely nutritional, and improved with vitamin k. ","PRIMARY: [Drug induced neutropenia] -SECONDARY: [Pneumonia, organism unspecified; Malignant neoplasm of liver, secondary; Secondary malignant neoplasm of lung; Candidiasis of mouth; Acute kidney failure, unspecified; ; Malignant neoplasm of other specified part of esophagus; Bacteremia; Dehydration; Anemia, unspecified; ; Atrial fibrillation; Other stomatitis and mucositis (ulcerative); Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use; Abnormal coagulation profile; Diarrhea; Pneumococcus infection in conditions classified elsewhere and of unspecified site; Unilateral paralysis of vocal cords or larynx, partial; Unspecified essential hypertension; Other and unspecified noninfectious gastroenteritis and colitis]" +SECONDARY: [Pneumonia, organism unspecified; Malignant neoplasm of liver, secondary; Secondary malignant neoplasm of lung; Candidiasis of mouth; Acute kidney failure, unspecified; ; Malignant neoplasm of other specified part of esophagus; Bacteremia; Dehydration; Anemia, unspecified; ; Atrial fibrillation; Other stomatitis and mucositis (ulcerative); Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use; Abnormal coagulation profile; Diarrhea; Pneumococcus infection in conditions classified elsewhere and of unspecified site; Unilateral paralysis of vocal cords or larynx, partial; Unspecified essential hypertension; Other and unspecified noninfectious gastroenteritis and colitis]","pneumococcal infection: while the patient was neutropenic, he +was febrile once. cultures were sent and he was started on +empiric cefepime. this +resolved rapidly and he returned to the floor. his anc continued to +trend down during admission until he became severely +neutropenic. a ct chest done +a few days later noted some transverse colitis, although he was +asymptomatic. esophageal cancer: on admission, he was day 9 status post +chemotherapy. nutrition: due to poor pos, ppn was started as there was not +enough access for tpn in the patients chest port due to +antibiotics and iv fluids.",mucositis: unable to tolerate po and was resuscitated with ivf. acute renal failure: essentially doubled from low baseline of 0.4-0.7. thrombocytopenia: secondary to chemotherapy. 30659,123675.0,13337,2146-03-26,13336,110439.0,2145-12-24,Discharge summary,"Admission Date: [**2145-12-20**] Discharge Date: [**2145-12-24**] Date of Birth: [**2087-12-9**] Sex: F @@ -120174,7 +122889,13 @@ insulin as needed. . ","PRIMARY: [Other complications due to other vascular device, implant, and graft] -SECONDARY: [Acute kidney failure, unspecified; Other ascites; Diastolic heart failure, unspecified; ; Urinary tract infection, site not specified; Hyposmolality and/or hyponatremia; Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation; Other iatrogenic hypotension; Cirrhosis of liver without mention of alcohol; Congestive heart failure, unspecified; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified; Chronic kidney disease, unspecified; Chronic hepatitis C without mention of hepatic coma; Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled; Hyperpotassemia; Asthma, unspecified type, unspecified; Dysthymic disorder; Esophageal reflux; Obstructive sleep apnea (adult)(pediatric); Epilepsy, unspecified, without mention of intractable epilepsy; ; Long-term (current) use of insulin]" +SECONDARY: [Acute kidney failure, unspecified; Other ascites; Diastolic heart failure, unspecified; ; Urinary tract infection, site not specified; Hyposmolality and/or hyponatremia; Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation; Other iatrogenic hypotension; Cirrhosis of liver without mention of alcohol; Congestive heart failure, unspecified; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified; Chronic kidney disease, unspecified; Chronic hepatitis C without mention of hepatic coma; Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled; Hyperpotassemia; Asthma, unspecified type, unspecified; Dysthymic disorder; Esophageal reflux; Obstructive sleep apnea (adult)(pediatric); Epilepsy, unspecified, without mention of intractable epilepsy; ; Long-term (current) use of insulin]","a 57 yo woman with hcv cirrhosis s/p tips is transferred from +osh with refractory ascites for consideration of tips revision. given the history of +apparent improvement in ascites after placement and subsequently +after revision of tips, she underwent tips revision with 10 mm +balloon and improved flow. diuretics were held +for elevated creatinine. urinary sodium was <10, consistent with prerenal vs +hrs. # pancytopenia: hematocrit and platelets were at baseline.","a 57 yo woman with hcv cirrhosis s/p tips is transferred from osh with refractory ascites for consideration of tips revision. ultrasound showed lack of wall-to-wall flow in the mid to distal tips, suggestive of neo-intimal hyperplasia. she underwent tips revision with 10 mm balloon and improved flow. follow-up us two days later showed patent tips." 31692,116133.0,19351,2186-07-02,19350,174449.0,2186-04-13,Discharge summary,"Admission Date: [**2186-3-10**] Discharge Date: [**2186-4-13**] Date of Birth: [**2130-11-30**] Sex: M @@ -120725,7 +123446,20 @@ playing tricks on him. he was started on risperidone 1mg po bid with prn haldol for agitation. ","PRIMARY: [Obstructive chronic bronchitis with acute bronchitis] -SECONDARY: [Pneumonia due to Pseudomonas; Acute posthemorrhagic anemia; Pneumonia, organism unspecified; Acidosis; Other pulmonary embolism and infarction; Pathologic fracture of other specified site; Sarcoidosis; Lung involvement in other diseases classified elsewhere; Obstructive sleep apnea (adult)(pediatric); Unspecified viral hepatitis C without hepatic coma; Other dependence on machines, supplemental oxygen; Third or oculomotor nerve palsy, partial; Dysthymic disorder; Spinal stenosis, unspecified region; Constipation, unspecified; Encounter for palliative care; Other disorders of muscle, ligament, and fascia; Other chronic pulmonary heart diseases; Hypoxemia; Other chronic pain; Other abnormal glucose; Adrenal cortical steroids causing adverse effects in therapeutic use; Osteoporosis, unspecified]" +SECONDARY: [Pneumonia due to Pseudomonas; Acute posthemorrhagic anemia; Pneumonia, organism unspecified; Acidosis; Other pulmonary embolism and infarction; Pathologic fracture of other specified site; Sarcoidosis; Lung involvement in other diseases classified elsewhere; Obstructive sleep apnea (adult)(pediatric); Unspecified viral hepatitis C without hepatic coma; Other dependence on machines, supplemental oxygen; Third or oculomotor nerve palsy, partial; Dysthymic disorder; Spinal stenosis, unspecified region; Constipation, unspecified; Encounter for palliative care; Other disorders of muscle, ligament, and fascia; Other chronic pulmonary heart diseases; Hypoxemia; Other chronic pain; Other abnormal glucose; Adrenal cortical steroids causing adverse effects in therapeutic use; Osteoporosis, unspecified]","#shortness of breath / viral bronchitis / sarcoidosis / anxiety +mr. [** as the patient had had recent bleeding with +rectus sheath hematomas, anticoagulation was not started.his +outpt pulmonologist was made aware and agreed with holding off +on anticoagulation. he will be followed +closely as an outpt with dr. [** sputum culture was +obtained which was notable for multidrug-resistant pseudomonas. heparin at a lower dose of 5000 [**hospital1 **] was +restarted. #fall +the patient fell on [**2186-4-6**] while toileting. #pain medication issues +the patient was seen by nursing to be saving pain medication for +his daughter. # mental status +the patient is typically fully oriented, though he had frequent +periods where he was unsure of surroundings. he was started on risperidone 1mg po bid +with prn haldol for agitation.","mr. [**known lastname 52653**] was admitted with worsening sob and lower oxygen saturations. this was not felt to be a flare of sarcoidosis but more likely a viral infection on top of severe underlying lung disease caused by sarcoid. he was 97% on 6l nc and shovel mask mist support, slightly tachypnic." 31969,151726.0,21685,2110-05-14,21684,116681.0,2109-12-27,Discharge summary,"Admission Date: [**2109-12-23**] Discharge Date: [**2109-12-27**] Date of Birth: [**2033-9-7**] Sex: F @@ -121104,7 +123838,16 @@ restarted on discharge. # code: full ","PRIMARY: [Acute kidney failure, unspecified] -SECONDARY: [Other specified aplastic anemias; Hyposmolality and/or hyponatremia; Acidosis; Hypovolemia; Personal history of venous thrombosis and embolism; Personal history of malignant neoplasm of other gastrointestinal tract; Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use; Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled; Epistaxis; Unspecified essential hypertension; Aortic valve disorders; Long-term (current) use of anticoagulants]" +SECONDARY: [Other specified aplastic anemias; Hyposmolality and/or hyponatremia; Acidosis; Hypovolemia; Personal history of venous thrombosis and embolism; Personal history of malignant neoplasm of other gastrointestinal tract; Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use; Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled; Epistaxis; Unspecified essential hypertension; Aortic valve disorders; Long-term (current) use of anticoagulants]","a/p: 76 yo f w/ h/o pancreatic cancer, currently receiving +chemotherapy who presented with fever and hypotension requiring +pressors: pt initially admitted to icu for r/o sepsis. she was started on levophed in the ed and +after 12 hours in icu levofed was successfully weaned and bp was +stable. also received 1 unit platelets (see below). because cx +data was negative cipro and flagyl were discontinued on the day +that she was called out from the micu. # hx of pe: treated with coumadin at home. was +transfused 1 unit of platelets (nadir value was 40 with +bleeding), with resolution of epistaxis. therefore, given enoxaparin daily injections with +plan for outpt inr checks.",pt with mildly positive ua and no other clear source of infection was admitted to icu for r/o sepsis. she was started on levophed in the ed and after 12 hours in icu levofed was successfully weaned and bp was stable. pt was continued on home viokase for pancreatic enzyme replacement and immodium and lomotil for chronic diarrhea. 32247,113222.0,15732,2122-09-29,15731,180961.0,2122-09-17,Discharge summary,"Admission Date: [**2122-9-11**] Discharge Date: [**2122-9-17**] Date of Birth: [**2059-1-8**] Sex: F @@ -121358,7 +124101,13 @@ pre-hospitalization. next hd saturday [**9-20**]. stable per renal. ","PRIMARY: [Other specified disorders of intestine] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease; ; Acidosis; Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled; Atrial fibrillation; Hypotension, unspecified; ]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease; ; Acidosis; Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled; Atrial fibrillation; Hypotension, unspecified; ]","63 y/o female s/p failed kidney transplant in past and recent +admission for she now returns with abdominal pain. she was taken to the or +with dr [**first name8 (namepattern2) **] [**last name (namepattern1) **]. multiple diverticula are noted throughout the +left-sided colon as well +as 1 or 2 small diverticula in the small bowel, but again no +evidence of perforation, no gangrenous changes, no pneumatosis +was identified. she was extubated on pod 1 and remained stable thereafter.","63 y/o female s/p failed kidney transplant in past and recent admission. ct scan showed portal venous air and pneumatosis involving the right colon. no evidence of perforation, gangrenous changes, pneumatosis or gangrenous changes." 32247,127308.0,15733,2122-12-31,15732,113222.0,2122-09-29,Discharge summary,"Admission Date: [**2122-9-22**] Discharge Date: [**2122-9-29**] Date of Birth: [**2059-1-8**] Sex: F @@ -121764,7 +124513,18 @@ sleep study to evaluate sleep apnea. ","PRIMARY: [Toxic encephalopathy] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease; Acidosis; Kidney replaced by transplant; Other postoperative infection; Angioneurotic edema, not elsewhere classified; Diabetes with renal manifestations, type II or unspecified type, uncontrolled; Other convulsions; Abdominal pain, left lower quadrant; Other chronic pain; Atrial fibrillation; Apnea; Benzodiazepine-based tranquilizers causing adverse effects in therapeutic use; Diabetes with other specified manifestations, type II or unspecified type, uncontrolled; Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation; Other iatrogenic hypotension; Abnormal coagulation profile; Other and unspecified hyperlipidemia; Osteoarthrosis, unspecified whether generalized or localized, site unspecified; ; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Tracheostomy status; Gastrostomy status; Other postprocedural status]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease; Acidosis; Kidney replaced by transplant; Other postoperative infection; Angioneurotic edema, not elsewhere classified; Diabetes with renal manifestations, type II or unspecified type, uncontrolled; Other convulsions; Abdominal pain, left lower quadrant; Other chronic pain; Atrial fibrillation; Apnea; Benzodiazepine-based tranquilizers causing adverse effects in therapeutic use; Diabetes with other specified manifestations, type II or unspecified type, uncontrolled; Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation; Other iatrogenic hypotension; Abnormal coagulation profile; Other and unspecified hyperlipidemia; Osteoarthrosis, unspecified whether generalized or localized, site unspecified; ; Personal history of venous thrombosis and embolism; Long-term (current) use of anticoagulants; Tracheostomy status; Gastrostomy status; Other postprocedural status]","altered mental status/seizure/intubation: most likely +etiology is multiple missed hemodialysis sessions/uremia. she was evaluated by +neurology and was given ativan and depakote for complex partial +seizure. angioedema/respiratory failure: her tongue was noted to be +swollen prior to the administration of depakote during +suctioning prior to intubation. it is recommended she have an outpatient +sleep study to evaluate for obstructive sleep apnea as well as +an outpatient allergy evaluation. she was dialyzed daily in the micu from [**date range (1) 45316**] +then returned to her scheduled of t/t/saturday. atrial fibrillation: rate control with metoprolol. her inr will need to be followed in +rehabilitation and outpatient monitoring set up prior to +discharge home. her staples were removed by the surgical +team during this hospitalization.",most likely etiology is multiple missed hemodialysis sessions/uremia. she was given ativan and depakote for complex partial seizure. she was intubated for airway protection due to angioedema. 32247,127308.0,15733,2122-12-31,15730,105172.0,2122-09-10,Discharge summary,"Admission Date: [**2122-9-3**] Discharge Date: [**2122-9-10**] Date of Birth: [**2059-1-8**] Sex: F @@ -122097,7 +124857,15 @@ warfarin was restarted and heparin was stopped due to a therapeutic inr of 2.2. ","PRIMARY: [Altered mental status] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease; Urinary tract infection, site not specified; Complications of transplanted kidney; Other complications due to renal dialysis device, implant, and graft; Acute venous embolism and thrombosis of unspecified deep vessels of lower extremity; Epilepsy, unspecified, without mention of intractable epilepsy; Long-term (current) use of anticoagulants; Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled; Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation; Other and unspecified hyperlipidemia; ; Personal history of noncompliance with medical treatment, presenting hazards to health; Other specified cardiac dysrhythmias; Osteoarthrosis, unspecified whether generalized or localized, site unspecified; ]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease; Urinary tract infection, site not specified; Complications of transplanted kidney; Other complications due to renal dialysis device, implant, and graft; Acute venous embolism and thrombosis of unspecified deep vessels of lower extremity; Epilepsy, unspecified, without mention of intractable epilepsy; Long-term (current) use of anticoagulants; Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled; Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation; Other and unspecified hyperlipidemia; ; Personal history of noncompliance with medical treatment, presenting hazards to health; Other specified cardiac dysrhythmias; Osteoarthrosis, unspecified whether generalized or localized, site unspecified; ]","1) altered mental status: pt with similar presentations in the +past. her arms were +clutched to her chest in fists and her eyes were deviated to the +left. she +remained confused and agitated, and her somnolence increased. she +was transferred to the micu for observation, received iv haldol +for agitation, and was called out the next day as she remained +stable. once ct head showed no bleed, her heparin was +continued.","pt was initially treated with cipro for a suspected uti, but stopped on day 2. she was given 1 mg of ativan and remained disoriented and somnolent. her mental status improved and she was a&ox3 at discharge, although likely with some chronic cognitive deficits." 32247,113222.0,15732,2122-09-29,15730,105172.0,2122-09-10,Discharge summary,"Admission Date: [**2122-9-3**] Discharge Date: [**2122-9-10**] Date of Birth: [**2059-1-8**] Sex: F @@ -122430,7 +125198,15 @@ warfarin was restarted and heparin was stopped due to a therapeutic inr of 2.2. ","PRIMARY: [Altered mental status] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease; Urinary tract infection, site not specified; Complications of transplanted kidney; Other complications due to renal dialysis device, implant, and graft; Acute venous embolism and thrombosis of unspecified deep vessels of lower extremity; Epilepsy, unspecified, without mention of intractable epilepsy; Long-term (current) use of anticoagulants; Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled; Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation; Other and unspecified hyperlipidemia; ; Personal history of noncompliance with medical treatment, presenting hazards to health; Other specified cardiac dysrhythmias; Osteoarthrosis, unspecified whether generalized or localized, site unspecified; ]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease; Urinary tract infection, site not specified; Complications of transplanted kidney; Other complications due to renal dialysis device, implant, and graft; Acute venous embolism and thrombosis of unspecified deep vessels of lower extremity; Epilepsy, unspecified, without mention of intractable epilepsy; Long-term (current) use of anticoagulants; Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled; Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation; Other and unspecified hyperlipidemia; ; Personal history of noncompliance with medical treatment, presenting hazards to health; Other specified cardiac dysrhythmias; Osteoarthrosis, unspecified whether generalized or localized, site unspecified; ]","1) altered mental status: pt with similar presentations in the +past. her arms were +clutched to her chest in fists and her eyes were deviated to the +left. she +remained confused and agitated, and her somnolence increased. she +was transferred to the micu for observation, received iv haldol +for agitation, and was called out the next day as she remained +stable. once ct head showed no bleed, her heparin was +continued.","pt was initially treated with cipro for a suspected uti, but stopped on day 2. she was given 1 mg of ativan and remained disoriented and somnolent. her mental status improved and she was a&ox3 at discharge, although likely with some chronic cognitive deficits." 32247,127308.0,15733,2122-12-31,15731,180961.0,2122-09-17,Discharge summary,"Admission Date: [**2122-9-11**] Discharge Date: [**2122-9-17**] Date of Birth: [**2059-1-8**] Sex: F @@ -122684,7 +125460,13 @@ pre-hospitalization. next hd saturday [**9-20**]. stable per renal. ","PRIMARY: [Other specified disorders of intestine] -SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease; ; Acidosis; Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled; Atrial fibrillation; Hypotension, unspecified; ]" +SECONDARY: [End stage renal disease; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease; ; Acidosis; Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled; Atrial fibrillation; Hypotension, unspecified; ]","63 y/o female s/p failed kidney transplant in past and recent +admission for she now returns with abdominal pain. she was taken to the or +with dr [**first name8 (namepattern2) **] [**last name (namepattern1) **]. multiple diverticula are noted throughout the +left-sided colon as well +as 1 or 2 small diverticula in the small bowel, but again no +evidence of perforation, no gangrenous changes, no pneumatosis +was identified. she was extubated on pod 1 and remained stable thereafter.","63 y/o female s/p failed kidney transplant in past and recent admission. ct scan showed portal venous air and pneumatosis involving the right colon. no evidence of perforation, gangrenous changes, pneumatosis or gangrenous changes." 40526,101343.0,18227,2123-06-06,18226,100456.0,2123-05-25,Discharge summary,"Admission Date: [**2123-4-26**] Discharge Date: [**2123-5-25**] Date of Birth: [**2091-8-18**] Sex: F @@ -123075,7 +125857,17 @@ reviewed with the patient and all questions answered. she will follow up with dr. [**last name (stitle) 1120**] in [**11-20**] weeks. ","PRIMARY: [Regional enteritis of small intestine with large intestine] -SECONDARY: [Peritoneal abscess; Other candidiasis of other specified sites; Peritonitis (acute) generalized; Anorexia nervosa; Pulmonary collapse; Unspecified pleural effusion; Streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus; Arthropathy associated with gastrointestinal conditions other than infections; Obsessive-compulsive disorders; Dehydration; Iron deficiency anemia, unspecified; Other acute pain; Other chronic pain; Abdominal pain, right lower quadrant; Abdominal pain, left upper quadrant; Other specified cardiac dysrhythmias; Dysthymic disorder; Personal history of tobacco use; Long-term (current) use of steroids]" +SECONDARY: [Peritoneal abscess; Other candidiasis of other specified sites; Peritonitis (acute) generalized; Anorexia nervosa; Pulmonary collapse; Unspecified pleural effusion; Streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus; Arthropathy associated with gastrointestinal conditions other than infections; Obsessive-compulsive disorders; Dehydration; Iron deficiency anemia, unspecified; Other acute pain; Other chronic pain; Abdominal pain, right lower quadrant; Abdominal pain, left upper quadrant; Other specified cardiac dysrhythmias; Dysthymic disorder; Personal history of tobacco use; Long-term (current) use of steroids]","31f here with long-standing refractory crohns presenting with a +severe flare and intravascular depletion. - ivf resuscitation +- pain control with morphine 2-4mg iv prn +- broad spectrum abx + +. her pain medication was changed from morphine to dilaudid +with good effect. she was taken to ir for drain placement, 2 drains +placed for a total of 4 drains. her +tpn was cycled and with the return of bowel function and flatus +her diet was advanced from sips to regular. her tpn was d/cd +once she tolerated regular diet. last name (stitle) 1120**] in [**11-20**] weeks.",31f with long-standing refractory crohns presenting with a severe flare and intravascular depletion. evaluated by surgery in ed and upon admission to [**hospital unit name 153**]. received iv vancomycin/zosyn. per gi to continue hydrcortisone 100 mg qdaily. 40577,144014.0,18944,2144-12-23,18943,135411.0,2144-12-04,Discharge summary,"Admission Date: [**2144-11-8**] Discharge Date: [**2144-12-4**] Date of Birth: [**2092-8-6**] Sex: M @@ -123452,7 +126244,21 @@ discharge. proph: hep sq tid. gi prophylaxis ceased upon tolerance of tf. ","PRIMARY: [Open fracture of shaft of ulna (alone)] -SECONDARY: [; Open wound of knee, leg [except thigh], and ankle, with tendon involvement; Acute posthemorrhagic anemia; Injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum; Traumatic shock; Acute kidney failure with lesion of tubular necrosis; Pneumonia due to other gram-negative bacteria; Mechanical complication due to other implant and internal device, not elsewhere classified; Other postoperative infection; Cellulitis and abscess of upper arm and forearm; Hyperosmolality and/or hypernatremia; Other motor vehicle traffic accident involving collision with motor vehicle injuring motorcyclist; Closed dislocation of wrist, unspecified part; Open Monteggia's fracture; Open wound of abdominal wall, lateral, complicated; Morbid obesity; Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation; Bariatric surgery status; Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation; Chronic kidney disease, unspecified; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified; Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation; Open wound of nose, unspecified site, complicated; Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled; Congestive heart failure, unspecified; Obstructive sleep apnea (adult)(pediatric); Psoriatic arthropathy]" +SECONDARY: [; Open wound of knee, leg [except thigh], and ankle, with tendon involvement; Acute posthemorrhagic anemia; Injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum; Traumatic shock; Acute kidney failure with lesion of tubular necrosis; Pneumonia due to other gram-negative bacteria; Mechanical complication due to other implant and internal device, not elsewhere classified; Other postoperative infection; Cellulitis and abscess of upper arm and forearm; Hyperosmolality and/or hypernatremia; Other motor vehicle traffic accident involving collision with motor vehicle injuring motorcyclist; Closed dislocation of wrist, unspecified part; Open Monteggia's fracture; Open wound of abdominal wall, lateral, complicated; Morbid obesity; Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation; Bariatric surgery status; Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation; Chronic kidney disease, unspecified; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified; Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation; Open wound of nose, unspecified site, complicated; Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled; Congestive heart failure, unspecified; Obstructive sleep apnea (adult)(pediatric); Psoriatic arthropathy]","52yo m brought to [**hospital1 18**] by ambulance as a trauma basic. a dpl was +attempted and was not confirmatory for the absence of +hemoperitoneum. accordingly, he was brought to the operating +room for exploratory laparotomy which did not reveal an +intraabdominal injury, as well as washout/debridement of his bl +ue injuries by orthopedics; please see each operative report for +further details. neuro: sedation and analgesia provided by drips during +intubation, weaned after tracheotomy. he did have an enterobacter pna on hd 15, resistant to +zosyn/cephalosporins, which was treated with a 7-day course of +cipro iv and tobramycin inhaled. one +additional attempt at diuresis on hd 25 caused sl increase in +creatinine and further attempts have been put on hold. msk: bl open monteggia fractures washed out on hd 1, r fixed +with orif on hd 2, l fixed with orif on hd 3. r knee +degloving injury was washed out by ortho on hd 1, wrapped, and +stitched eventually removed.","52yo m brought to trauma bay by ambulance as a trauma basic. evaluation demonstrated persistent hypotension which mildly improved with ivf resuscitation and 3u prbc transfusion, despite a negative fast examination. post-operatively he was brought to the tsicu, intubated and sedated, and hemodynamically stable." 43122,168271.0,13574,2101-06-13,13573,180308.0,2101-05-19,Discharge summary,"Admission Date: [**2101-5-12**] Discharge Date: [**2101-5-19**] @@ -123735,7 +126541,13 @@ exception of verapamil, were re-started shortly after surgery and were continued during her hospital course. ","PRIMARY: [Chronic or unspecified duodenal ulcer with perforation, without mention of obstruction] -SECONDARY: [Unspecified peritonitis; Cellulitis and abscess of upper arm and forearm; Cardiac complications, not elsewhere classified; Other specified disorders of peritoneum; Unspecified essential hypertension; Depressive disorder, not elsewhere classified; Chronic obstructive asthma, unspecified; Tachycardia, unspecified; Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation; Atrial fibrillation]" +SECONDARY: [Unspecified peritonitis; Cellulitis and abscess of upper arm and forearm; Cardiac complications, not elsewhere classified; Other specified disorders of peritoneum; Unspecified essential hypertension; Depressive disorder, not elsewhere classified; Chronic obstructive asthma, unspecified; Tachycardia, unspecified; Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation; Atrial fibrillation]","*)duodenal ulcer +she was taken to the operating room, where a 4mm defect in the +pyloroduodenal area was noted. *)tachycardia +her post-operative course was complicated by tachycardia, which +was initially thought to be atrial fibrillation. she was +discharged to a rehabilitation facility to continue her +post-operative recovery.",a 4mm defect in the pyloroduodenal area was noted. the defect was repaired and reinforced with an omental patch. she was discharged on a course of bactrim to complete 7 days of antibiotics. 43126,132026.0,23429,2124-09-26,23428,124079.0,2124-08-17,Discharge summary,"Admission Date: [**2124-3-1**] Discharge Date: [**2124-8-17**] Date of Birth: [**2067-4-22**] Sex: M @@ -125435,7 +128247,75 @@ encouraged to eat and drink. if food and drink is put in front of him he will eat it. ","PRIMARY: [Other malignant lymphomas, unspecified site, extranodal and solid organ sites] -SECONDARY: [Acute kidney failure, unspecified; Toxic encephalopathy; Other specified septicemias; Sepsis; Hepatic encephalopathy; Chronic lymphoid leukemia, without mention of having achieved remission; Other complications due to other vascular device, implant, and graft; Acute venous embolism and thrombosis of superficial veins of upper extremity; Complications of transplanted bone marrow; Acute graft-versus-host disease; Bacteremia; Unspecified pleural effusion; Other ascites; Urinary tract infection, site not specified; Acute venous embolism and thrombosis of subclavian veins; Alkalosis; Meningitis due to adenovirus; Hemorrhage of gastrointestinal tract, unspecified; Portal hypertension; Hyposmolality and/or hyponatremia; Toxic myopathy; Other disorders of neurohypophysis; Candidiasis of mouth; Other specified erythematous conditions; Diarrhea; Neutropenia, unspecified; Fever presenting with conditions classified elsewhere; Hepatitis, unspecified; Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use; Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus]; Infection with microorganisms without mention of resistance to multiple drugs; Streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus; Human herpesvirus 6 infection; Other specified viral infection; Microscopic hematuria; ; Pure hypercholesterolemia; Unspecified essential hypertension]" +SECONDARY: [Acute kidney failure, unspecified; Toxic encephalopathy; Other specified septicemias; Sepsis; Hepatic encephalopathy; Chronic lymphoid leukemia, without mention of having achieved remission; Other complications due to other vascular device, implant, and graft; Acute venous embolism and thrombosis of superficial veins of upper extremity; Complications of transplanted bone marrow; Acute graft-versus-host disease; Bacteremia; Unspecified pleural effusion; Other ascites; Urinary tract infection, site not specified; Acute venous embolism and thrombosis of subclavian veins; Alkalosis; Meningitis due to adenovirus; Hemorrhage of gastrointestinal tract, unspecified; Portal hypertension; Hyposmolality and/or hyponatremia; Toxic myopathy; Other disorders of neurohypophysis; Candidiasis of mouth; Other specified erythematous conditions; Diarrhea; Neutropenia, unspecified; Fever presenting with conditions classified elsewhere; Hepatitis, unspecified; Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use; Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus]; Infection with microorganisms without mention of resistance to multiple drugs; Streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus; Human herpesvirus 6 infection; Other specified viral infection; Microscopic hematuria; ; Pure hypercholesterolemia; Unspecified essential hypertension]","known lastname **] is a 56-year-old male with history of cll with large +cell transformation who was admitted for a scheduled allogeneic +mud sct on [**2124-3-10**]. he was discharged to [**hospital1 **] in stable condition +with symptomatic improvement. his initial transplant +proceeded without incident. biopsies of the sigmoid and rectum +were non-diagnostic but consistent with gvhd. steroid taper +was ultimately unsuccessful with patient requiring +methylprednisolone 25 mg in am and 20 mg in pm. the cefepime was switched to meropenem and derm was +once again consulted on [**5-31**]. cultures remained negative and no source was identified. he was +started on linezolid and cefepime. his ij was removed as was his +picc line for access. the fevers resolved as did the bacteremia. # fevers - the patient again became febrile on [**5-31**]. he had no +symptoms and his vital signs remained stable. # hhv6 infection: the patient spiked a fever [**3-27**] when he was +no longer neutropenic and he developed a splotchy and evanescent +rash, which disappeared within 24 hours. blood +cultures eventually grew strep milleri. the patient was treated +with vancomycin initially and then switched to ceftazadime and +flagyl and then to cefepime per id recommendations. # bk virus: in early [**month (only) **], while the patient was on multiple +immunosuppressant medications for gvhd, he developed dysuria, +difficulty voiding and hematuria. on [**6-13**] the patients mental +status worsened. an mri was conducted which showed no pathology that +would account for the mental status change. he +is also on steroids and mycophenolate and received etanercept. on [**6-11**] nifedipine was stopped due to low blood +pressures. he had a hickmann tunnelled +catheter which was removed because it was non-functional. pt had recent vre bacteremia, +after central line placement, the midline was removed and sent +for culture. mri shows possible embolic infarcts which raises +concern for endocarditis as another possible source of sepsis. tsh was low normal ruling out hypothyroid myxedema. not likely dilutional +(plts, wbc increased). [** month (only) 116**] be related to blood draws vs +bleeding. the diarrhea improved significantly +on tincture of opium, however this caused the patient to become +confused. he was switched to lomotil which has alleviated the +diarrhea somewhat. during +his most recent episode on [**2124-7-12**], his blood pressure also +dropped to 90/60, and he was started on meropenem and daptomycin +because of the possibility of sepsis. the patients blood +pressure improved with boluses and antibiotics. = += += += += += += += += += += += += += += += += += += += += +================================================================ +from [**2124-7-17**] to [**2124-8-17**] (date of discharge) +1. increased tbili: this was thought to be gvhd vs drug effect. pt was +to get an mri abdomen but was unable to sit still long enough to +get it, therefore was sent for ct abdomen with and without +contrast [**2124-7-18**], which showed an interval increase in his +ascites, increase in his pleural effusions l>r, and chronic +ileal wall thickening c/w gvhd. acyclovir was added +on and continued at discharge. concurrent with this was hypothermia and +hypotension. an lp performed on [**7-14**] was non diagnostic and +all viral studies from that procedure were negative. it was questioned whether he was +sleeping on that arm which led to its swelling. if steroids can be tapered, he may be able to regain his +strength.","mr. [**known lastname **] is a 56-year-old male with history of cll with large cell transformation. his course was complicated by febrile neutropenia and acute gvhd involving the intestinal tract, liver and skin. he was discharged to [**hospital1 **] in stable condition with symptomatic improvement." 43147,180640.0,12752,2127-03-27,12751,161625.0,2127-03-09,Discharge summary,"Admission Date: [**2127-3-3**] Discharge Date: [**2127-3-9**] @@ -125819,7 +128699,15 @@ ionized calcium was wnl and stable. ","PRIMARY: [Pneumonitis due to inhalation of food or vomitus] -SECONDARY: [Acute respiratory failure; Septic shock; Severe sepsis; Hyposmolality and/or hyponatremia; Alkalosis; Hypocalcemia; Anemia in chronic kidney disease; Unspecified essential hypertension; Alzheimer's disease; Dementia in conditions classified elsewhere without behavioral disturbance; Benign neoplasm of pituitary gland and craniopharyngeal duct; Unspecified acquired hypothyroidism; Other late effects of cerebrovascular disease; Long-term (current) use of aspirin]" +SECONDARY: [Acute respiratory failure; Septic shock; Severe sepsis; Hyposmolality and/or hyponatremia; Alkalosis; Hypocalcemia; Anemia in chronic kidney disease; Unspecified essential hypertension; Alzheimer's disease; Dementia in conditions classified elsewhere without behavioral disturbance; Benign neoplasm of pituitary gland and craniopharyngeal duct; Unspecified acquired hypothyroidism; Other late effects of cerebrovascular disease; Long-term (current) use of aspirin]","89f with shock and respiratory failure likely from pna. patient had recent aca stroke +and failed speach and swallow and not thought to be a good +candidate for tube feeds but the family wanted to continue to +feed her, putting her at high risk for aspiration. - pt was started on vanco/zosyn for hap given recent hospital +stay and current living situation in the rehab. - bronchoalveolar lavage sample showed 4+ pmns, cmv culture +negative to date, andrespiratory cultures negative. ct abdomen and pelvis was done, which +showed no abscesses or specific source of bacteremia. it should be followed up by the rehab +facility. # thyroid: pt with goiter and low tsh in setting of pit +macroadenoma; free t4 was wnl.","89f with shock and respiratory failure likely from pna. family wanted to continue to feed her, putting her at high risk for aspiration. she was intubated on presentation to the hospital and then extubated successfully." 43529,172162.0,16873,2115-09-26,16872,194815.0,2115-08-23,Discharge summary,"Admission Date: [**2115-8-20**] Discharge Date: [**2115-8-23**] Date of Birth: [**2032-12-31**] Sex: M @@ -126327,7 +129215,22 @@ baseline creatinine of 1.7 during the course of the admission. ","PRIMARY: [Congestive heart failure, unspecified] -SECONDARY: [Pneumonia, organism unspecified; Urinary tract infection, site not specified; Acute on chronic diastolic heart failure; Atrial fibrillation; Gout, unspecified; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified; Chronic kidney disease, unspecified; Venous (peripheral) insufficiency, unspecified; Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS); Other and unspecified hyperlipidemia; Hematuria, unspecified; Coronary atherosclerosis of native coronary artery; Long-term (current) use of anticoagulants]" +SECONDARY: [Pneumonia, organism unspecified; Urinary tract infection, site not specified; Acute on chronic diastolic heart failure; Atrial fibrillation; Gout, unspecified; Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified; Chronic kidney disease, unspecified; Venous (peripheral) insufficiency, unspecified; Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS); Other and unspecified hyperlipidemia; Hematuria, unspecified; Coronary atherosclerosis of native coronary artery; Long-term (current) use of anticoagulants]","assessment and plan: 82 year old man with history of cad s/p +pcta 15 years ago, diastolic chf with history of fluid overload +on lasix, atrial fibrillation on coumadin with recent admission +for retinal occlusion, admitted with dyspnea on exertion, +hypoxia, and fever and transferred to the icu due to increasing +oxygen requirements. consequently, he was treated +for community acquired pneumonia with azithromycin and +ceftriaxone/cefpodoxime for a total five day course to end on +[**2115-8-24**]. in addition, tte showed new lv dilation likely causing +more severe mr [**first name (titles) **] [**last name (titles) **] with preserved lvef (although this is +likely over-estimated in mr) consistent with acute exacerbation +of his diastolic chf. # pump: patient has history of diastolic dysfunction and has had +episodes of fluid overload treated with oral lasix in the past. tte on this admission revealed new lv dilation and worsening of +his mr with pulmonary artery hypertension, likely related to his +acute fluid overload. he is unable to tolerate ace inhibitors or beta +blockers. # hyperlipidemia: continued home dose of statin.","82 year old man with history of cad s/p pcta 15 years ago admitted with dyspnea on exertion, hypoxia, and fever. admitted with evidence of volume overload on exam, on cxr, and with an elevated bnp. he was treated for community acquired pneumonia with azithromycin and ceftriaxone/cefpodoxime." 47733,175486.0,21693,2151-04-24,21692,162330.0,2151-03-28,Discharge summary,"Admission Date: [**2151-3-7**] Discharge Date: [**2151-3-28**] Date of Birth: [**2111-7-13**] Sex: M @@ -126875,7 +129778,20 @@ code: full colde ","PRIMARY: [Paroxysmal ventricular tachycardia] -SECONDARY: [Chronic systolic heart failure; Ebstein's anomaly; Acute respiratory failure; Pneumonitis due to inhalation of food or vomitus; Cardiogenic shock; Acute and subacute necrosis of liver; Acute kidney failure with lesion of tubular necrosis; Iatrogenic pneumothorax; Ventilator associated pneumonia; Congestive heart failure, unspecified; Hyposmolality and/or hyponatremia; Alkalosis; Closed fracture of two ribs; Cardiac arrest; Other iatrogenic hypotension; Other specified misadventures during medical care; Other and unspecified hyperlipidemia; Unspecified essential hypertension; Obstructive sleep apnea (adult)(pediatric); Mitral valve disorders; Obesity, unspecified; Anemia, unspecified; Venous (peripheral) insufficiency, unspecified; Gout, unspecified; Personal history of venous thrombosis and embolism; Personal history of thrombophlebitis; Other postprocedural status]" +SECONDARY: [Chronic systolic heart failure; Ebstein's anomaly; Acute respiratory failure; Pneumonitis due to inhalation of food or vomitus; Cardiogenic shock; Acute and subacute necrosis of liver; Acute kidney failure with lesion of tubular necrosis; Iatrogenic pneumothorax; Ventilator associated pneumonia; Congestive heart failure, unspecified; Hyposmolality and/or hyponatremia; Alkalosis; Closed fracture of two ribs; Cardiac arrest; Other iatrogenic hypotension; Other specified misadventures during medical care; Other and unspecified hyperlipidemia; Unspecified essential hypertension; Obstructive sleep apnea (adult)(pediatric); Mitral valve disorders; Obesity, unspecified; Anemia, unspecified; Venous (peripheral) insufficiency, unspecified; Gout, unspecified; Personal history of venous thrombosis and embolism; Personal history of thrombophlebitis; Other postprocedural status]","39m w/ pmh of ebsteins anomaly, s/p tricuspid valve +reconstruction, right and left sided systolic congestive heart +failure, presenting with unstable ventricular tachycardia, s/p +resuscitation with return to sinus tachycardia, s/p intubation +and extubation. patient underwent cpr and intubation with +return to normal sinus rhythm. had cardiac mri with final read as +above. last name (stitle) **] in [**2-12**] weeks to discuss possible +icd placement in the future. initially primarily +hypoxemic, with unclear etiology. improvement with nitric +oxide suggested some shunt physiology, although intracardiac +shunt was not evident on tee. respiratory failure improved with +diuresis. #gout: patient as outpatient on colchicine and allopurinol +although patient not taking allopurinol at home. fen: regular cardiac diet, replete lytes prn +.","39m w/ pmh of ebsteins anomaly, s/p tricuspid valve reconstruction, right and left sided systolic congestive heart failure. patient underwent cpr and intubation with return to normal sinus rhythm. suppressed ectopy with amiodarone. also started metoprolol for rate-control." 49081,140192.0,14375,2161-11-27,14374,127653.0,2161-11-05,Discharge summary,"Admission Date: [**2161-10-18**] Discharge Date: [**2161-11-5**] Date of Birth: [**2099-7-2**] Sex: M @@ -127414,7 +130330,17 @@ patient was sent to the micu on that day. code- full ","PRIMARY: [Malignant pleural effusion] -SECONDARY: [Human immunodeficiency virus [HIV] disease; Pneumonia, organism unspecified; Acute kidney failure with lesion of tubular necrosis; Malignant neoplasm of upper lobe, bronchus or lung; Secondary malignant neoplasm of bone and bone marrow; Alkalosis; Mixed acid-base balance disorder; Hyperosmolality and/or hypernatremia; Other specified gastritis, without mention of hemorrhage; Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus; Vestibular neuronitis; Unspecified essential hypertension; Unspecified gastritis and gastroduodenitis, without mention of hemorrhage; Cyst of kidney, acquired; Lumbago; Unspecified adjustment reaction; Unspecified condition of brain; Esophageal reflux; Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH]; Constipation, unspecified; Other drugs and medicinal substances causing adverse effects in therapeutic use; Depressive disorder, not elsewhere classified]" +SECONDARY: [Human immunodeficiency virus [HIV] disease; Pneumonia, organism unspecified; Acute kidney failure with lesion of tubular necrosis; Malignant neoplasm of upper lobe, bronchus or lung; Secondary malignant neoplasm of bone and bone marrow; Alkalosis; Mixed acid-base balance disorder; Hyperosmolality and/or hypernatremia; Other specified gastritis, without mention of hemorrhage; Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus; Vestibular neuronitis; Unspecified essential hypertension; Unspecified gastritis and gastroduodenitis, without mention of hemorrhage; Cyst of kidney, acquired; Lumbago; Unspecified adjustment reaction; Unspecified condition of brain; Esophageal reflux; Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH]; Constipation, unspecified; Other drugs and medicinal substances causing adverse effects in therapeutic use; Depressive disorder, not elsewhere classified]","62 year old male with a h/o metastatic large cell lung cancer to +bone c/b recurrent malignant pleural effusion requiring pleurex +catheter placement, hiv (cd4 535) on haart, htn who presented +with dyspnea, unchanged pleural effusion on cxr and low grade +fever. # pleural effusion: drained by ip frequently throughout +hospitalization usually followed by improvement in dyspnea. see +above for pleural fluid analysis at discharge. # hypertension: controlled well with amlodpine + +# depression/suicidal ideation: iniatlly followed by pscyh for +question of suicidal ideation on admission but this appears to +have been a misunderstanding.",# pleural effusion drained by ip frequently throughout hospitalization. likely contrast induced nephropathy though elevation persisted longer than expected. # tachypnea/anxiety. patient was transferred to micu overnight. 51698,190004.0,23245,2142-03-09,23244,137588.0,2142-02-19,Discharge summary,"Admission Date: [**2142-2-13**] Discharge Date: [**2142-2-19**] Date of Birth: [**2072-4-9**] Sex: M @@ -127742,7 +130668,12 @@ pt was cleared to go to rehab on [**2142-2-19**] ","PRIMARY: [Subdural hemorrhage] -SECONDARY: [Compression of brain; Cerebral artery occlusion, unspecified with cerebral infarction; Pneumonia, organism unspecified; Hemiplegia, unspecified, affecting unspecified side; Acute venous embolism and thrombosis of deep vessels of proximal lower extremity; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism; Hip joint replacement; Other and unspecified hyperlipidemia; Unspecified essential hypertension; Obesity, unspecified]" +SECONDARY: [Compression of brain; Cerebral artery occlusion, unspecified with cerebral infarction; Pneumonia, organism unspecified; Hemiplegia, unspecified, affecting unspecified side; Acute venous embolism and thrombosis of deep vessels of proximal lower extremity; Long-term (current) use of anticoagulants; Personal history of venous thrombosis and embolism; Hip joint replacement; Other and unspecified hyperlipidemia; Unspecified essential hypertension; Obesity, unspecified]","known lastname 1794**] was admitted to [**hospital1 18**] under the care of dr [**first name (stitle) **]. he was extubated aorund noon on [**2142-2-14**]. the joint decision between +neurosurgery and hematology was to initiate anti-coagulation +approxiamtely 2 weeks after the sdh evacuation. the patient will f/u with the +neurology clinic for work up of hypercoagulability. kub +showed a decrease in air in small bowel and repeat head ct was +stable.",sputum cultures showed a left superficial femoral dvt that was either chronic or a new partially occlusive dvt. the patient has been on coumdain since then without a new diagnosis of dvt. hematology was consulted with regards to whether anticoagulation is warranted. 54610,122829.0,19216,2150-07-15,19215,100003.0,2150-04-21,Discharge summary,"Admission Date: [**2150-4-17**] Discharge Date: [**2150-4-21**] Date of Birth: [**2090-5-19**] Sex: M @@ -128041,7 +130972,10 @@ on prophylactic medications. # full code ","PRIMARY: [Acute gastric ulcer with hemorrhage, without mention of obstruction] -SECONDARY: [Acute posthemorrhagic anemia; Chronic hepatitis C without mention of hepatic coma; Cirrhosis of liver without mention of alcohol; Esophageal varices in diseases classified elsewhere, without mention of bleeding; Other specified disorders of stomach and duodenum; Unspecified essential hypertension; Unspecified gastritis and gastroduodenitis, without mention of hemorrhage; Edema]" +SECONDARY: [Acute posthemorrhagic anemia; Chronic hepatitis C without mention of hepatic coma; Cirrhosis of liver without mention of alcohol; Esophageal varices in diseases classified elsewhere, without mention of bleeding; Other specified disorders of stomach and duodenum; Unspecified essential hypertension; Unspecified gastritis and gastroduodenitis, without mention of hemorrhage; Edema]","mr [**known lastname 52368**] is a 59m w hcv cirrhosis w grade ii esophageal varices +admitted w coffee-ground emesis and melena concerning for ugib, +s/p micu stay for hypotension. pt did remember +taking increased doses of naproxen for backache.",mr [**known lastname 52368**] is a 59m w hcv cirrhosis w grade ii esophageal varices admitted w coffee-ground emesis and melena concerning for ugib. egd revealed erythema and erosion in the antrum and pylorus compatible with non-steroidal induced gastritis. started on pantoprazole 40mg po 54610,147673.0,19217,2150-12-28,19216,122829.0,2150-07-15,Discharge summary,"Admission Date: [**2150-7-13**] Discharge Date: [**2150-7-15**] Date of Birth: [**2090-5-19**] Sex: M @@ -128337,7 +131271,16 @@ urinalysis were negative. he was afebrile throughout hospital course. ","PRIMARY: [Chronic hepatitis C with hepatic coma] -SECONDARY: [Hyposmolality and/or hyponatremia; Hemorrhage of rectum and anus; Portal hypertension; Esophageal varices in diseases classified elsewhere, without mention of bleeding; Alcoholic cirrhosis of liver; Other and unspecified alcohol dependence, unspecified; Anemia, unspecified; Other specified disorders of stomach and duodenum; Unspecified gastritis and gastroduodenitis, without mention of hemorrhage; Unspecified essential hypertension; Tobacco use disorder]" +SECONDARY: [Hyposmolality and/or hyponatremia; Hemorrhage of rectum and anus; Portal hypertension; Esophageal varices in diseases classified elsewhere, without mention of bleeding; Alcoholic cirrhosis of liver; Other and unspecified alcohol dependence, unspecified; Anemia, unspecified; Other specified disorders of stomach and duodenum; Unspecified gastritis and gastroduodenitis, without mention of hemorrhage; Unspecified essential hypertension; Tobacco use disorder]","# concern for gi bleed - considering that the patient had stable +hematocrits after his admission to the hospital and that blood +was only found in his rectum on exam, it was felt that he was +not experiencing a significant gi bleed. he +is scheduled for an outpatient colonoscopy with dr. [** # altered mental status - the patient presented with a history +of unstable gait, a possible facial droop, and slurred speech of +questionable chronicity. # hepatitis c cirrhosis and worsening lfts - the most striking +change in the patients liver function tests was the increase in +his total and direct bilirubin. this could be progression of +cirrhosis as he failed interferon twice.","the patient had stable hematocrits after his admission to the hospital and that blood was only found in his rectum on exam. he was kept on an octreotide drip and an iv ppi overnight. his hematocrit remained stable overnight and he did not have any gi bleeding events. the following day, he was transferred to the floor and is scheduled for an outpatient colonoscopy." 61932,165934.0,15105,2159-07-20,15104,126267.0,2159-05-22,Discharge summary,"Admission Date: [**2159-5-7**] Discharge Date: [**2159-5-22**] Date of Birth: [**2093-11-29**] Sex: M @@ -128790,7 +131733,13 @@ appropriate rehab facility on [**2159-5-22**] with follow up scheduled in the brain tumor clinic. ","PRIMARY: [Secondary malignant neoplasm of brain and spinal cord] -SECONDARY: [Intracerebral hemorrhage; Secondary malignant neoplasm of lung; Secondary and unspecified malignant neoplasm of lymph nodes of axilla and upper limb; Iatrogenic cerebrovascular infarction or hemorrhage; Cerebral edema; Personal history of malignant melanoma of skin; Lack of coordination; Other musculoskeletal symptoms referable to limbs; Dysphagia, unspecified; Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation; Diverticulosis of colon (without mention of hemorrhage); Personal history of tobacco use]" +SECONDARY: [Intracerebral hemorrhage; Secondary malignant neoplasm of lung; Secondary and unspecified malignant neoplasm of lymph nodes of axilla and upper limb; Iatrogenic cerebrovascular infarction or hemorrhage; Cerebral edema; Personal history of malignant melanoma of skin; Lack of coordination; Other musculoskeletal symptoms referable to limbs; Dysphagia, unspecified; Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation; Diverticulosis of colon (without mention of hemorrhage); Personal history of tobacco use]","the patient was admitted to the neurosurgery service on [**5-7**]. on +[**5-9**] he went to the operating room for a left sided craniotomy +to resect the first of two brain lesions. post operatively, he was again transferred to the icu +for continued monitoring. the steroids were again +increased to 4mg qid; and to remain at this dose until wbr +therapy was initiated and could have this re-evaluated. on [**5-21**],he was transported to the [**hospital1 18**] [**hospital ward name **] to receive +mapping planning for wbr.",the patient underwent a left sided craniotomy to resect the first of two brain lesions. post operatively he was monitored in the icu for 24hrs without incident. he was evaluated by neuro-oncology and was scheduled for a brain clinic appointment. 65449,169230.0,9518,2193-01-21,9517,187354.0,2192-12-26,Discharge summary,"Admission Date: [**2192-12-23**] Discharge Date: [**2192-12-26**] Date of Birth: [**2168-10-28**] Sex: M @@ -129183,7 +132132,21 @@ eventually [**telephone/fax (3) **] ","PRIMARY: [Acute on chronic systolic heart failure] -SECONDARY: [Other primary cardiomyopathies; Jaundice, unspecified, not of newborn; Congestive heart failure, unspecified; Other chronic pulmonary heart diseases; Unspecified sleep apnea; Tachycardia, unspecified; Iron deficiency anemia, unspecified; Morbid obesity; Other chronic nonalcoholic liver disease; Unspecified disorder of liver; Leukocytosis, unspecified]" +SECONDARY: [Other primary cardiomyopathies; Jaundice, unspecified, not of newborn; Congestive heart failure, unspecified; Other chronic pulmonary heart diseases; Unspecified sleep apnea; Tachycardia, unspecified; Iron deficiency anemia, unspecified; Morbid obesity; Other chronic nonalcoholic liver disease; Unspecified disorder of liver; Leukocytosis, unspecified]","known lastname 32362**] is a 24 year old man with a history of non-ischemic +cardiomyopathy, nyh class ii chf, ef 15-20% who presents with +doe/sob over one month, acutely over one week. he was discharged to optimize his fluid status prior to +an aicd placement + +by problem +1. this improved somewhat with diuresis and improvement of +his respiratory status. both of these parameters were slightly above his +previous values though he doe have a known element of +non-alcoholic steatohepatitis (defined by alt/ast and us/ct +evidence of fatty infiltration). his negative transaminases and +elevated bilirubin (half direct, half indirect) were likely in +the setting of hepatic congestion and decreased cardiac output +during his heart failure exacerbation. leukocytosis: the patient had a mild leukocytosis that was +trending down at the time of discharge.","a 24-year-old man with a history of non-ischemic cardiomyopathy, nyh class ii chf, ef 15-20% who presents with doe/sob over one month, acutely over one week. he was diuresed with iv and then po lasix, achieving a net negative balance of 7 litres. he was discharged to optimize his fluid status prior to an aicd placement." 66256,187869.0,13112,2169-12-02,13111,166051.0,2169-11-28,Discharge summary,"Admission Date: [**2169-11-23**] Discharge Date: [**2169-11-28**] Date of Birth: [**2105-9-19**] Sex: F @@ -129502,7 +132465,13 @@ follow-up as an outpatient. ","PRIMARY: [] -SECONDARY: [Chronic obstructive asthma with (acute) exacerbation; Pneumonitis due to inhalation of food or vomitus; Pulmonary collapse; Other specified forms of effusion, except tuberculous; Other diseases of trachea and bronchus; Other chest pain; Atrial fibrillation; Sarcoidosis; Lung involvement in other diseases classified elsewhere; Obstructive sleep apnea (adult)(pediatric); Other chronic pain; Morbid obesity; Unspecified essential hypertension; Esophageal reflux; Diaphragmatic hernia without mention of obstruction or gangrene; Long-term (current) use of steroids; Personal history of tobacco use; Other artificial opening status]" +SECONDARY: [Chronic obstructive asthma with (acute) exacerbation; Pneumonitis due to inhalation of food or vomitus; Pulmonary collapse; Other specified forms of effusion, except tuberculous; Other diseases of trachea and bronchus; Other chest pain; Atrial fibrillation; Sarcoidosis; Lung involvement in other diseases classified elsewhere; Obstructive sleep apnea (adult)(pediatric); Other chronic pain; Morbid obesity; Unspecified essential hypertension; Esophageal reflux; Diaphragmatic hernia without mention of obstruction or gangrene; Long-term (current) use of steroids; Personal history of tobacco use; Other artificial opening status]","64f with osa, severe copd, and tbp s/p removal of y-stent [**11-23**] +who is admitted to the micu post-procedurally with left lung +collapse and evidence of mucus plugging and aspiration and +respiratory failure. on [**2168-11-23**] she had flexible bronchoscopy which +showed granulation tissue distal to lms occluding 75% of lunar. mechanical debridement of +granulation tissue, left main-stem. her diet was advanced and she +ambulated in the halls.","64f with osa, severe copd, and tbp s/p removal of y-stent. she was placed on cpap with aggressive pulmonary toileting, chest pt and mucolytics. she was given iv lopressor with spontaneous conversion to sinus rhythm." 66264,173568.0,9141,2103-01-15,9112,133806.0,2102-08-24,Discharge summary,"Admission Date: [**2102-8-14**] Discharge Date: [**2102-8-24**] Date of Birth: [**2061-5-10**] Sex: F @@ -130033,7 +133002,19 @@ will f/u with pt. note that pt is very reluctant to discuss some information with her caregivers. ","PRIMARY: [Universal ulcerative (chronic) colitis] -SECONDARY: [Acute combined systolic and diastolic heart failure; Other protein-calorie malnutrition; Other and unspecified postsurgical nonabsorption; Unspecified disease of pericardium; Cyst and pseudocyst of pancreas; Loss of weight; Anorexia; Bariatric surgery status; Dehydration; Calculus of gallbladder without mention of cholecystitis, without mention of obstruction; Hepatitis, unspecified; Congestive heart failure, unspecified; Unspecified essential hypertension; Other chronic pulmonary heart diseases; Precordial pain; Spondylosis of unspecified site, without mention of myelopathy; Myalgia and myositis, unspecified; Other specified cardiac dysrhythmias; Scoliosis [and kyphoscoliosis], idiopathic; Other iatrogenic hypotension; Other antihypertensive agents causing adverse effects in therapeutic use; Depressive disorder, not elsewhere classified; Internal hemorrhoids with other complication; Iron deficiency anemia, unspecified; Epilepsy, unspecified, without mention of intractable epilepsy; Other disorders of plasma protein metabolism]" +SECONDARY: [Acute combined systolic and diastolic heart failure; Other protein-calorie malnutrition; Other and unspecified postsurgical nonabsorption; Unspecified disease of pericardium; Cyst and pseudocyst of pancreas; Loss of weight; Anorexia; Bariatric surgery status; Dehydration; Calculus of gallbladder without mention of cholecystitis, without mention of obstruction; Hepatitis, unspecified; Congestive heart failure, unspecified; Unspecified essential hypertension; Other chronic pulmonary heart diseases; Precordial pain; Spondylosis of unspecified site, without mention of myelopathy; Myalgia and myositis, unspecified; Other specified cardiac dysrhythmias; Scoliosis [and kyphoscoliosis], idiopathic; Other iatrogenic hypotension; Other antihypertensive agents causing adverse effects in therapeutic use; Depressive disorder, not elsewhere classified; Internal hemorrhoids with other complication; Iron deficiency anemia, unspecified; Epilepsy, unspecified, without mention of intractable epilepsy; Other disorders of plasma protein metabolism]","the patient is a 41 year old female with seizure disorder, +gastrectomy, degenerative disc disease who presented with vague +gi complaints, weight loss, and admitted to ccu after an episode +of chest pain and she was found to have severe systolic/dystolic +function as well as tachycardia. ms.[**known lastname 31410**] +. random cortisol low normal and cortisone +stimulation test was normally responsive. pt is not orthostatic +or dizzy, is able to ambulate easily and denies any symptoms. on muscle relaxer at home and chronic narcotics +(roxicet) which pt states is ineffective. noted +increased filling pressures and furosemide and lasix po started. multiple viral tests performed, all negative except for +ebv and cmr which are pending. pt describes very +poor protein and calorie intake last 2 months. had +some rectal bleeding with stools recently, [**1-2**] hemmorhoids.","the patient is a 41 year old female with seizure disorder, gastrectomy, degenerative disc disease who presented with vague gi complaints. she was found to have severe systolic/dystolic function as well as tachycardia. she was discharged in good condition, with stable vital signs, with appropriate outpatient follow-up arranged." 66831,140947.0,8449,2130-07-27,8448,115882.0,2130-07-14,Discharge summary,"Admission Date: [**2130-7-10**] Discharge Date: [**2130-7-14**] Date of Birth: [**2047-4-25**] Sex: F @@ -130405,7 +133386,14 @@ and follow-up instructions with understanding verbalized and agreement with the discharge plan. ","PRIMARY: [Unspecified septicemia] -SECONDARY: [Septic shock; Cholangitis; Obstruction of bile duct; Malignant neoplasm of extrahepatic bile ducts; Chronic pancreatitis; Acute kidney failure, unspecified; Severe sepsis; Atrial fibrillation; Unspecified essential hypertension; Unspecified acquired hypothyroidism; Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled; Myasthenia gravis without (acute) exacerbation]" +SECONDARY: [Septic shock; Cholangitis; Obstruction of bile duct; Malignant neoplasm of extrahepatic bile ducts; Chronic pancreatitis; Acute kidney failure, unspecified; Severe sepsis; Atrial fibrillation; Unspecified essential hypertension; Unspecified acquired hypothyroidism; Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled; Myasthenia gravis without (acute) exacerbation]","the patient with a history of peri-ampullary cancer was admitted +from [**hospital1 **] [**location (un) 620**] ed to the sicu on [**2130-7-10**] in stable condition +for treatment of cholangitis. believed to be due to demand ischemia secondary to +hypotensive episode and/or sepsis. the +patient was extubated without events and transferred to the sicu +for continued management. at the time of discharge on [**2130-7-14**], the patient was doing well, +afebrile with stable vital signs. she will return for planned +whipple surgery [**2130-8-2**].","the patient with a history of peri-ampullary cancer was admitted to the sicu on [**2130-7-10**] in stable condition for treatment of cholangitis. she was made npo, started on iv fluids and iv cipro and flagyl, and a foley was placed. she then underwent ercp, which revealed distal migration of the pre-existing biliary stent in the major papill" 68140,112268.0,18626,2157-03-01,18625,190006.0,2157-02-16,Discharge summary,"Admission Date: [**2157-1-19**] Discharge Date: [**2157-2-16**] Date of Birth: [**2073-4-5**] Sex: M @@ -130905,7 +133893,21 @@ own. # type 2 dm: controlled with iss in house. ","PRIMARY: [Unspecified septicemia] -SECONDARY: [Septic shock; Acute kidney failure, unspecified; Urinary tract infection, site not specified; Acute venous embolism and thrombosis of deep vessels of proximal lower extremity; Acidosis; Hyposmolality and/or hyponatremia; Hyperosmolality and/or hypernatremia; Acute posthemorrhagic anemia; Pseudomonas infection in conditions classified elsewhere and of unspecified site; Malignant neoplasm of dome of urinary bladder; Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled; Gross hematuria; Unspecified essential hypertension; Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS); Retention of urine, unspecified; Severe sepsis; Other transfusion reaction; Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Hypoxemia; Other persistent mental disorders due to conditions classified elsewhere]" +SECONDARY: [Septic shock; Acute kidney failure, unspecified; Urinary tract infection, site not specified; Acute venous embolism and thrombosis of deep vessels of proximal lower extremity; Acidosis; Hyposmolality and/or hyponatremia; Hyperosmolality and/or hypernatremia; Acute posthemorrhagic anemia; Pseudomonas infection in conditions classified elsewhere and of unspecified site; Malignant neoplasm of dome of urinary bladder; Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled; Gross hematuria; Unspecified essential hypertension; Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS); Retention of urine, unspecified; Severe sepsis; Other transfusion reaction; Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Hypoxemia; Other persistent mental disorders due to conditions classified elsewhere]","83yo gentleman with h/o bladder cancer, recurrent utis, and +dementia called out from the micu for continuing treatment of +urosepsis. a foley catheter was placed at admission. ct to assess for invasion/ +lymph node involvement-> no clear evid of invasion or ln +involvement however mult lung nodules concerning for metastatic +disease. ct scan done for +staging as above showed dvt extended up to dvt filter. given +that he bled enough to require multiple transfusions during this +admission, it was ultimately felt that anticoagulation should be +held with the decision to re-start deferred to the outpatient +setting. he frequently became agitated, +pulling at his picc line and foley. he frequently required soft +restraints to prevent him from injuring himself and occasionally +required haldol (ecg checked and qtc wnl). # hypernatremia, mild, asymptomatic: likely [**1-25**] poor po water +intake.","83yo gentleman with h/o bladder cancer, recurrent utis, and dementia called out from the micu for continuing treatment of urosepsis. patient received 7 l ivf with improvement in blood pressure, never needed vasopressor support. he was started on meropenem given prior urine cx sensitivities." 73488,199332.0,17651,2169-12-09,17650,185762.0,2169-10-23,Discharge summary,"Admission Date: [**2169-10-14**] Discharge Date: [**2169-10-23**] Date of Birth: [**2130-2-9**] Sex: M @@ -131418,7 +134420,16 @@ disposition: home with iv antibiotics and vna service ","PRIMARY: [Pneumonia, organism unspecified] -SECONDARY: [Quadriplegia, unspecified; Acute respiratory failure; Other encephalopathy; Acute kidney failure, unspecified; Urinary tract infection, site not specified; Generalized convulsive epilepsy, with intractable epilepsy; Hyperosmolality and/or hypernatremia; ; Late effect of spinal cord injury; Late effects of motor vehicle accident; Myelodysplastic syndrome, unspecified; Obstructive sleep apnea (adult)(pediatric); Other specified cardiac dysrhythmias; Depressive disorder, not elsewhere classified; Hyperpotassemia; Chronic kidney disease, Stage II (mild); Pressure ulcer, heel; Pressure ulcer, stage II]" +SECONDARY: [Quadriplegia, unspecified; Acute respiratory failure; Other encephalopathy; Acute kidney failure, unspecified; Urinary tract infection, site not specified; Generalized convulsive epilepsy, with intractable epilepsy; Hyperosmolality and/or hypernatremia; ; Late effect of spinal cord injury; Late effects of motor vehicle accident; Myelodysplastic syndrome, unspecified; Obstructive sleep apnea (adult)(pediatric); Other specified cardiac dysrhythmias; Depressive disorder, not elsewhere classified; Hyperpotassemia; Chronic kidney disease, Stage II (mild); Pressure ulcer, heel; Pressure ulcer, stage II]","39 yom with h/o c5 quadriplegia, mds, and recurrent utis who was +transferred from osh for assessment of altered mental status and +uti. #seizures/ams: on [**2169-10-15**], pt had a generalized tonic clonic +seizure with hypoxia of 88% on ra. he was treated with iv ativan +and was subsequently post-ictal. eeg showed left mid to posterior temporal +theta slowing. his respiratory rate was [**5-1**]/min with periods of apnea. he continued bipap at night per his home regimen. patient will be discharged home with iv vancomycin and aztreonam +to finish a 10d course. the last day of the antibiotics will be +[**2169-10-26**]. according to records, this seems to +be his baseline. fen: d5w boluses d/t hypernatremia, repleted electrolytes, +advanced to normal diet after extubation.","39 yom with h/o c5 quadriplegia, mds, and recurrent utis was transferred from osh for assessment of altered mental status and uti. hospital course was complicated by hap and tonic clonic seizures. he was treated with iv ativan and subsequently noted to be hypoxic to 85% on 4l nasal cannula." 74562,138356.0,12886,2162-03-26,12885,116713.0,2162-03-13,Discharge summary,"Admission Date: [**2162-3-6**] Discharge Date: [**2162-3-13**] Date of Birth: [**2094-12-7**] Sex: M @@ -131731,7 +134742,10 @@ g-tube was placed. he should stay on aspirin 81mg until his coumadin becomes therapeutic (inr [**2-9**]). ","PRIMARY: [Cerebral embolism with cerebral infarction] -SECONDARY: [Chronic airway obstruction, not elsewhere classified; Dysphagia, unspecified; Coronary atherosclerosis of native coronary artery; Other and unspecified hyperlipidemia; Atrial fibrillation; Personal history of malignant neoplasm of bronchus and lung; Pure hypercholesterolemia; Personal history of tobacco use; Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled; Unspecified essential hypertension]" +SECONDARY: [Chronic airway obstruction, not elsewhere classified; Dysphagia, unspecified; Coronary atherosclerosis of native coronary artery; Other and unspecified hyperlipidemia; Atrial fibrillation; Personal history of malignant neoplasm of bronchus and lung; Pure hypercholesterolemia; Personal history of tobacco use; Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled; Unspecified essential hypertension]","pt was initially admitted to the neuro-icu for observation +following his acute infarct. he was started on aspirin +but anticoagulation was not initiallly started because of the +size of the lesion and risk for hemorrhagic conversion.",pt was initially admitted to the neuro-icu for observation following his acute infarct. an mri showed an acute infarct in left mca territory. he was started on aspirin but anticoagulation was not initially started. 74674,160180.0,12815,2176-10-29,12814,194853.0,2176-10-11,Discharge summary,"Admission Date: [**2176-10-5**] Discharge Date: [**2176-10-11**] Date of Birth: [**2098-7-21**] Sex: M @@ -132105,7 +135119,15 @@ code: full comm: with patient and wife, [**name (ni) 39471**], [**telephone/fax (1) 39472**] ","PRIMARY: [Subendocardial infarction, initial episode of care] -SECONDARY: [Acute kidney failure, unspecified; Paroxysmal ventricular tachycardia; Acute on chronic systolic heart failure; Congestive heart failure, unspecified; Atrial fibrillation; Coronary atherosclerosis of native coronary artery; Other and unspecified angina pectoris; Unspecified essential hypertension; Other and unspecified hyperlipidemia; Anemia, unspecified; Anxiety state, unspecified; Aortic valve disorders; Atherosclerosis of aorta; Abdominal aneurysm without mention of rupture]" +SECONDARY: [Acute kidney failure, unspecified; Paroxysmal ventricular tachycardia; Acute on chronic systolic heart failure; Congestive heart failure, unspecified; Atrial fibrillation; Coronary atherosclerosis of native coronary artery; Other and unspecified angina pectoris; Unspecified essential hypertension; Other and unspecified hyperlipidemia; Anemia, unspecified; Anxiety state, unspecified; Aortic valve disorders; Atherosclerosis of aorta; Abdominal aneurysm without mention of rupture]","78 year old gentleman with coronary artery disease with pci in +[**2174**], hypertension, moderate aortic stenosis, atrial +fibrillation, presented with rest angina in the setting of rapid +heart rate with wide complex tachycardia. inr 1.2 on discharge, will +recheck inr in three days. imdur +was added to lisinopril, metoprolol, sotalol on discharge. # abdominal aortic aneurysm: abdominal ultrasound showed aaa +measuring 4.1 cm at the widest diameter, slight interval +increase from the ultrasound of [**2173-10-24**]. last creatinine in our +system is 0.9 in [**2173**].","78 year old gentleman presented with rest angina in the setting of rapid heart rate with wide complex tachycardia. diagnostic left heart cath showed patent coronaries with prior stents in place, no evidence of renal artery stenosis. pt received heparin drip during hospitalization, as coumadin was held in anticipation of procedures." 75420,151414.0,8209,2190-10-22,8208,114387.0,2190-10-10,Discharge summary,"Admission Date: [**2190-10-8**] Discharge Date: [**2190-10-10**] Date of Birth: [**2123-7-4**] Sex: F @@ -132509,7 +135531,12 @@ prophylaxis: scds were used for dvt prophylaxis. code: full ","PRIMARY: [Other specified cardiac dysrhythmias] -SECONDARY: [Cardiac complications, not elsewhere classified; Unspecified disease of pericardium; Other iatrogenic hypotension; Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation; Other and unspecified hyperlipidemia; Anxiety state, unspecified; Other specified disorders of liver; Personal history of malignant neoplasm of bladder; Personal history of malignant neoplasm of breast; Other postprocedural status]" +SECONDARY: [Cardiac complications, not elsewhere classified; Unspecified disease of pericardium; Other iatrogenic hypotension; Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation; Other and unspecified hyperlipidemia; Anxiety state, unspecified; Other specified disorders of liver; Personal history of malignant neoplasm of bladder; Personal history of malignant neoplasm of breast; Other postprocedural status]","66 y/o lady with history of svt now with pericardial effusion +s/p attempted ep ablation. her blood pressure remained stable over +the next 24 hours, and a repeat tte on [**10-9**] did not show +worsening of the pericardial effusion. also slow +pathway ablation was performed to prevent initiation of the +avrt. # h/o breast ca and papillary bladder ca: stable. fen: patient was maintained on cardiac prudent diet.","66 y/o lady with history of svt now with pericardial effusion s/p attempted ep ablation. tte also showed mild ra collapse without any rv collapse. emergently, patient received a right heart cath that was consistent with a non-hemodynamically signicant effusion." 85258,179741.0,29926,2131-04-11,29853,122457.0,2131-01-19,Discharge summary,"Admission Date: [**2130-12-4**] Discharge Date: [**2131-1-19**] Date of Birth: [**2090-5-18**] Sex: F @@ -133560,7 +136587,7 @@ Date/Time:[**2131-2-8**] 9:00 ",82,2130-12-04 19:01:00,2131-01-19 21:25:00,EMERGENCY,PHYS REFERRAL/NORMAL DELI,HOME HEALTH CARE,"ESOPHAGEAL MASS, NECK PAIN"," the following summary is divided into sections due to the ","PRIMARY: [Malignant neoplasm of cervical esophagus] -SECONDARY: [Perforation of esophagus; Secondary malignant neoplasm of lung; Malignant pleural effusion; Parapharyngeal abscess; Pneumonia, organism unspecified; Stricture and stenosis of esophagus; Unspecified disease of the jaws; Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Accidents occurring in other specified places; Anemia in neoplastic disease; Stenosis of larynx; Drug induced neutropenia; Penicillins causing adverse effects in therapeutic use; Accidents occurring in residential institution]" +SECONDARY: [Perforation of esophagus; Secondary malignant neoplasm of lung; Malignant pleural effusion; Parapharyngeal abscess; Pneumonia, organism unspecified; Stricture and stenosis of esophagus; Unspecified disease of the jaws; Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Accidents occurring in other specified places; Anemia in neoplastic disease; Stenosis of larynx; Drug induced neutropenia; Penicillins causing adverse effects in therapeutic use; Accidents occurring in residential institution]",the following summary is divided into sections due to the,the following summary is divided into sections due to the nature of the project. the following summary is divided into sections due to the nature of the project. the following summary is divided into sections due to the nature of the project. 85258,125297.0,29930,2131-06-11,29926,179741.0,2131-04-11,Discharge summary,"Admission Date: [**2131-3-26**] Discharge Date: [**2131-4-11**] Date of Birth: [**2090-5-18**] Sex: F @@ -134039,7 +137066,19 @@ while in the icu and d/c while in the icu. # dispo: home with free hospice. ","PRIMARY: [Drug induced neutropenia] -SECONDARY: [Malignant neoplasm of other specified part of esophagus; Other specified septicemias; Sepsis; Acute respiratory failure; Fever presenting with conditions classified elsewhere; Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use; Stricture and stenosis of esophagus; Anemia in neoplastic disease; Dehydration; Stridor; Backache, unspecified]" +SECONDARY: [Malignant neoplasm of other specified part of esophagus; Other specified septicemias; Sepsis; Acute respiratory failure; Fever presenting with conditions classified elsewhere; Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use; Stricture and stenosis of esophagus; Anemia in neoplastic disease; Dehydration; Stridor; Backache, unspecified]","40 yo f with metastatic esophageal carcinoma s/p recent +initiation of carboplatin and 5fu, s/p trach in past, admitted +to oncology with febrile neutropenia and transferred for +concerning increased stridor and narrowed airway. she was evaluated by thoracic +surgeons who took her emergently to the or for trach placement +with heliox given prior. she had an emergent bronch which showed patent airways. she initally had difficulty weaning from the vent. she also spiked fever subsequently after +coming back from the or. she also dropped her pressures and was +started on levo (weaned off on [**3-29**]) and boluses ivf to maintain +a map> 65 and a cvp>10. as +per family meetings while in the icu, the plan is to give her 2 +week holiday and then assess and consider palliative +chemotherapy. she has not required blood transfusion +since [**3-29**]. # access: right portacath, left piv, cvl.","40 yo f with metastatic esophageal carcinoma s/p recently initiation of carboplatin and 5fu, s/p trach in past. admitted to oncology with febrile neutropenia and transferred for concerning increased stridor and narrowed airway. based on ent evaluation, patients airway narrowed to 1-2 mm." 85258,125297.0,29930,2131-06-11,29853,122457.0,2131-01-19,Discharge summary,"Admission Date: [**2130-12-4**] Discharge Date: [**2131-1-19**] Date of Birth: [**2090-5-18**] Sex: F @@ -135090,7 +138129,7 @@ Date/Time:[**2131-2-8**] 9:00 ",143,2130-12-04 19:01:00,2131-01-19 21:25:00,EMERGENCY,PHYS REFERRAL/NORMAL DELI,HOME HEALTH CARE,"ESOPHAGEAL MASS, NECK PAIN"," the following summary is divided into sections due to the ","PRIMARY: [Malignant neoplasm of cervical esophagus] -SECONDARY: [Perforation of esophagus; Secondary malignant neoplasm of lung; Malignant pleural effusion; Parapharyngeal abscess; Pneumonia, organism unspecified; Stricture and stenosis of esophagus; Unspecified disease of the jaws; Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Accidents occurring in other specified places; Anemia in neoplastic disease; Stenosis of larynx; Drug induced neutropenia; Penicillins causing adverse effects in therapeutic use; Accidents occurring in residential institution]" +SECONDARY: [Perforation of esophagus; Secondary malignant neoplasm of lung; Malignant pleural effusion; Parapharyngeal abscess; Pneumonia, organism unspecified; Stricture and stenosis of esophagus; Unspecified disease of the jaws; Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure; Accidents occurring in other specified places; Anemia in neoplastic disease; Stenosis of larynx; Drug induced neutropenia; Penicillins causing adverse effects in therapeutic use; Accidents occurring in residential institution]",the following summary is divided into sections due to the,the following summary is divided into sections due to the nature of the project. the following summary is divided into sections due to the nature of the project. the following summary is divided into sections due to the nature of the project. 86146,128337.0,8936,2104-02-19,8935,112417.0,2103-12-21,Discharge summary,"Admission Date: [**2103-12-16**] Discharge Date: [**2103-12-21**] Date of Birth: [**2047-1-31**] Sex: M @@ -135413,7 +138452,15 @@ recommended outpatient pt for [**2-25**] more days and ambulation with a cane, as the patient was not entirely steady on his feet. ","PRIMARY: [Alcohol withdrawal] -SECONDARY: [Unspecified protein-calorie malnutrition; Other convulsions; Alcoholic fatty liver; Other and unspecified alcohol dependence, unspecified; Thrombocytopenia, unspecified; Black eye, not otherwise specified; Unspecified fall; Conjunctivitis, unspecified; Stricture and stenosis of esophagus; Personal history of tuberculosis]" +SECONDARY: [Unspecified protein-calorie malnutrition; Other convulsions; Alcoholic fatty liver; Other and unspecified alcohol dependence, unspecified; Thrombocytopenia, unspecified; Black eye, not otherwise specified; Unspecified fall; Conjunctivitis, unspecified; Stricture and stenosis of esophagus; Personal history of tuberculosis]","known lastname **] was admitted to the micu after having 2 witnessed +seizures in the setting of alcohol withdrawal. he required no further +benzodiazepines after [**2103-12-19**]. his liver function tests were normal through +his hospital course. he was advised not to eat +steak and to seek medical attension if he had pain with +swallowing or the feeling of food getting stuck in his throat. known lastname **] was put on sc heparin for dvt prophylaxis, a ppi and a +bowel regimen during his hospital course. known lastname **] was evaluated by pt who +recommended outpatient pt for [**2-25**] more days and ambulation with +a cane, as the patient was not entirely steady on his feet.","mr. [**known lastname **] was admitted to the micu after having 2 witnessed seizures in the setting of alcohol withdrawal. he was put on a ciwa protocol and given diazepam po to treat his withdrawal. his withdrawal sytmptoms were controlled and he had no witness seizures. he was given thiamine, folate and a multivitamin and was put on a ppi." 93632,159011.0,15560,2108-01-30,15559,199940.0,2108-01-19,Discharge summary,"Admission Date: [**2108-1-4**] Discharge Date: [**2108-1-19**] Date of Birth: [**2026-2-17**] Sex: M @@ -135699,4 +138746,10 @@ physical therapy following. [**hospital 25403**] rehab bed. ","PRIMARY: [Atherosclerosis of native arteries of the extremities with gangrene] -SECONDARY: [; Ulcer of heel and midfoot; Pneumonitis due to inhalation of food or vomitus; Other respiratory complications; Disruption of external operation (surgical) wound; Pneumonia, organism unspecified; Acute posthemorrhagic anemia; Pressure ulcer, stage III; Pressure ulcer, lower back; Unspecified essential hypertension; Gout, unspecified; Dysphagia, unspecified; Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation]" +SECONDARY: [; Ulcer of heel and midfoot; Pneumonitis due to inhalation of food or vomitus; Other respiratory complications; Disruption of external operation (surgical) wound; Pneumonia, organism unspecified; Acute posthemorrhagic anemia; Pressure ulcer, stage III; Pressure ulcer, lower back; Unspecified essential hypertension; Gout, unspecified; Dysphagia, unspecified; Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation]","routine nursing care, labs, ecg, cxr +were done. [**2108-1-6**] pod1 on lower extremity bypass pathway. [**2108-1-9**] pod4 speech and swallow re-evaluation at bedside, +continue to have possible aspirations-recs continue to keep npo, +tpn for nutrition. daugnter pat notifed of +event.bronchoscoopy done. speech and swallow signed off.low urinary out put-fluid +resustated.extubated.transfered to vicu for continued care. l leg +distal wound still draining, aced from forefoot-below knee.","cxr-showed lll pneumonia. underwent successful left femoral-posterior tibial bypass. no airway mucus or secreations, new lll pneumonia."